Repaglinide and Metformin (Oral)

Repaglinide and Metformin are prescription only medications that are used to treat high blood sugar levels in those with type 2 diabetes.

Overview

Repaglinide and Metformin is a dual-ingredient medication that is commonly prescribed to those that suffer from high blood sugar levels as a result of the condition type 2 diabetes. Metformin is part of a group of drugs called bigaunides, which work by reducing the amount of sugar that the liver produces, leading to less absorption of sugar by the stomach and intestines. Repaglinide is a drug that stimulates the release of insulin from the body, preventing it from building up and causing high blood sugar levels.

Repaglinide and Metformin tablets are usually prescribed along with a comprehensive exercise regime and healthy diet plan, to help reduce sugar in the blood, and control the condition going forward. The tablets are administered orally and are usually recommended for consumption twice per day with meals.

High blood sugar is caused as a result of a number of factors. People with type 2 diabetes are often prone to developing higher levels of sugar in the blood as their condition can interfere with the body's natural ability to produce and release insulin. This can lead to a build-up of glucose in the blood. Those that are vulnerable to developing the condition can also see it brought on by poor diet - especially the consumption of sugary foods and drinks.

Although high blood sugar levels are more common in those that suffer from type 2 diabetes, it can be experienced by anyone. The condition can also be onset by other factors such as illness, stress or lack of exercise. High blood pressure is characterized by symptoms such as increased thirst, tiredness, needing to pass urine more often and suffering from recurring fungal infections such as thrush. If left untreated, high blood sugar levels can lead to a range of health complications, such as heart, liver and kidney problems - which can hold a serious threat to a patient's life.

Repaglinide and Metformin is most effective when all dosage instructions are adhered to and patients keep as active and as healthy as possible. The drug can also be used in combination with other antidiabetic medication.

Repaglinide and Metformin tablets are also known under the brand name PrandiMe in the United States.

Conditions Treated

  • High blood sugar levels (hyperglycaemia), in those with type 2 diabetes

Type of Medicine

  • Tablet, for oral consumption

Side Effects

Some people can take Repaglinide and Metformin without having any side effects at all. However, it is not uncommon for those that have recently started taking the medication to experience some side effects as the body gets used to the drug. It is likely that any unpleasant side effects that happen as a result of taking Repaglinide and Metformin will subside on their own after a few days - and if they don't, patients should contact their doctors for advice. A doctor may be able to alter the dosage to help ease the patient into taking the medication, or it may be that a different medication is more suitable.

These are the common side effects of taking Repaglinide and Metformin:

  • Nausea and vomiting
  • Anxiety, nervousness of feelings of temporary depression
  • Aches and pains in the body
  • Blurry vision
  • Confusion
  • Pale and pasty skin
  • Chills or cold sweats
  • Cough or wheezing
  • Difficulty breathing
  • Congestion in the nose, ears and sinuses
  • Change in heartbeat, such as an increase, decrease or irregularities
  • Increased appetite
  • Hoarseness of the voice, or loss of voice
  • Fever or flu-like symptoms
  • Vivid dreams or nightmares
  • Slurry speech, or difficulty constructing a sentence
  • Extreme tiredness
  • Weak feeling, particularly in the muscles
  • Sore throat
  • Runny nose
  • Excessive sneezing or irritation in the nose
  • Shakiness

There are rare instances where patients may experience more serious side effects. In the instance of any of the below symptoms, it is important that the patient seeks advice as soon as possible from their medical provider. Serious side effects may be the sign of a dangerous condition developing and it may be that the medication needs to be stopped.

  • Coma
  • Difficulty breathing
  • Seizures and fits
  • Blurred vision
  • Slurred speech
  • Faintness or fainting
  • High fever

Patients should never just stop taking Repaglinide and Metformin on their own accord. This can produce withdrawal symptoms, such as dizziness, nausea, vomiting, nervousness and anxiety. Always seek medical advice first. If you believe you should stop taking Repaglinide and Metformin immediately, call your doctor at once.

Before taking Repaglinide and Metformin, your doctor should discuss with you the risks and benefits of taking the medication to control and manage your condition. This will include a comprehensive discussion about side effects, what to expect, and how you can minimize any discomfort caused by side effects. You can also help to avoid them by telling your doctor about any other conditions that you suffer from or any allergies that you have.

Dosage

Patients should always adhere to the individual dosages that are prescribed to them by their medical care providers. These dosages will have been set in the best interests of the patient according to his or her condition severity, age, medical history and other medications being taken.

The starting dose for Repaglinide and Metformin is Repaglinide 1 mg / metformin 500 mg, to be taken orally twice per day. Patients should take each dose with a meal to help the body digest the tablets and prevent side effects such as nausea and headaches.

The dosage of Repaglinide and Metformin may be increased incrementally depending on the patient's tolerance and response to the initial dose, up to a maximum of Repaglinide 4 mg / Metformin 1,000 mg per single dose, or Repaglinide 10 mg / Metformin 2,500 mg per daily dose.

It is important that the doses are taken with a meal. If necessary, the daily dosage can be broken down into three individual doses. If the patient skips a meal, they should also skip their medication. If the patient forgets to take a dose, it is fine to skip it and take the next dose as normal. Do not take extra medication to make up for missed doses - it will not have any positive benefit on your health and will increase your changes of suffering from an adverse reaction.

Patients that have not received a similar medication in the past should start taking Repaglinide and Metformin at a lower dosage. This will reduce the risk of developing hypoglycaemia (low blood sugar levels).

The levels of glucose in the blood should be measured regularly to monitor the patient's response to the drug.

Interactions

If you are taking any of the below medications, you should not be taking Repaglinide and Metformin at the same time. This is because these drugs can interact with Repaglinide and Metformin, causing adverse reactions and health complications.

  • Angiografin (diatrizoate)
  • Cardiografin (diatrizoate)
  • Cholografin Meglumine (iodipamide)
  • Clopidogrel
  • Conray (iothalamate)
  • Conray-30 (iothalamate)
  • Conray-400 (iothalamate)
  • Conray-43 (iothalamate)
  • Cyclosporine
  • Cysto-Conray (iothalamate)
  • Cysto-Conray II (iothalamate)
  • Cystografin (diatrizoate)
  • Cystografin-Dilute (diatrizoate)
  • Diatrizoate
  • Diatrizoate / iodipamide
  • Gastrografin (diatrizoate)
  • Gatifloxacin
  • Gemfibrozil
  • Gengraf (cyclosporine)
  • Hexabrix (ioxaglate)
  • Hypaque (diatrizoate)
  • Hypaque Cysto (diatrizoate)
  • Hypaque Meglumine (diatrizoate)
  • Hypaque Sodium (diatrizoate)
  • Hypaque-76 (diatrizoate)
  • Hypaque-M (diatrizoate)
  • Iodamide
  • Iodipamide
  • Iodixanol
  • Iohexol
  • Iopamidol
  • Iopamidol-370 (iopamidol)
  • Iopromide
  • Iothalamate
  • Ioversol
  • Ioxaglate
  • Ioxilan
  • Isovue-128 (iopamidol)
  • Isovue-200 (iopamidol)
  • Isovue-250 (iopamidol)
  • Isovue-300 (iopamidol)
  • Isovue-370 (iopamidol)
  • Isovue-M-200 (iopamidol)
  • Isovue-M-300 (iopamidol)
  • Lopid (gemfibrozil)
  • MD-76 (diatrizoate)
  • MD-76 R (diatrizoate)
  • MD-Gastroview (diatrizoate)
  • Metrizamide
  • Myelo-Kit (iohexol)
  • Neoral (cyclosporine)
  • Omnipaque 140 (iohexol)
  • Omnipaque 180 (iohexol)
  • Omnipaque 180 Redi-Unit (iohexol)
  • Omnipaque 210 (iohexol)
  • Omnipaque 240 (iohexol)
  • Omnipaque 240 Redi-Unit (iohexol)
  • Omnipaque 300 (iohexol)
  • Omnipaque 350 (iohexol)
  • Omnipaque Flexipak (iohexol)
  • Optiray 160 (ioversol)
  • Optiray 240 (ioversol)
  • Optiray 300 (ioversol)
  • Optiray 320 (ioversol)
  • Optiray 350 (ioversol)
  • Oraltag (iohexol)
  • Oxilan (ioxilan)
  • Plavix (clopidogrel)
  • Reno-30 (diatrizoate)
  • Reno-60 (diatrizoate)
  • Reno-Dip (diatrizoate)
  • Reno-M-30 (diatrizoate)
  • Reno-M-60 (diatrizoate)
  • Reno-M-DIP (diatrizoate)
  • Renocal-76 (diatrizoate)
  • Renografin-60 (diatrizoate)
  • Renografin-76 (diatrizoate)
  • Renovist (diatrizoate)
  • Renovist II (diatrizoate)
  • Renovue-65 (iodamide)
  • Renovue-Dip (iodamide)
  • Sandimmune (cyclosporine)
  • Sinografin (diatrizoate / iodipamide)
  • Tequin (gatifloxacin)
  • Tequin Teqpaq (gatifloxacin)
  • Ultravist (iopromide)
  • Urografin 150 (diatrizoate)
  • Urografin 325 (diatrizoate)
  • Urografin 370 (diatrizoate)
  • Urovison (diatrizoate)
  • Visipaque (iodixanol)

Warnings

Cardiovascular complications

Various medical studies have been carried out to determine the impact of this drug on the heart, and to compare its safety to alternative popular drugs that treat high blood sugar levels. It has been found that cardiovascular events were more commonplace in patients that took Repaglinide and Metformin compared with alternative medication, sulfonylurea. Approximately four percent of patients that took part in a clinical trial suffered from a serious cardiovascular event, compared with three percent that were taking a sulfonylurea drug. There was no difference in mortality rates between the two drugs.

Studies have found that Repaglinide and Metformin should also not be prescribed with insulin, as this can seriously increase the risk of the patient suffering from events of myocardial ischemia, angina and chest pain.

Disease interactions

It is especially important that, before prescribing this medication, the doctor is fully aware of the patient's medical history. This includes any other diseases or conditions he or she currently suffers from, has previously suffered from, or is at known risk of developing. There are some diseases that may mean the patient is unsuitable for this medication, including the below:

  • Renal Impairment
  • Cardiovascular Risk
  • Type I Diabetes
  • B12 Deficiency
  • Liver Disease
  • Lactic Acidosis
  • Hypoglycemia

Liver disease

Repaglinide and Metformin is not suitable to be taken by those that suffer from liver diseases.

Type 1 diabetes

Patients that are sufferers of type 1 diabetes should not take Repaglinide and Metformin. This medication interacts with insulin, which is needed for those with type 1. Taking these medications together puts the patient at risk of coma.

Children

There is no data to suggest more severe side effects in children than in adults. However, if prescribing to children, doctors may wish to start the patient on a lower dosage.

Pregnancy

There is currently no data available on the effects of this drug on human pregnancy. However, studies on rats have found that use of Repaglinide and Metformin during pregnancy had contributed to an impact on long bone growth. Patients should tell their doctors if they are pregnant, could be pregnant, or are trying to become pregnant. Also, tell your doctor if you would like to conceive in the near future. The doctor will be able to advise patients on the risks and weigh these up against the benefits. It is generally recommended that patients do opt to use the drug, as the positive effects on the body can lead to a healthier pregnancy.

Food

Those that suffer from high blood sugar levels should adapt their diets appropriately to help lower levels and aid the effectiveness of the medications they are prescribed. An extremely important aspect of the treatment of high blood sugar levels is undertaking a healthy diet. Without committing to this, Repaglinide and Metformin may not be enough alone to reverse the impact of the condition.

Those taking Repaglinide and Metformin should not consume grapefruit. The juice from grapefruit can increase plasma concentrations of medications consumed via the mouth. Patients that consume grapefruit in any form while taking Repaglinide and Metformin should be monitored for side effects and developing conditions. The patient should be advised to stop eating the fruit.

Alcohol

Patients taking Repaglinide and Metformin should take care to reduce alcohol consumption to a minimum - this generally means no more than one drink per day for women, and two drinks per day for men. Patients should avoid alcohol with high levels of sugar, as this may make blood sugar levels higher and may impact the effectiveness of the Repaglinide and Metformin prescription. Consuming excessive amounts of alcohol while taking Repaglinide and Metformin may increase your risk of developing a condition called lactic acidosis (see warning below).

Patients with diabetes that is not well controlled should avoid drinking alcohol completely until their condition improves. Once the condition is under control, moderate alcohol intake can generally be introduced without it impacting on blood sugar levels.

Lactic Acidosis

This is a rare condition that can be brought on by Repaglinide and Metformin tablets. It is a serious health complication that arises when metformin accumulates in the system and is also associated with other conditions such as renal impairment, dehydration, hepatic impairment, sepsis and congestive heart failure. It is often difficult to detect if a patient is developing lactic acidosis, but some signs may be the development of other conditions such as myalgia, gastrointestinal discomfort and difficulty breathing. Patients may also suffer from a low PH and elevated blood lactate. If this condition is detected, the intake of Repaglinide and Metformin must be stopped immediately and the patient must be kept in hospital for treatment.

Storage

Repaglinide and Metformin tablets should be kept at room temperature at all times - this means temperatures between 20 and 25 degrees centigrade. Patients should also take care to keep the tablets out of direct sunlight, away from radiators or heat sources, and out of rooms that can become damp, such as bathrooms. If the box has been supplied with a drying agent, leave the tablets in the box with the drying agent when not in use - do not throw the drying agent away.

You should also take extra care to keep your prescriptive medications out of the reach of children. There are many cases reported by hospitals every year of children that have had to be taken to emergency rooms because of drugs they have mistakenly consumed. You can help lower that figure and keep your children safe by keeping your Repaglinide and Metformin tablets in a locked medical cabinet.

Always make sure your tablets remain clearly labelled, in their original packaging. This will prevent them getting mixed up with other drugs and mistakenly taken by other people in your household.

Disposal

Sometimes, you will have leftover tablets that you haven't taken - for any number of reasons. In this case, you should dispose of the tablets in a responsible way. The FDA recommends that you do not simply throw them into your trash can in their original box; this leaves them open to abuse and likely to end up in the wrong hands. Instead, take the tablets out of the packaging and mix them with an undesirable substance, like used cat litter, used ground coffee or manure from the garden. You can read further instructions for safe medicine disposal on the FDA's website.

Summary

Repaglinide and Metformin is a common treatment for those with high blood sugar levels, typically caused as a result of type 2 diabetes. They are designed as a long-term treatment that can lower blood sugar levels relatively quickly, and keep them at a healthy level going forward. However, the medication is rarely enough on its own to reverse the effects of high blood sugar levels. Patients will always be given further advice to follow, alongside taking their prescription regularly. Diet and exercise are equally as important in treating the condition, and patients must take active steps to engage in regular exercise and a healthy eating plan.

Patients taking Repaglinide and Metformin must take care not to miss doses of their treatment. This can lead to a relapse in high blood sugar levels, which can result in unpleasant symptoms for the patient, including tiredness and increased risk of fungal infections. Provided all of the usage instructions are followed, Repaglinide and Metformin can be a highly effective treatment for maintaining healthy sugar levels in the blood, and can help the bodies of patients with type 2 diabetes to store and break down glucose at normal levels. Long-term use of and responsiveness to Repaglinide and Metformin can help patients with type 2 diabetes improve their quality of life, and eradicate unpleasant symptoms of high blood pressure. Proper use of the medication can also keep the condition under control and prevent glucose levels in the blood rising in the future. If the patient conducts a healthy lifestyle - participating in regular exercise and health eating - he or she can expect to reap long-term health benefits from Repaglinide and Metformin, and live a normal and fulfilled life.

The drug is relatively safe to use with little to no side effects in the majority of people.

 

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Last Reviewed:
January 28, 2018
Last Updated:
April 05, 2018
Content Source: