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Meglitinide (Short-acting Insulin Secretagogue) Pregnancy: Contraindicated — use insulin in pregnancy.

Repaglinide

Brand names: Prandin, NovoNorm

Adult dose

Dose: 500 micrograms (0.5mg) before each main meal if drug-naive; 1–4mg with each main meal if previously on other antidiabetic agents
Route: Oral
Frequency: Before each main meal (TDS or QDS) — omit dose if meal skipped
Max: 4mg per meal; 16mg daily
Short duration of action (3–4h) — targets postprandial glucose. Useful in irregular meal patterns. Must be taken 15–30 minutes before meal. Omit if meal skipped — avoids hypoglycaemia.

Paediatric dose

Route: Oral
Frequency: Before meals
Max: Not applicable
Not licensed under 18 years. Seek specialist opinion.

Dose adjustments

Renal

Mild-moderate renal impairment: use with caution. Severe impairment (eGFR <25): start at lowest dose (500 micrograms) — repaglinide mainly metabolised hepatically but hypoglycaemia risk increases.

Hepatic

Avoid in moderate-severe hepatic impairment — impaired metabolism leads to drug accumulation and prolonged hypoglycaemia risk.

Clinical pearls

  • Gemfibrozil interaction is severe and contraindicated — check all lipid-lowering therapy before prescribing
  • Advantage over sulphonylureas: dose can be omitted with a missed meal — flexible for irregular eating patterns
  • Antidote for hypoglycaemia: oral glucose if conscious; IV dextrose 10% if unconscious (shorter duration hypoglycaemia than sulphonylureas)
  • Less commonly used since introduction of DPP-4i and SGLT2i — consider position in pathway per NICE NG28

Contraindications

  • Type 1 DM
  • DKA
  • Severe hepatic impairment
  • Concomitant gemfibrozil (significantly increases repaglinide levels — severe hypoglycaemia)
  • Hypersensitivity to repaglinide

Side effects

  • Hypoglycaemia (less than sulphonylureas)
  • Weight gain
  • GI upset
  • Elevated liver enzymes (rare)
  • Hypersensitivity

Interactions

  • Gemfibrozil — contraindicated; inhibits CYP2C8 and OATP1B1 → 8-fold increase in repaglinide AUC
  • Itraconazole — CYP3A4 inhibition → increased levels
  • Rifampicin — CYP3A4 induction → reduced efficacy
  • Beta-blockers — mask hypoglycaemia

Monitoring

  • Blood glucose (pre-meal)
  • HbA1c 3–6 monthly
  • Renal and liver function

Reference: BNFc; BNF 90; NICE NG28 (Type 2 DM). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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