Meglitinide (Short-acting Insulin Secretagogue) Pregnancy: There are no studies of repaglinide in pregnant women — repaglinide should be avoided during pregnancy. There are no studies in breast-feeding women — repaglinide should not be used in breast-feeding women (§4.6).

Repaglinide

Brand names: Prandin, NovoNorm

Repaglinide is a short-acting oral antidiabetic of the meglitinide class used to improve glycaemic control in type 2 diabetes, taken with meals.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Recommended starting dose 0.5 mg before main meals (1 mg if transferring from another oral hypoglycaemic medicinal product); titrate individually, allowing one to two weeks between titration steps

Route: Oral

Frequency: Preprandially before each main meal (2, 3 or 4 times a day), usually within 15 minutes of the meal — may range from immediately preceding the meal to 30 minutes before

Max: Recommended maximum single dose 4 mg taken with main meals; total maximum daily dose should not exceed 16 mg

Source: UK SPC §4.2 for Repaglinide 0.5 mg tablets. The dose is determined by the physician according to the patient's requirements and titrated to optimise glycaemic control; monitor blood glucose periodically to determine the minimum effective dose and to detect primary or secondary failure. Patients who skip a meal (or add an extra meal) should skip (or add) the dose for that meal. Transfer from other oral hypoglycaemics can be direct — no exact dosage relationship exists; recommended maximum starting dose on transfer is 1 mg before main meals. In combination with metformin (when metformin alone gives insufficient control): maintain the metformin dose and start repaglinide 0.5 mg before main meals, titrating as for monotherapy — note that combination with metformin is associated with an increased risk of hypoglycaemia. Debilitated or malnourished patients: conservative initial and maintenance dosage with careful titration to avoid hypoglycaemia. Elderly: no clinical studies in patients over 75 years. Hepatic impairment: no clinical studies conducted; severe hepatic function disorder is a contraindication. Paediatric: safety and efficacy in children below 18 years have not been established — no data available. Short-term administration may be sufficient during periods of transient loss of control in type 2 diabetes usually well controlled on diet.

Dose adjustments

Renal

Repaglinide is not affected by renal disorders; 8% of a dose is excreted through the kidneys and total plasma clearance is decreased in renal impairment. As insulin sensitivity is increased in diabetic patients with renal impairment, caution is advised when titrating these patients (§4.2). No specific dose reduction is stated in the UK SPC.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to repaglinide or to any of the excipients
Diabetes mellitus type 1, C-peptide negative
Diabetic ketoacidosis, with or without coma
Severe hepatic function disorder
Concomitant use of gemfibrozil

Side effects

Hypoglycaemia (common); hypoglycaemic coma and hypoglycaemic unconsciousness (frequency not known)
Abdominal pain and diarrhoea (common); nausea (not known); vomiting and constipation (very rare)
Cardiovascular disease (rare) — use might be associated with an increased incidence of acute coronary syndrome
Abnormal hepatic function and increased liver enzymes (very rare); severe hepatic dysfunction reported very rarely
Hypersensitivity of the skin — erythema, itching, rashes, urticaria (not known); generalised hypersensitivity including anaphylactic reaction or vasculitis (very rare)
Refraction disorder / transient visual disturbance from changes in blood glucose, especially at commencement of treatment (very rare)

Interactions

Gemfibrozil — concomitant use is contraindicated (§4.3, §4.5)
Repaglinide is metabolised predominantly by CYP2C8, with a minor role for CYP3A4 — a number of medicinal products are known to influence its metabolism and possible interactions must be taken into account
Medicinal products influencing repaglinide metabolism — repaglinide should be used with caution or avoided; if concomitant use is necessary, perform careful blood glucose and close clinical monitoring (§4.4)
Insulin secretagogues: combination has not been investigated in clinical trials; combination with metformin increases the risk of hypoglycaemia; benefit-risk of combination with NPH insulin or thiazolidinediones remains to be established (§4.4)

Clinical monograph

How it works

It stimulates insulin release from pancreatic beta cells by closing ATP-sensitive potassium channels, producing a rapid, short-lived prandial insulin response.

Prescribing in practice

Repaglinide can cause hypoglycaemia, and because it is taken with meals a dose should be omitted if a meal is skipped to avoid hypoglycaemia.
It is metabolised hepatically, so caution and careful titration are needed in hepatic impairment, and significant drug interactions affecting its metabolism can alter its effect.
Concomitant use with gemfibrozil is contraindicated because it markedly increases repaglinide exposure and hypoglycaemia risk.

Monitoring

Monitor glycaemic control through HbA1c and self-monitored blood glucose, with attention to hypoglycaemic episodes.

Counselling the patient

Take each dose shortly before a meal, and skip the dose if you skip that meal.
Recognise and treat low blood sugar, carrying a fast-acting source of glucose.
Report new medicines started by other prescribers, as some interact strongly.

Evidence & guidelines

Repaglinide is an established prandial glucose regulator for type 2 diabetes as described in the SPC and reflected in NICE guidance on type 2 diabetes management.

Reference: NICE NG28 (Type 2 DM); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways