Repaglinide

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.