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Diabetes Medications and New Drugs

Repaglinide (Prandin or NovoNorm)

What is Prandin?

Prandin or Repaglinide is an oral blood glucose lowering drug which helps control blood sugar levels in people who have type 2 diabetes. Repaglinide is the first of a new class of blood glucose lowering drugs called the ‘meglitinides’.

Prandin was previously known as Novonorm under which name it has been prescribed for many years. These drugs are aimed at controlling the surge in blood sugar levels which occurs after meals. The word ‘Prandial’ is derived from a Latin word which refers to mealtimes.

Why the name change from Novonorm to Prandin?

NovoNorm was initially manufactured by a large Danish pharmaceutical company called NovoNordisk. This company also manufactures NovoRapid, Human Mixtard, NovoMix 30 and other insulin preparations which are in widespread use. The drug is now manufactured by a different company, Sankyo, which has rebranded the drug as ‘Prandin’. The chemical compound is still called Repaglinide.

How does Prandin work?

Repaglinide is very similar to the sulphonylureas (eg. Gliclazide, Glipizide) in that it stimulates the beta cells of the pancreas to release more insulin. However, unlike the sulphonylureas, Repaglinide has to be taken before each meal. The drug has a short duration of action which concentrates it’s effect around meal time.

What is the dose of Prandin?

Prandin should be taken about half an hour before meals. It is usually taken three times a day before your three main meals. The recommended starting dose is 500 micrograms three times a day before meals. This dose is usually increased to 1 mg three times a day. The maximum recommended dose is 4 mg three to four times a day.

What happens if I forget to take a dose?

If you forget to take a dose of Prandin before a meal, you should skip this dose until the next meal. Do not take it after your meal to make up for the missed dose.

Is there anyone who should not take this medication?

Repaglinide is not recommended in children (under 18 years) or in elderly patients over the age of 75 years. You should not take this drug if you are pregnant or are breast-feeding your child.

What are the side effects of Prandin?

Abdominal pain, diarrhoea and constipation.

Prandin as with the sulphonylureas may lower blood glucose too much though this is a rare occurence. This will result in symptoms and signs of hypoglycaemia. You will feel hungry, tremulous, sweaty and dizzy. All the symptoms of hypoglycaemia are dealt with comprehensively in a separate section of this website. If these symptoms occur you should take some glucose tablets ideally, once you have checked your blood glucose levels should you have a blood glucose meter to hand.

How can I minimise the risk of these side effects?

The risk of hypoglycaemia is highest in those who skip a meal or eat very little after taking Prandin. You should never take Prandin if you do not plan to eat a meal. The risk is also raised by strenous physical exercise and excessive alcohol. You should take particular care if driving as hypoglycaemia on the road poses a risk to other road users as well as yourself.

Can Prandin be combined with other blood glucose lowering drugs?

Yes. Prandin may be combined with other drugs such as Metformin, Rosiglitazone or Pioglitazone. It should not be combined with any of the sulphonylureas such as Gliclazide, Glipizide or Glimepiride which have a very similar mode of action.

 

Dr Nishan Wijenaike MD FRCP
Consultant Physician
West Suffolk Hospital NHS Trust
October 2007

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Drugs for Type 2 diabetes