In the U.S.—

• Antidiabetic agent

Repaglinide ( re-PAG-lin-ide) is used to treat a certain type of diabetes mellitus (sugar diabetes) called type 2 diabetes. When you have type 2 diabetes, insulin is still being produced by your pancreas. Sometimes the amount of insulin you produce may not be enough or your body may not be using it properly and you may still need more. Repaglinide works by causing your pancreas to release more insulin into the blood stream. Repaglinide may be used alone or with another oral diabetes medicine called metformin.

This medicine is available only with your doctor's prescription, in the following dosage form:

Oral
• Tablets (U.S.)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For repaglinide, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to repaglinide. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Repaglinide has not been studied in pregnant women. However, it is easier during pregnancy to control your blood sugar by using injections of insulin, rather than by taking repaglinide. Close control of your blood sugar can reduce the chance of your baby gaining too much weight, having birth defects, or having high blood sugar before birth. Be sure to tell your doctor if you plan to become pregnant or if you think you are pregnant.

Breast-feeding—It is not known whether repaglinide passes into human breast milk. However, it has been shown to cause unwanted effects in nursing animals. It may be necessary for you to take another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of repaglinide in children with use in other age groups.

Older adults—This medicine has been tested in a limited number of patients 65 years of age or older and has not been shown to cause different side effects or problems in older people than it does in younger adults. However, the first signs of low blood sugar are not easily seen or do not occur at all in older patients. This may increase the chance of low blood sugar developing during treatment.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking repaglinide, it is especially important that your health care professional know if you are taking any of the following:

• Beta-adrenergic blocking agents (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin], betaxolol [e.g., Kerlone], bisoprolol [e.g., Zebeta], carteolol [e.g., Cartrol], labetalol [e.g., Trandate], metoprolol [e.g., Lopressor], nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Betapace], timolol [e.g., Blocadren])—These medicines may increase the chance that high or low blood sugar can occur; also, they can hide symptoms of low blood sugar (such as fast heartbeat). Because of this, a person with diabetes might not recognize that he or she has low blood sugar and might not take immediate steps to treat it

• Infection or
• Ketones in the blood (diabetic ketoacidosis) or
• Surgery or
• Trauma or
• Type 1 (insulin-dependent) diabetes or
• Unusual stress—Insulin may be needed to control diabetes in patients with these conditions

• Kidney disease or
• Liver disease—Higher blood levels of repaglinide may occur; this may change the amount of medicine you need

• Underactive adrenal gland or
• Underactive pituitary gland or
• Undernourished condition or
• Weakened physical condition—Patients with these conditions may be more likely to develop low blood sugar while taking repaglinide

Follow carefully the special meal plan your doctor gave you. This is the most important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

This medicine usually is taken 15 minutes before a meal but may be taken up to 30 minutes before a meal.

Dosing—

The dose of repaglinide will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of repaglinide. If your dose is different, do not change it unless your doctor tells you to do so.

• For oral dosage form (tablets):
  • For type 2 diabetes:
    • Adults:
      • For patients who have never taken medicine to lower their blood sugar or who have a glycosylated hemoglobin (hemoglobin A _1c) measurement that is less than 8%: At first the dose is 0.5 milligram (mg) fifteen to thirty minutes before each meal. The dose may then be adjusted by your doctor based on your fasting blood sugar level.
      • For patients who have taken medicine to lower their blood sugar and who have a hemoglobin A _1c measurement that is higher than 8%: At first the dose is 1 or 2 mg fifteen to thirty minutes before each meal. The dose may then be adjusted by your doctor based on your fasting blood sugar level.
    • Children: Use and dose must be determined by your doctor.

Missed dose—

You should skip a dose of repaglinide if a meal is skipped and add a dose of repaglinide if you eat an extra meal.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Your doctor will want to check your progress at regular visits , especially during the first few weeks you take this medicine.

It is very important to follow carefully any instructions from your health care team about:

• Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
• Other medicines—Do not take other medicines during the time you are taking repaglinide unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy.
• Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.

In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.

Too much repaglinide can cause low blood sugar (hypoglycemia). Low blood sugar also can occur if you use repaglinide with another antidiabetic medicine, delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people may feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly.

Symptoms of low blood sugar include anxiety; behavior change similar to being drunk; blurred vision; cold sweats; confusion; cool, pale skin; difficulty in thinking; drowsiness; excessive hunger; fast heartbeat; headache (continuing); nausea; nervousness; nightmares; restless sleep; shakiness; slurred speech; or unusual tiredness or weakness.

If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes; or drink fruit juice, nondiet soft drink, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar. Get to a doctor or a hospital right away if the symptoms do not improve. Someone should call for emergency help immediately if severe symptoms such as convulsions (seizures) or unconsciousness occur. Food or drink should not be forced because the patient could choke from not swallowing correctly.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

Symptoms of high blood sugar include blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination; ketones in urine; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); unconsciousness; or unusual thirst.

If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• More common
  • Convulsions (seizures);  unconsciousness  
  
  

Check with your doctor as soon as possible if any of the following side effects occur:

• More common
  • Cough;  fever;  low blood sugar, including anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in thinking, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, or unusual tiredness or weakness;  pain in the chest;  runny or stuffy nose;  shortness of breath ;  sinus congestion with pain;  sneezing;  sore throat 
  
  

• Less common
  • Bloody or cloudy urine;  burning, painful, or difficult urination;  chest pain;  chills;  frequent urge to urinate;  problems with teeth;  skin rash, itching, or hives;  tearing of eyes;  tightness in chest;  trouble in breathing;  vomiting;  wheezing 
  
  

• Rare
  • Black, tarry stools;  blood in stools ;  fast or irregular heartbeat;  hoarseness;  lower back or side pain;  pinpoint red spots on skin;  unusual bleeding or bruising 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Back pain;  diarrhea;  joint pain 
  
  

• Less common
  • Constipation;  feeling of burning, numbness, tightness, tingling, warmth, or heat;  indigestion  
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.