II. Mechanism

  1. Insulin secretogogue

III. Indication

  1. Early Type II Diabetes Mellitus Oral Agent
  2. Elevated postprandial Glucose
  3. Consider if only used intermittently pre-meal

IV. Contraindications

V. Category

VI. Mechanism

  1. Benzoic acid derivative
  2. Similar to Sulfonylurea
    1. Binds different sites from Sulfonylureas
    2. Closes ATP sensitive K+ channels
    3. Results in Insulin secretion
    4. Shorter duration of binding and shorter effect
  3. Predominately effects postprandial Glucose

VII. Advantages

  1. Low risk of Hypoglycemia (2.4%)
  2. Effect depends on Ambient Blood Glucose levels
  3. No significant gastrointestinal side effects
  4. Minimal weight gain
  5. No lab monitoring required
  6. No significant Drug Interactions
  7. No Lactic Acidosis
  8. No adjustments needed (other than per meal)
    1. No adjustment in Congestive Heart Failure
    2. No adjustment for age
    3. No adjustment in Renal Insufficiency

VIII. Adverse Effects

  1. Hypoglycemia (lower risk of Sulfonylureas)

IX. Disadvantages

  1. Two to three times as expensive as Sulfonylureas

X. Agents

  1. Repaglinide (Prandin)
  2. Nateglinide (Starlix)
    1. Significantly weaker activity compared with Prandin

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Related Studies

Cost: Medications

repaglinide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
REPAGLINIDE 0.5 MG TABLET Generic $0.11 each
REPAGLINIDE 1 MG TABLET Generic $0.12 each
REPAGLINIDE 2 MG TABLET Generic $0.13 each
nateglinide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
NATEGLINIDE 120 MG TABLET Generic $0.30 each
NATEGLINIDE 60 MG TABLET Generic $0.27 each