Administration of Repaglinide 2mg
Repaglinide 2mg should be taken orally 15-30 minutes before meals, with dosing required before each main meal (typically 2-4 times daily depending on the patient's meal pattern). 1
Dosing Schedule and Administration
- Repaglinide is a short-acting insulin secretagogue with rapid onset and short duration of action
- Administration timing:
- Take 15-30 minutes before each meal
- Skip the dose if the corresponding meal is skipped
- Maximum daily dose: 16mg (FDA approved maximum)
- Maximum single dose: 4mg per meal
Specific Dosing Considerations
- Standard dosing: 0.5-4mg before each meal based on glycemic control needs 1
- Meal flexibility: One of repaglinide's key advantages is that it follows the eating pattern rather than requiring a fixed eating schedule 2
- Dose titration: Dose should be doubled up to 4mg with each meal until satisfactory glycemic control is achieved, with at least one week between dose adjustments 1
Renal Impairment Considerations
For patients with reduced kidney function:
- eGFR >30 mL/min/1.73 m²: No dose adjustment required 3
- eGFR <30 mL/min/1.73 m²: Start conservatively at 0.5mg with meals 3
- Severe renal impairment (CrCl=20-40 mL/min): Initiate at 0.5mg before each meal and gradually titrate if needed 1
Drug Interaction Adjustments
Dose modifications are necessary with certain medications:
- With cyclosporine: Do not exceed total daily dose of 6mg 1
- With clopidogrel: Start at 0.5mg before meals; do not exceed total daily dose of 4mg 1
- With gemfibrozil: Contraindicated - do not use together 1
- With strong CYP3A4 or CYP2C8 inhibitors/inducers: Dosage adjustments recommended 1
Special Populations and Situations
- During Ramadan fasting: Repaglinide is particularly suitable due to its short duration of action; can be taken twice daily before sunset and predawn meals 3
- Missed meals: Skip the corresponding repaglinide dose to reduce hypoglycemia risk 1
- Hypoglycemia management: If hypoglycemia occurs, reduce the repaglinide dose 1
Clinical Advantages
- Lower risk of hypoglycemia when meals are skipped compared to longer-acting sulfonylureas 2
- Primarily metabolized by the liver with minimal renal excretion, making it suitable for patients with kidney disease 4, 5
- Flexible dosing that accommodates variable meal patterns 2
Repaglinide's pharmacokinetic profile with rapid absorption (peak <1 hour) and short half-life (<1 hour) makes it particularly well-suited for controlling postprandial glucose excursions while minimizing the risk of between-meal hypoglycemia when properly administered 2, 5.