Repaglinide Dosing and Administration
Repaglinide should be administered at a dose of 0.5-4 mg taken before each meal (2-4 times daily), with a maximum daily dose of 16 mg. 1
Initial Dosing
- For patients with HbA1c <8%: Start with 0.5 mg before each meal 1
- For patients with HbA1c ≥8%: Start with 1-2 mg before each meal 1
- Take within 30 minutes before meals 1
- Dose titration: Double the dose up to 4 mg per meal until satisfactory glycemic control is achieved, allowing at least one week between dose adjustments 1
Dosing Frequency
Repaglinide is a rapid-acting insulin secretagogue with a short duration of action that targets early-phase insulin release to reduce postprandial glucose excursions 2. Due to this pharmacokinetic profile:
- Typically administered 2-4 times daily before meals 1
- Follow the principle of "one meal, one dose; no meal, no dose" 3
- If a meal is skipped, the corresponding dose should also be skipped to reduce hypoglycemia risk 1
Special Populations
Renal Impairment
- For severe renal impairment (CrCl 20-40 mL/min): Start with 0.5 mg before each meal and titrate gradually as needed 1
Drug Interactions
- With cyclosporine: Do not exceed a total daily dose of 6 mg 1
- With clopidogrel: If concomitant use cannot be avoided, start with 0.5 mg before each meal with maximum daily dose of 4 mg 1
- Concomitant use with gemfibrozil is contraindicated 1
Efficacy and Advantages
- Provides similar glycemic control to sulfonylureas but with potentially better control of postprandial glucose 4, 5
- Allows for flexible meal timing, which is beneficial for patients with variable schedules 3
- May be particularly useful during Ramadan fasting, as it can be taken twice daily before the sunset and predawn meals 6
- Effective in both treatment-naïve patients and those previously treated with other antidiabetic medications 2
Potential Pitfalls and Considerations
- Hypoglycemia risk: Monitor for symptoms, especially when initiating therapy or increasing doses 1
- Cost considerations: Repaglinide has a median AWP of $878 for 2 mg tablets, significantly higher than some other oral antidiabetic medications 6
- Multiple daily dosing: The need for multiple daily doses may affect adherence compared to once-daily medications
Monitoring and Follow-up
- Allow at least one week between dose adjustments to assess response 1
- In patients experiencing hypoglycemia, reduce the dose 1
- Regular monitoring of glycemic control is essential to determine effectiveness and need for dose adjustments
Repaglinide's flexible dosing schedule and rapid onset/short duration make it particularly suitable for patients with irregular meal patterns or those who need targeted control of postprandial hyperglycemia, with the primary goal of reducing morbidity and mortality through improved glycemic control.