Repaglinide Dosing Recommendations
The recommended starting dose of repaglinide is 0.5 mg taken orally before each meal for patients with HbA1c less than 8%, and 1-2 mg before each meal for patients with HbA1c of 8% or greater, with a maximum daily dose of 16 mg. 1
Standard Dosing Protocol
Initial dosing:
- HbA1c < 8%: 0.5 mg before each meal
- HbA1c ≥ 8%: 1-2 mg before each meal
Dose titration:
- Double the dose up to 4 mg per meal until satisfactory glycemic control is achieved
- Allow at least one week between dose adjustments to assess response
- Dose range: 0.5-4 mg before meals
Administration timing:
- Take within 30 minutes before meals
- May be dosed 2,3, or 4 times daily depending on meal pattern
- Skip dose if meal is skipped to reduce hypoglycemia risk
Special Population Considerations
Renal Impairment
- Normal to moderate renal impairment: No special dosage adjustment required 2
- Severe renal impairment (CrCl 20-40 mL/min): Start with 0.5 mg before each meal and titrate gradually as needed 1
- Repaglinide can accumulate when kidney function decreases, requiring careful monitoring 3
Drug Interactions
- With strong CYP3A4 or CYP2C8 inhibitors/inducers: Dose adjustments recommended 1
- With clopidogrel: Start at 0.5 mg before meals, maximum daily dose 4 mg 1
- With cyclosporine: Maximum daily dose 6 mg 1
- With gemfibrozil: Contraindicated 1
Efficacy and Monitoring
- Repaglinide provides similar glycemic control to sulfonylureas like glibenclamide in clinical trials of up to 1 year 4
- Particularly effective at controlling postprandial glucose excursions due to its rapid onset of action 5
- Allows for flexible meal schedules due to its short duration of action 6
Safety Considerations
- Primary risk is hypoglycemia, though severe episodes are less common than with some sulfonylureas 7
- Monitor blood glucose regularly, especially when initiating therapy or adjusting doses
- Risk of hypoglycemia increases in patients with advanced CKD (stages 4-5) 3
- Weight gain may be less pronounced compared to some sulfonylureas 4
Cost Considerations
- Repaglinide has a significantly higher cost compared to some other oral antidiabetic medications, with a median AWP of $659 for 2 mg tablets 3
- This cost factor may influence treatment decisions, particularly for patients paying out-of-pocket
Repaglinide's rapid onset and short duration of action make it particularly suitable for patients with irregular meal schedules or those who need flexible dosing options. Its effectiveness in controlling postprandial glucose excursions while carrying a lower risk of severe hypoglycemia compared to some sulfonylureas makes it a valuable option in the management of type 2 diabetes.