What is the recommended dose of repaglinide (oral antidiabetic agent) for adults with type 2 diabetes?

Repaglinide Dosing for Adults with Type 2 Diabetes

The recommended starting dose of repaglinide is 0.5 mg taken orally before each meal if HbA1c is less than 8%, and 1-2 mg before each meal if HbA1c is 8% or greater, with a maximum daily dose of 16 mg. 1

Dosing Guidelines

• Initial dosing:

  • 0.5 mg before each meal if HbA1c < 8%
  • 1-2 mg before each meal if HbA1c ≥ 8%

• Dose titration:

  • Dose should be doubled up to 4 mg per meal until satisfactory glycemic control is achieved
  • Allow at least one week between dose adjustments to assess response
  • Maximum single dose: 4 mg per meal
  • Maximum daily dose: 16 mg

• Timing:

  • Take within 30 minutes before meals
  • Skip dose if meal is skipped to reduce hypoglycemia risk

Special Populations

• Renal impairment:
  • Severe renal impairment (CrCl = 20-40 mL/min): Start with 0.5 mg before each meal 1
  • Mild to moderate renal impairment: No dose adjustment required 2

Drug Interactions

Dose modifications required when used with:

• Clopidogrel: Avoid concomitant use
• Cyclosporine: Limit daily repaglinide dose to 6 mg
• CYP2C8 and CYP3A4 inhibitors: May require dose reduction
• CYP2C8 and CYP3A4 inducers: May require dose increase

Efficacy and Monitoring

• Repaglinide is effective at lowering postprandial glucose excursions by targeting early-phase insulin release 3
• In clinical trials, repaglinide provided effective glycemic control with HbA1c reductions of approximately 1.07-1.25% 4
• Pharmacotherapy-naive patients showed marked decreases in mean HbA1c from 9.4% at baseline to 7.6% at 3 months and 7.9% at 12 months 5

Common Side Effects

The most common adverse reactions (≥5% incidence) include:

• Hypoglycemia
• Upper respiratory infection
• Headache
• Sinusitis
• Arthralgia
• Nausea
• Diarrhea
• Back pain 1

Important Considerations

• Blood glucose response to repaglinide is dose-dependent across the 0.25-4 mg dose range 6
• Repaglinide is not indicated for treatment of type 1 diabetes or diabetic ketoacidosis
• Reduce dose if hypoglycemia occurs
• Not recommended for use with NPH insulin due to risk of serious cardiovascular adverse reactions 1

Monitoring Recommendations

• Monitor for hypoglycemia, especially when initiating therapy
• Assess glycemic response after at least one week following dose adjustments
• Consider more frequent monitoring when used with medications that may increase hypoglycemia risk