metformin/repaglinide (Rx)

Brand and Other Names:PrandiMet
  • Print

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

metformin/repaglinide

tablet

  • 500mg/1mg
  • 500mg/2mg
more...

Type 2 Diabetes Mellitus

Indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are already treated with a meglitinide and metformin, or who have inadequate glycemic control on a meglitinide alone or metformin alone

Currently using comcomitant repaglinide and metformin

  • Start initial PrandiMet dose similar to patient's current repaglinide/metformin dosage, but do not exceed; titrate as necessary to acheive targeted glycemic control

Inadequately controlled with either metformin or a meglitinide monotherapy

  • 500 mg/1 mg PO q12hr ac initially
  • May gradually increase dose based on glycemic response

Dosage Modifications

Hepatic impairment: Do not administer

Renal impairment

  • Obtain eGFR before starting metformin
  • eGFR <30 mL/min/1.73 m²: Contraindicated
  • eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate treatment
  • Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly)
  • If eGFR falls below 45mL/min/1.73 m² while taking metformin, risks and benefits of continuing therapy should be evaluated
  • If eGFR falls below 30 mL/min/1.73 m²: while taking metformin, discontinue the drug

Oral Administration

May be administered PO q8-12hr

Generally given within 15 minutes prior to meals, but timing can vary from immediately preceding the meal up to 30 minutes before the meal

Not to exceed 1000 mg/4 mg per meal

Not to exceed cumulative daily dose of 2500 mg/10 mg

Safety and efficacy not established; not recommended for use in children

Currently using comcomitant repaglinide and metformin

Start initial PrandiMet dose similar to patient's current repaglinide/metformin dosage, but do not exceed; titrate as necessary to acheive targeted glycemic control

Do not administer to patients >80 years before assessing renal function and determined to be normal

Inadequately controlled with either metformin or meglitinide monotherapy

500 mg/1 mg PO q12hr ac initially

May gradually and conservatively increase dose based on glycemic response

Do not administer to patients >80 years before assessing renal function and determined to be normal

Next:

Interactions

Interaction Checker

and metformin/repaglinide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Warnings

            Black Box Warnings

            Lactic acidosis is a rare but potentially severe consequence of therapy with metformin; characterized by elevated blood lactate levels (>5 mmol/L), decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. When metformin is implicated as the cause of lactic acidosis, metformin plasma concentrations >5 mcg/mL are generally found

            Patients with CHF requiring pharmacologic management, in particular those with unstable or acute CHF who are at risk of hypoperfusion and hypoxemia, are at an increased risk of lactic acidosis. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient’s age

            Do not start in patients aged 80 years or older unless CrCl demonstrates that renal function is not reduced because these patients are more susceptible to developing lactic acidosis. Metformin should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis

            Should generally be avoided in patients with clinical or laboratory evidence of hepatic disease; caution patients against excessive alcohol intake, either acute or chronic, during metformin therapy because alcohol potentiates the effects of metformin on lactate metabolism

            The onset of lactic acidosis often is subtle and accompanied by nonspecific symptoms (eg, malaise, myalgias, respiratory distress, increasing somnolence, nonspecific abdominal distress); with marked acidosis, hypothermia, hypotension, and resistant bradyarrhythmias may occur; instruct patients to recognize symptoms and notify their physician immediately if they occur; withdraw metformin until the situation is clarified

            Serum electrolytes, ketones, blood glucose, and if indicated, blood pH, lactate levels, and even blood metformin levels may be useful

            Once a patient is stabilized on any dose level of metformin, GI symptoms, which are common during initiation of therapy, are unlikely to be drug related; later occurrences of GI symptoms could be due to lactic acidosis or other serious disease

            Lactic acidosis is a medical emergency necessitating hospitalization and should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia); discontinue metformin immediately if lactic acidosis suspected

            Metformin is highly dialyzable (clearance up to 170 mL/min under good hemodynamic conditions); prompt hemodialysis is recommended to correct the acidosis and to remove the accumulation

            Contraindications

            Severe renal disease: eGFR <30 ml/min/1.73 m²

            Acute or chronic metabolic acidosis, including diabetic ketoacidosis

            Concomitant gemfibrozil and itraconazole

            Hypersensitivity to repaglinide or metformin

            Cautions

            Risk of lactic acidosis due to accumulation of metformin; if metformin-associated lactic acidosis suspected, general supportive measures should be instituted promptly in a hospital setting, along with immediate discontinuation of therapy; in patients with a diagnosis or strong suspicion of lactic acidosis, prompt hemodialysis is recommended to correct acidosis and remove accumulated metformin (metformin hydrochloride is dialyzable, with a clearance of up to170 mL/minute under good hemodynamic conditions); hemodialysis has often resulted in reversal of symptoms and recovery

            Use caution in hepatic impairment

            Several of the postmarketing cases of metformin-associated lactic acidosis occurred in setting of acute congestive heart failure (particularly when accompanied by hypoperfusion and hypoxemia); cardiovascular collapse (shock) acute myocardial infarction, sepsis, and other conditions associated with hypoxemia have been associated with lactic acidosis and may also cause prerenal azotemia; discontinue therapy when such events occur

            Avoid excessive alcohol

            Risk of hypoglycemia: elderly; patients taking beta blockers

            May decrease levels of Vit B12

            Withholding of food and fluids during surgical or other procedures may increase risk for volume depletion, hypotension, and renal impairment; therapy should be temporarily discontinued while patients have restricted food and fluid intake; suspend temporarily for any surgical procedure until patient is no longer NPO and normal renal function has resumed

            During loss of blood sugar control: suspend PrandiMet temporarily and administer insulin

            Before initiating therapy, obtain an estimated glomerular filtration rate

            Discontinue during hypoxic states: acute CHF, MI or other event

            Clinical recommendations based upon the patient’s renal function

            • Before initiating therapy, obtain an eGFR
            • Initiation of therapy is not recommended in patients with eGFR between 30 –45 mL/minute/1.73 m²
            • Obtain an eGFR at least annually in all patients receiving therapy
            • In patients at increased risk for development of renal impairment (e.g., the elderly), renal function should be assessed more frequently
            • If eGFR later falls below 45 mL/minute/1.73 m², assess benefit and risk of continuing therapy

            Iodinated contrast imaging procedures

            • Discontinue metformin at the time of or before an iodinated contrast imaging procedure in patients with an eGFR between 30-60 mL/minute/1.73 m²; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinate contrast
            • Reevaluate eGFR 48 hr after the imaging procedure; restart metformin if renal function is stable
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known if excreted in breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous