II. Mechanism

  1. Insulin secretogogue

III. Indication

  1. Early Type II Diabetes Mellitus Oral Agent
  2. Elevated postprandial Glucose
  3. Consider if only used intermittently pre-meal

IV. Contraindications

V. Category

VI. Mechanism

  1. Benzoic acid derivative
  2. Similar to Sulfonylurea
    1. Binds different sites from Sulfonylureas
    2. Closes ATP sensitive K+ channels
    3. Results in Insulin secretion
    4. Shorter duration of binding and shorter effect
  3. Predominately effects postprandial Glucose

VII. Advantages

  1. Low risk of Hypoglycemia (2.4%)
  2. Effect depends on Ambient Blood Glucose levels
  3. No significant gastrointestinal side effects
  4. Minimal weight gain
  5. No lab monitoring required
  6. No significant drug interactions
  7. No Lactic Acidosis
  8. No adjustments needed (other than per meal)
    1. No adjustment in Congestive Heart Failure
    2. No adjustment for age
    3. No adjustment in Renal Insufficiency

VIII. Adverse Effects

  1. Hypoglycemia (lower risk of Sulfonylureas)

IX. Disadvantages

  1. Two to three times as expensive as Sulfonylureas

X. Agents

  1. Repaglinide (Prandin)
  2. Nateglinide (Starlix)
    1. Significantly weaker activity compared with Prandin

Images: Related links to external sites (from Google)

Cost: Medications

Prandin (on 2/9/2012 at DrugStore.com)
Prandin 0.5mg Tablets #30 for $91.21 ($3.04/unit)
Prandin 1mg Tablets #30 for $91.21 ($3.04/unit)
Prandin 2mg Tablets #90 for $263.75 ($2.93/unit)
Nateglinide (on 2/9/2012 at DrugStore.com)
Nateglinide 60mg Tablets #30 for $47.99 ($1.60/unit)
Starlix (on 2/9/2012 at DrugStore.com)
Starlix 60mg Tablets #30 for $66.99 ($2.23/unit)
Starlix 120mg Tablets #30 for $65.99 ($2.20/unit)

Ontology: Meglitinide (C0065880)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH C030516
SnomedCT 109075003, 372566000
English 4-(2-(5-chloro-2-methoxybenzamido)ethyl)benzoic acid, meglitinide, MEGLITINIDE, meglitinide [Chemical/Ingredient], meglitinides, Meglitinide, Meglitinide (product), Meglitinide (substance)
Spanish meglitinida (producto), meglitinida (sustancia), meglitinida

Ontology: repaglinide (C0246689)

Definition (NCI) A benzoic acid derivative belonging to the meglitinide class of antidiabetic agents. Repaglinide blocks ATP-dependent potassium channels in pancreatic beta cells, thereby causing depolarization of the cell membrane and subsequent opening of calcium channels. The increased calcium influx into the pancreatic beta cells induces insulin secretion, thereby lowering blood glucose levels.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH C072379
SnomedCT 109074004, 386964000
English repaglinide, (+)-2-Ethoxy-alpha-(((S)-alpha-isobutyl-o-piperidinobenzyl)carbamoyl)-p-toluic Acid, Benzoic Acid, 2-ethoxy-4-(2-((3-methyl-1-(2-(1-piperidinyl)phenyl)butyl)amino)-2-oxoethyl)-,(S)-, repa-glinide, repaglinide (medication), REPAGLINIDE, repaglinide [Chemical/Ingredient], (S)-2-ethoxy-4-(2-((3-methyl-1-(2-(1-piperidinyl)-phenyl)butyl)amino)-2-oxoethyl)-benzoic acid, Repaglinide, Repaglinide (product), Repaglinide (substance)
Japanese レパグリニド
Spanish repaglinida (producto), repaglinida (sustancia), repaglinida

Ontology: Prandin (C0722725)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH C072379
English Prandin, repaglinide (Prandin), prandin, Novo Nordisk brand 2 of repaglinide

Ontology: nateglinide (C0903898)

Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance(T121)
MSH C060142
SnomedCT 129496008, 134604002, 387070004
English IPCCPA, N-((4-isopropylcyclohexyl)carbonyl)phenylalanine, nate-glinide, nateglinide (medication), NATEGLINIDE, nateglinide [Chemical/Ingredient], nateglinide, D-phenylalanine, N-((trans-4-(1-methylethyl)cyclohexyl)carbonyl)-, senaglinide, Nateglinide (product), Nateglinide (substance), Nateglinide
Spanish nateglinida (concepto no activo), nateglinida (producto), nateglinida (sustancia), nateglinida

Ontology: Starlix (C1323198)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH C060142
English starlix, Starlix, Novartis brand of nateglinide