← Search & browse all drugs
ALIMENTARY TRACT AND METABOLISM › DRUGS USED IN DIABETES › BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS › Combinations of oral blood glucose lowering drugs
metformin and repaglinide
A10BD14
Forms & Strengths
- Metformin HCl / Repaglinide 500 mg / 1 mg tablet
- Metformin HCl / Repaglinide 500 mg / 2 mg tablet
Adult Dosing
- Type 2 diabetes mellitus: Initial dose based on prior therapy, typically 1 tablet twice daily with meals
- Titrate dose gradually based on blood glucose and HbA1c levels, up to maximum recommended daily dose
- Maximum recommended daily dose: 2000 mg metformin / 8 mg repaglinide, taken before meals
Pediatric Dosing
- Safety and efficacy in pediatric patients under 18 years of age have not been established
Indications
- Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both metformin and repaglinide is appropriate
Mechanism of Action
- Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity
- Repaglinide stimulates insulin release from the pancreatic beta cells by closing ATP-sensitive potassium channels
- Combined action addresses both insulin resistance and impaired insulin secretion
Contraindications
- Hypersensitivity to metformin, repaglinide, or any component of the formulation
- Renal disease or renal dysfunction (e.g., serum creatinine >=1.5 mg/dL in males, >=1.4 mg/dL in females, or abnormal creatinine clearance)
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
- Congestive heart failure requiring pharmacologic treatment
- Co-administration with gemfibrozil
Adverse Reactions
- Hypoglycemia
- Gastrointestinal disturbances (diarrhea, nausea, vomiting, abdominal pain)
- Upper respiratory tract infection
- Headache
- Arthralgia
- Lactic acidosis (rare, associated with metformin accumulation)
Drug Interactions
- Gemfibrozil: Contraindicated due to significant inhibition of repaglinide metabolism leading to severe hypoglycemia
- CYP2C8 and CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): May increase repaglinide plasma concentrations and risk of hypoglycemia
- CYP2C8 and CYP3A4 inducers (e.g., rifampin, barbiturates): May decrease repaglinide efficacy
- Cationic drugs eliminated by renal tubular secretion (e.g., cimetidine): May increase metformin concentration
- Alcohol: Potentiates the effect of metformin on lactate metabolism and increases hypoglycemia risk with repaglinide
Curated Content: Needs Vetting Before Put to Clinical Use