Meglitinides: Uses, common brands, and safety info

There are many treatment options available for people with Type 2 diabetes. In addition to diet, exercise, and weight loss, there are oral and injectable medications as well as insulin. One drug class commonly used in the treatment of Type 2 diabetes to control blood glucose levels is called meglitinides. Meglitinides require a prescription and include two drugs—repaglinide and nateglinide. Both drugs are approved by the U.S. Food and Drug Administration (FDA) and are available in tablet form. Meglitinides are taken about 30 minutes before mealtime. They are usually prescribed by an endocrinologist (a doctor of endocrinology, who handles diabetes care) or a primary care provider. 

This article will discuss the drugs in the meglitinide class—their names, uses, side effects, warnings, and other important information. The chart below lists the currently available meglitinide drugs.

*Prandin is no longer available as a brand name in the U.S. It is only available in generic form.

What are meglitinides?

Meglitinides are known as short-acting insulin secretagogues. Insulin secretagogues help the pancreas make and release insulin, which helps control blood sugar levels. 

A meglitinide drug may be used alone as monotherapy, or as combination therapy with other diabetes medications such as a sulfonylurea like glyburide, glipizide, or glimepiride, or metformin, or a thiazolidinedione like pioglitazone. A meglitinide drug can help lower the hemoglobin A1C (HbA1c) level by about 1.5%. The hemoglobin A1C measures blood sugar control over a 3-month period. 

How do meglitinides work?

In general terms, meglitinides work to treat hyperglycemia (high blood sugar) by helping the body regulate the amount of sugar in the blood. These medications decrease glucose (sugar) by helping the pancreatic beta cells release insulin. 

In more specific terms, the mechanism of action by which meglitinides work is by closing ATP-dependent potassium channels in the beta-cell membrane. This leads to an opening of calcium channels, which induces insulin secretion. 

What are meglitinides used for?

Meglitinides are used, along with diet and exercise, to improve blood glucose control in adults with Type 2 diabetes mellitus. 

Meglitinides are not for the treatment of Type 1 diabetes or diabetic ketoacidosis. Diabetic ketoacidosis (DKA) is a complication of diabetes, where the body produces high levels of blood acids (ketones). DKA can lead to a coma or even death. 

Who can take meglitinides?

Before taking a meglitinide, talk to your healthcare provider about all of your medical conditions and medical history. Tell your doctor about all of the medications you take, including prescription and OTC drugs, vitamins, and supplements. 

Men

Men with Type 2 diabetes can take meglitinides if there are no restrictions for their use. 

Women

Women with Type 2 diabetes—who are not pregnant or breastfeeding—can take meglitinides, if there are no restrictions for their use. 

Women who are pregnant or breastfeeding

Women who are pregnant or planning to become pregnant should consult their doctor before taking a meglitinide. If you are already taking a meglitinide and find out that you are pregnant, consult your doctor for medical advice. 

Women who are breastfeeding should not take a meglitinide because the medication can cause hypoglycemia (low blood sugar) in the nursing baby. Consult your doctor for medical advice. Generally, the mother will stop nursing, or a different medication can be prescribed. 

Children

Meglitinides are not approved for use in children under age 18, because they have not been studied for safety and efficacy in this age group. 

Seniors 

Adults 65 years and older had similar results in terms of safety and efficacy as younger adults. However, some older adults may have greater sensitivity to these drugs. Consult the doctor for advice on meglitinides. A dosage adjustment may be suggested by the doctor. 

Are meglitinides safe?

Recalls

No meglitinide recalls at this time. 

Restrictions

Meglitinides are not safe for everyone. Only a doctor can determine if a meglitinide is safe to take, taking into consideration the patient’s medical conditions and history, and other medications being taken. Meglitinides are contraindicated in people who:

• Are allergic to a meglitinide or any component of the medication

• Have Type 1 diabetes

• Are in diabetic ketoacidosis

• Are taking gemfibrozil

In some cases, a meglitinide drug may be prescribed with caution, if the doctor determines it is safe and that benefits outweigh risks. A meglitinide drug may be prescribed with caution in people who:

• Have renal/kidney disease or liver (hepatic) problems, impairment, or dysfunction

• Are older adults

• Are debilitated or malnourished

• Have adrenal insufficiency 

• Have hypopituitarism

• Have autonomic neuropathy

Meglitinides have drug interactions with certain medications. Your doctor can review your medication list and determine if a meglitinide is safe in combination with the medicines you already take. Some examples of medications that interact with meglitinides include gemfibrozil, cyclosporine, and Plavix (clopidogrel).

Are meglitinides controlled substances?

No, meglitinides are not controlled substances.

Common meglitinides side effects

Because meglitinides work on blood sugar, they can cause hypoglycemia, or low blood sugar. Hypoglycemia can cause symptoms like shakiness, dizziness, and hunger, and can affect reaction time and concentration. In studies, people who took a meglitinide had a higher incidence of hypoglycemia compared with people who took a placebo pill. 

Talk to your doctor about how often you should monitor your blood sugar. Also, talk to your doctor about how to treat hypoglycemic episodes, for example, with a small amount of juice, glucose tablets, or other sources of fast-acting carbohydrates. Taking a meglitinide in combination with other antidiabetic medications increases the risk of hypoglycemia. Meglitinides are taken about 30 minutes before a meal. If you skip a meal, you should skip the dose of medication. 

Severe hypoglycemia can cause seizures, or even be life-threatening or cause death. A severe hypoglycemic event is an emergency and requires immediate hospitalization. Your doctor may prescribe glucagon in the form of an injection or nasal spray to be used in case of a hypoglycemic emergency. Be sure your loved ones know how to use it, in case of emergency. 

Other common side effects of meglitinides include:

• Upper respiratory tract infection symptoms, cough, bronchitis

• Flulike symptoms

• Dizziness

• Accidental injury

• Headache

• Joint pain or joint disease

• Back pain

• Nausea, vomiting, diarrhea, or constipation

• Indigestion 

• Numbness and tingling

• Chest pain

• Urinary tract infection

• Tooth problems  

• Weight gain

Serious adverse effects are rare. If you experience symptoms of an allergic reaction, such as hives, difficulty breathing, or swelling of the face, lips, throat, or tongue, get emergency medical help right away. If you have signs of a serious skin reaction, such as fever, burning eyes, red or purple rash, or blistering and peeling of the skin, get emergency medical help immediately. 

This is not a full list of side effects. Ask your doctor what side effects to expect and how to address them.  

How much do meglitinides cost?

Meglitinides are a relatively affordable treatment for most people. Available in generic form, most insurance companies cover meglitinides. Medicare prescription coverage varies. Contact your insurance plan for up-to-date coverage information. You can always use a free SingleCare card to save money on your meglitinide prescription. A one-month supply of repaglinide, for example, can cost less than $15 at participating pharmacies, compared to the regular price of $300 or more (Prices vary based on dosage and quantity prescribed). Always ask your pharmacist to check your SingleCare card or coupon before making your purchase.