Metformin/repaglinide

Detailed encyclopedia article on Metformin/Repaglinide

Metformin/repaglinide is a combination medication used in the management of type 2 diabetes mellitus. This combination leverages the complementary mechanisms of action of two different classes of antidiabetic agents: metformin, a biguanide, and repaglinide, a meglitinide. The combination aims to improve glycemic control in patients who require more than one oral antidiabetic agent to achieve optimal blood glucose levels.

Pharmacology

Metformin

Metformin is a member of the biguanide class of medications. It primarily works by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilization. Metformin is often the first-line medication for the treatment of type 2 diabetes due to its efficacy, safety profile, and potential cardiovascular benefits.

Repaglinide

Repaglinide belongs to the meglitinide class of medications. It acts by stimulating the release of insulin from the pancreatic beta cells. Repaglinide is characterized by its rapid onset and short duration of action, which makes it particularly useful for controlling postprandial blood glucose levels. It is typically taken before meals to enhance insulin secretion in response to food intake.

Mechanism of Action

The combination of metformin and repaglinide targets different aspects of glucose regulation:

• Metformin reduces basal and postprandial blood glucose levels by decreasing hepatic glucose production and improving insulin sensitivity.
• Repaglinide enhances insulin secretion in response to meals, thereby reducing postprandial glucose excursions.

Together, these mechanisms provide a synergistic effect, improving overall glycemic control in patients with type 2 diabetes.

Clinical Use

Metformin/repaglinide is indicated for patients with type 2 diabetes who have not achieved adequate glycemic control with metformin alone. It is particularly beneficial for patients who experience significant postprandial hyperglycemia.

Side Effects

Common side effects of metformin/repaglinide include:

• Gastrointestinal disturbances: such as nausea, vomiting, diarrhea, and abdominal discomfort, primarily due to metformin.
• Hypoglycemia: a potential risk associated with repaglinide, especially if meals are skipped or delayed.
• Weight gain: less common with this combination compared to other antidiabetic agents.

Contraindications

Metformin/repaglinide is contraindicated in patients with:

• Severe renal impairment
• Metabolic acidosis, including diabetic ketoacidosis
• Known hypersensitivity to either metformin or repaglinide

Also see

• Type 2 diabetes mellitus
• Biguanide
• Meglitinide
• Insulin therapy
• Glycemic control