Prandin

Prandin contains repaglinide, a member of the meglitinide class of oral diabetes medicines. It prompts the pancreas to release a short burst of insulin, closely timed to the rise in blood glucose that follows eating. The UK SmPC for repaglinide covers adults with type 2 diabetes whose blood sugar is not adequately controlled by diet, weight loss and exercise alone. It can be used by itself or added to metformin when metformin on its own is not enough. Its effect starts within about half an hour and wears off within a few hours, so it targets the after-meal spikes in glucose rather than providing steady background cover through the night.

This product is available as 0.5 mg, 1 mg and 2 mg tablets, with every strength offered in packs of 30, 60, 90, 120, 180 and 360. These strengths are the same as those licensed in the UK. Prandin itself is an imported brand that is not licensed in the UK. Patients in Britain are usually prescribed repaglinide tablets under the generic name.

Repaglinide is swallowed within 15 minutes before a main meal, although anywhere from 30 minutes before to the start of eating is acceptable. The rule is simple: one meal, one dose; no meal, no dose. The SmPC recommends 0.5 mg as the starting dose, or 1 mg for people moving across from another oral diabetes medicine. Adjustments are made at intervals of one to two weeks according to blood glucose results. A single dose should not exceed 4 mg, and the total daily amount should stay at or below 16 mg. Your prescriber sets the exact dose.

Repaglinide is a prescription-only medicine (POM) in the UK and is normally supplied by several generic manufacturers. It is generally considered when other first-line diabetes treatments are unsuitable or when irregular mealtimes make a flexible, meal-linked tablet more practical.

Prandin is not suitable for type 1 diabetes, diabetic ketoacidosis or severe liver disease, or for anyone allergic to repaglinide. It must never be taken with gemfibrozil, a cholesterol medicine that can increase repaglinide levels several-fold and cause prolonged hypoglycaemia. Clopidogrel, ciclosporin, trimethoprim, clarithromycin, itraconazole and some other antifungals can also strengthen its effect, whereas rifampicin, carbamazepine and barbiturates may weaken it. Beta-blockers can mask the warning signs of a hypo, and alcohol both lowers blood sugar and hides symptoms.

Low blood sugar is the main risk, signalled by shakiness, sweating, hunger, a fast heartbeat, confusion or blurred vision. Keeping glucose tablets or a sugary drink close at hand allows quick treatment. Stomach pain and diarrhoea are also reported. A hypo is more likely after unusual exercise, a delayed or skipped meal, or drinking on an empty stomach, and older people or those with kidney or liver problems are more sensitive. Rarely, visual disturbance occurs when blood glucose changes quickly at the start of treatment, and allergic skin reactions or raised liver enzymes have been described.

Regular blood glucose monitoring, HbA1c checks and an annual diabetes check-up remain essential, alongside diet and activity. Inform the DVLA if your treatment requires it. Whether Prandin or another repaglinide product is appropriate for you is decided by your doctor or prescriber.