PrandiMet

Generic Name: metformin and repaglinide (met FOR min and re PAG li nide)Brand Names: PrandiMet

What is metformin and repaglinide?

Metformin and repaglinide are oral diabetes medications that help control blood sugar levels. Repaglinide works by causing the pancreas to produce insulin. Metformin works by decreasing glucose (sugar) production in the liver and decreasing absorption of glucose by the intestines.

The combination of metformin and repaglinide is used together with diet and exercise to treat type 2 (non-insulin dependent) diabetes.

Metformin and repaglinide may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about metformin and repaglinide?Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired. You should not use this medication if you are allergic to metformin or repaglinide, or if you have type 1 diabetes, kidney disease, if you also take gemfibrozil (Lopid) and itraconazole (Sporanox), or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Do not use metformin and repaglinide together with NPH insulin (such as isophane insulin).

Before taking metformin and repaglinide, tell your doctor if you are allergic to any medications, or if you have liver disease.

Take care to keep your blood sugar from getting too low, causing hypoglycemia. Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, nausea, blurred vision, fast heartbeat, sweating, tremor, irritability, or trouble concentrating. Carry a piece of hard candy or glucose tablets with you in case you have low blood sugar. Also be sure your family and close friends know how to help you in an emergency.

Metformin and repaglinide is only part of a complete program of treatment that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.

What should I discuss with my doctor before taking metformin and repaglinide?

This medication may cause lactic acidosis (the build up of lactic acid in the body). Lactic acidosis can start slowly and gradually get worse. Symptoms include muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired. Get emergency medical help if you have any of these symptoms of lactic acidosis, even if they are only mild. Early signs of lactic acidosis generally get worse over time and this condition can be fatal.

You may be more likely to develop lactic acidosis if you have liver disease, kidney disease, or congestive heart failure, or if you drink large amounts of alcohol. Talk with your doctor about your individual risk.

You should not use this medication if you are allergic to metformin or repaglinide, or if you have:

• type 1 diabetes;

• kidney disease;

• if you also take gemfibrozil (Lopid) and itraconazole (Sporanox); or

• if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking metformin and repaglinide, tell your doctor if you are allergic to any medications, or if you have liver disease. You may need a dose adjustment or special tests to safely take this medication.

FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether metformin and repaglinide passes into breast milk or if it could be harmful to a nursing baby. Do not take metformin and repaglinide without telling your doctor if you are breast-feeding a baby.

How should I take metformin and repaglinide?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your dose needs may change if you are ill, if you have a fever or infection, or if you have surgery or a medical emergency. Do not change your dose of metformin and repaglinide without first talking to your doctor.

Metformin and repaglinide is usually taken 2 or 3 times daily, within 15 minutes before eating a meal. Follow your doctor's instructions. If you skip a meal, do not take your dose of metformin and repaglinide. Wait until your next meal.

Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them. Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. Severe hypoglycemia may cause loss of consciousness, seizures, or death. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

Your doctor may have you take extra vitamin B12 while you are taking metformin and repaglinide. Take only the amount of vitamin B12 that your doctor has prescribed.

To be sure this medication is helping your condition, you will need to check your blood sugar at home. Your blood will also need to be tested by your doctor on a regular basis. It is important that you not miss any scheduled visits to your doctor.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin and repaglinide. Be sure the doctor knows ahead of time that you are using this medication.

Metformin and repaglinide is only part of a complete program of treatment that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.

It is important to take metformin and repaglinide regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store metformin and repaglinide at room temperature away from moisture and heat.

See also: PrandiMet dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember, but only if you are getting ready to eat a meal. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of metformin may cause a life-threatening condition called lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

Overdose symptoms may also include diarrhea, or signs of low blood sugar, such as hunger, headache, confusion, irritability, trouble concentrating, drowsiness, dizziness, weakness, blurred vision, tremors, sweating, nausea, fast heartbeat, and seizure (convulsions).

What should I avoid while taking metformin and repaglinide?

Avoid drinking alcohol while taking metformin and repaglinide. Alcohol lowers blood sugar and may increase the risk of lactic acidosis while you are taking this medicine.

Metformin and repaglinide side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• chest pain;

• sudden numbness or weakness, especially on one side of the body; or

• stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• headache;

• mild nausea or stomach upset; or

• runny or stuffy nose, sneezing, cough, or cold symptoms.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them:

• hunger, weakness, nausea, irritability, tremors;

• drowsiness, dizziness, headache, blurred vision;

• confusion, irritability, trouble concentrating;

• sweating, fast heartbeat;

• seizure (convulsions); or

• fainting, coma (severe hypoglycemia can be fatal).

Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, hard candy, milk, or glucose tablets. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect metformin and repaglinide?

You should not use metformin and repaglinide together with NPH insulin (such as isophane insulin).

The following drugs can interact with metformin and repaglinide. Tell your doctor if you are using any of these:

• digoxin (digitalis, Lanoxin);

• morphine (Kadian, MS Contin, Oramorph, and others);

• quinine (Qualaquin);

• ranitidine (Zantac);

• an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), ketoconazole (Nizoral), rifampin (Rifadin, Rifater, Rifamate), trimethoprim (Bactrim, Septra, Cotrim), vancomycin (Vancocin), and others;

• a diuretic such as amiloride (Midamor) or triamterene (Dyrenium); or

• heart rhythm medication such as procainamide (Procan, Procanbid, Pronestyl) or quinidine (Quinaglute, Quinidex, Quin-Release).

This list is not complete and there may be other drugs that can interact with metformin and repaglinide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about metformin and repaglinide.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.02. Revision Date: 4/12/2009 4:46:27 PM.