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Pronounced: PRAN-din
Generic name: Repaglinide

Why is this drug prescribed: Prandin is used to reduce blood sugar levels in people with type 2 diabetes (the kind that does not require insulin shots). It's prescribed when diet and exercise alone fail to correct the problem. A combination of Prandin and a second diabetes drug called Glucophage can be prescribed if either drug alone proves insufficient.

Most important fact about this drug: Chronically high glucose levels have been implicated in the kidney failure, blindness, and loss of sensation that plague many people with long-standing diabetes. A low-calorie diet, weight loss, and exercise are your first line of defense against these problems. Medications such as Prandin are prescribed only as a back-up when these other measures still leave sugar too high. If diet, exercise, and a combination of Prandin and Glucophage all fail to do the job, your doctor may have to start you on insulin.

How should you take this medication: Prandin should be taken shortly before each meal. You can take it 30 minutes ahead of time or wait until just before starting; a 15-minute period is typical. You can take Prandin 2, 3, or 4 times a day, depending on the number of meals you have. If you skip a meal (or add an extra meal), skip (or add) a dose accordingly. --If you miss a dose... Wait until your next meal, then take your regular dose. Do not take 2 doses at once. --Storage instructions... Store at room temperature away from moisture in a tightly closed container.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Prandin. More common side effects may include: Back pain, bronchitis, chest pain, constipation, diarrhea, headache, indigestion, joint pain, low blood sugar, nasal inflammation, nausea, sinus inflammation, skin tingling, upper respiratory tract infection, urinary tract infection, vomiting Less common and rare side effects may include: Allergic reactions, angina (chest pain), tooth problems

Why should this drug not be prescribed: If you have type 1 (insulin-dependent) diabetes, you cannot use Prandin. The drug also cannot be used for diabetic ketoacidosis (a life-threatening emergency first signaled by excessive thirst, nausea, fatigue, and fruity-smelling breath). This condition must be treated with insulin. If you find that Prandin gives you an allergic reaction, you'll be unable to continue using it.

Special warnings about this medication: While taking Prandin, you should check your blood sugar regularly. Your doctor will also watch it; and to measure long-term glucose control, he will probably give you a glycosylated hemoglobin (HbA1C) test as well. Too much Prandin can cause low blood sugar (hypoglycemia), marked by shaking, sweating, and cold-clammy skin. If you develop these symptoms, take some orange juice or suck on a hard candy. The problem is more likely to surface if you are elderly, debilitated, or malnourished, have liver problems, or suffer from poor adrenal or pituitary function.

Possible food and drug interactions when taking this medication: If Prandin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Prandin with the following: Airway-opening medications such as Alupent, Proventil, and Ventolin Alcohol (excessive amounts can cause low blood sugar) Aspirin Barbiturates such as the sedatives Seconal and Nembutal Beta blockers such as the blood pressure medications Inderal and Tenormin Blood thinners such as Dicumarol and Miradon Calcium channel blockers such as the blood pressure medications Cardizem and Procardia Carbamazepine (Tegretol) Chloramphenicol (Chloromycetin) Erythromycin (Eryc, Ery-Tab, PCE) Estrogens such as Premarin Ketoconazole (Nizoral) Furosemide (Lasix) Glucose lowering agents such as Glucotrol and Micronase Isoniazid Major tranquilizers such as Mellaril and Stelazine MAO inhibitors such as the antidepressants Marplan, Nardil, and Parnate Niacin (Nicobid) Nonsteroidal anti-inflammatory drugs such as Advil, Motrin, Naprosyn, and Voltaren Oral contraceptives Phenytoin (Dilantin) Probenecid (Benemid, ColBENEMID) Rifampin (Rifadin, Rimactane) Steroids such as prednisone Sulfa drugs such as Gantanol Thyroid medications such as Synthroid Water pills such as the thiazide diuretics Dyazide and HydroDIURIL

Special information if you are pregnant or breastfeeding: Because abnormal blood sugar during pregnancy can cause fetal defects, your doctor will probably prescribe insulin injections until the baby is born. The effects of Prandin during pregnancy have not been adequately studied. It is not known whether Prandin appears in breast milk. Discuss with your doctor whether to discontinue breastfeeding or give up Prandin. If the medication is discontinued, and diet alone does not control your blood sugar levels, your doctor may recommend insulin injections.

Recommended dosage: ADULTS: Take Prandin before each meal. The recommended dose ranges from 0.5 milligram to 4 milligrams. If you have never taken a glucose-lowering medication before, you should start with the 0.5-milligram dose. If you have taken these drugs in the past, the starting dose is 1 or 2 milligrams. Take no more than 16 milligrams a day. Dose Adjustment Your dose of Prandin will be adjusted according to your fasting blood sugar levels. Your doctor will wait at least a week after each change in dose to check your response. Switching to Prandin When Prandin replaces another oral glucose-lowering medicine, you should start taking it the day after your final dose or the previous drug. Be alert for signs of low blood sugar; effects of the drugs may overlap. Combination Therapy: If Prandin is being added to Glucophage therapy, you should begin with a 0.5-milligram dose. Dosage will then be adjusted according to your blood glucose levels.

Overdosage: An overdose of Prandin taken without food can cause low blood sugar (hypoglycemia). Symptoms of mild hypoglycemia may include: Cold sweat, confusion, depression, dizziness, drowsiness, fatigue, headache, hunger, nausea, nervousness, rapid heartbeat, shaking Symptoms of severe hypoglycemia may include: Coma, pale skin, seizure, shallow breathing Consuming some sugar will usually correct the problem. If symptoms persist or worsen, contact your doctor.

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