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Pronounced: STAR-licks
Generic name: Nateglinide

Why is this drug prescribed: Starlix combats high blood sugar levels in people with type 2 diabetes (the kind that does not require insulin shots). Insulin speeds the transfer of sugar from the bloodstream to the body's cells, where it's burned to produce energy. In diabetes, the body either fails to make enough insulin, or proves unable to properly use what's available. Starlix attacks the problem from the production angle, stimulating the pancreas to secrete more insulin. Starlix can be used alone or combined with another diabetes drug, called Glucophage, that tackles the other part of the problem, working to improve the body's response to whatever insulin it makes. Starlix is prescribed only when diet and exercise--or Glucophage alone--have failed to control blood sugar levels.

Most important fact about this drug: Always remember that Starlix is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan can lead to serious complications, such as dangerously high or low blood sugar levels. Remember, too, that Starlix is not an oral form of insulin, and cannot be used in place of insulin shots.

How should you take this medication: Starlix should be taken before each meal, anywhere from 30 minutes to the moment before you begin to eat. If you skip a meal, skip your Starlix dose as well; wait until your next meal before taking the medication. --If you miss a dose... Wait until your next meal, then take your regular dose. Never take 2 doses at the same time. --Storage instructions... Store at room temperature 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 Starlix. More common side effects may include: Back pain, diarrhea, dizziness, flu-like symptoms, joint infection, upper respiratory infection Less common side effects may include: Accidental injury, bronchitis, coughing, low blood sugar Starlix, like all oral diabetes drugs, can cause hypoglycemia (low blood sugar). This risk is increased by missed meals, alcohol, other diabetes medications, and excessive exercise. Hypoglycemia is more likely in older or malnourished people and those with poorly functioning adrenal or pituitary glands. To avoid low blood sugar, take Starlix only at meals and closely follow the dietary and exercise regimen suggested by your doctor. Symptoms of mild low blood sugar may include: Blurred vision, cold sweats, dizziness, fast heartbeat, fatigue, headache, hunger, light-headedness, nausea, nervousness Symptoms of more severe low blood sugar may include: Coma, disorientation, pale skin, seizures, shallow breathing Mild hypoglycemia can usually be corrected by eating sugar or a sugar-based product. If symptoms of severe low blood sugar develop, contact your doctor immediately. Severe hypoglycemia should be considered a medical emergency, and prompt medical attention is essential.

Why should this drug not be prescribed: If you have type 1 (insulin-dependent) diabetes, you cannot use Starlix. The drug also cannot be used for diabetic ketoacidosis (a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, pain below the breastbone, and fruity-smelling breath). If you are already taking a drug that promotes insulin secretion, such as Micronase, you should not switch to Starlix or add it to your current drug. In addition, Starlix is not for you if you have been taking other antidiabetic drugs for a long time, or if Starlix gives you an allergic reaction.

Special warnings about this medication: You should periodically test your blood or urine for abnormal sugar (glucose) levels. Even people with well-controlled diabetes may find that injury, infection, surgery, or fever results in a temporary loss of blood sugar control. At such times, the doctor may recommend that you take insulin instead of Starlix. The effectiveness of any antidiabetic drug, including Starlix, may decrease with time. This may occur because of either a diminished responsiveness to the medication or a worsening of the diabetes. If you have liver disease, use Starlix with caution. Also, be aware that dialysis treatments may reduce the effectiveness of the drug. The safety and effectiveness of Starlix in children have not been established.

Possible food and drug interactions when taking this medication: If Starlix 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 Starlix with the following: Airway-opening drugs such as Alupent and Proventil Aspirin Beta blockers such as the blood pressure medications Inderal and Tenormin Corticosteroids such as prednisone (Deltasone) Decongestants such as Sudafed MAO inhibitors such as the antidepressants Nardil and Parnate Nonsteroidal anti-inflammatory drugs such as Advil, Motrin, and Naprosyn Salicylates such as the arthritis drugs Disalcid and Trilisate Thiazide diuretics such as the water pills Esidrix and HydroDIURIL Thyroid medications such as Synthroid Be careful about drinking alcohol, since excessive alcohol consumption can cause low blood sugar. Also be careful when having a liquid meal; it could reduce the effectiveness of the drug.

Special information if you are pregnant or breastfeeding: Because the effects of Starlix on the unborn child have not been adequately studied, this drug should not be used during pregnancy. Since studies suggest the importance of maintaining normal blood sugar levels during pregnancy, you may need to take insulin instead. It is not known whether Starlix appears in breast milk. Because of potential harm to the baby, you'll need to choose between breastfeeding and continuing treatment with Starlix.

Recommended dosage: Take Starlix shortly before meals. The usual dose of Starlix, whether taken alone or combined with Glucophage, is 120 milligrams three times a day. If your doctor finds that your glycosylated hemoglobin (HbA1C) levels are near normal before you start taking the drug, you may use the lower dose of 60 milligrams three times a day.

Overdosage: An overdose of Starlix can cause low blood sugar. (For symptoms, see "What side effects may occur?") Mild hypoglycemia can usually be corrected by eating sugar or a sugar-based product. If your symptoms persist or worsen, seek medical attention immediately.

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