Nateglinide

Class
Hypoglycemic agents
Subclass
Glinides
Substance name
Nateglinide
Common formulations
Tablet
Dosage and administration
Adults patients
No dosages available
Indications for use
Labeled indications
Adults
•
Treatment of diabetes mellitus type 2
Safety risks
Contraindications
T1DM or diabetic ketoacidosis
Pre-existing hypoglycemia
Specific populations
Renal impairment
eGFR 30-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 15-30 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR < 15 mL/min/1.73 m²
•
Reduce starting dose. Titrate to response.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Reduce starting dose. Dose as in eGFR < 15 mL/min/1.73 m². Titrate to response.
Peritoneal dialysis
•
Reduce starting dose. Dose as in eGFR < 15 mL/min/1.73 m². Titrate to response.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required. Monitor serum aminotransferases.
Child-Pugh B (moderate)
•
Use with caution. Monitor serum aminotransferases.
Child-Pugh C (severe)
•
Use with caution. Monitor serum aminotransferases.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Sulfonylureas may enter the fetal circulation and may cause neonatal hypoglycemia.
•
There are no adequate and well-controlled studies in pregnant women.
•
Nateglinide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
•
There are risks to the mother and fetus associated with poorly controlled diabetes in pregnancy.
•
Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity.
•
The ACOG (ACOG) and the American Diabetes Association (ADA) continue to recommend human insulin as the standard of care in pregnant women with diabetes mellitus and gestational diabetes mellitus (GDM) requiring medical therapy; insulin does not cross the placenta.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Arthropathy, bronchitis, ↓ blood glucose, influenza, accidental injury, back pain, cough, diarrhea, dizziness, upper respiratory tract infections
Unknown frequency
•
Cholestatic liver disease, ↑ liver enzymes, ↑ serum uric acid, jaundice, generalized pruritus, skin rash, weight gain, urticaria
Interactions
Drug(s)
Check Interactions
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