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 should I discuss with my healthcare provider 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:
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.
What happens if I miss a dose of metformin and repaglinide?
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.
Where can I get more information about metformin and repaglinide?
Your pharmacist has information about metformin and repaglinide written for health professionals that you may read.
What are the possible side effects of metformin and repaglinide?
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 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 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.
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.
What happens if I have an overdose of metformin and repaglinide?