Home Drug Guide Nateglinide

Drug Guide

Generic Name

Nateglinide

Brand Names Starlix

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Meglitinide (Insulin secretagogue)

FDA Approved Indications

Type 2 diabetes mellitus, to improve glycemic control

Mechanism of Action

Nateglinide stimulates rapid, short-lived insulin secretion from pancreatic beta cells by closing ATP-dependent potassium channels, thereby lowering blood glucose levels after meals.

Dosage and Administration

Adult: Start with 120 mg orally before meals. Adjust based on response, not exceeding 270 mg per day.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; dose adjustments may be necessary due to renal and hepatic function.

Renal Impairment: Use with caution; monitor for hypoglycemia. Dose adjustment may be needed.

Hepatic Impairment: Use with caution; hepatic metabolism may be impaired, increasing risk of hypoglycemia.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.

Distribution: Widely distributed; protein binding approx. 99%.

Metabolism: Primarily hepatic via CYP3A4 and glucuronidation.

Excretion: Primarily fecal; minor renal excretion.

Half Life: Approximately 1 hour for the parent compound.

Contraindications

Type 1 diabetes mellitus
Diabetic ketoacidosis

Precautions

Hepatic impairment, as drug is extensively metabolized by the liver.
Risk of hypoglycemia, especially when used with other insulin secretagogues or insulin.

Adverse Reactions - Common

Hypoglycemia (Common)
Headache (Uncommon)
Back pain (Uncommon)

Adverse Reactions - Serious

Severe hypoglycemia (Rare)
Allergic reactions, including rash, urticaria (Rare)

Drug-Drug Interactions

Sulfonylureas (increased risk of hypoglycemia)
Insulin (risk of hypoglycemia)
CYP3A4 inhibitors (e.g., ketoconazole, erythromycin; may increase nateglinide levels)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly. Assess for signs of hypoglycemia. Review hepatic function. Evaluate medication adherence.

Diagnoses:

Risk for unstable blood glucose levels
Risk for hypoglycemia

Implementation: Administer before meals as prescribed. Educate patient on recognizing hypoglycemia symptoms.

Evaluation: Evaluate blood glucose response and adjust dosage accordingly.

Patient/Family Teaching

Take medication 1-30 minutes before meals.
Report symptoms of hypoglycemia (shakiness, sweating, dizziness).
Maintain a consistent diet and meal times.
Monitor blood glucose as directed.

Special Considerations

Black Box Warnings:

Hypoglycemia risk; particularly when combined with other hypoglycemic agents.
Liver function should be monitored periodically.

Genetic Factors: No specific genetic contraindications.

Lab Test Interference: None reported.

Overdose Management

Signs/Symptoms: Severe hypoglycemia, including unconsciousness, seizures.

Treatment: Immediate administration of glucose; if unconscious, intravenous dextrose may be necessary. Monitor and support vital signs.

Storage and Handling

Storage: Store at room temperature between 20-25°C (68-77°F). Keep container tightly closed.

Stability: Stable under recommended storage conditions; check expiration date regularly.