nateglinide
nateglinide
[nah-teg´lĭ-nīd]nateglinide
Pharmacologic class: Amino acid derivative
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Action
Decreases blood glucose level by stimulating insulin secretion from pancreatic beta cells; interacts with calcium and potassium channels in pancreas
Availability
Tablets: 60 mg, 120 mg
Indications and dosages
➣ To decrease glucose levels in type 2 (non-insulin-dependent) diabetes mellitus not adequately controlled by diet and exercise
Adults: 120 mg P.O. t.i.d. up to 30 minutes before meals, or 60 mg P.O. t.i.d. if patient is near glycosylated hemoglobin (HbA1c) goal
Contraindications
• Hypersensitivity to drug or its components
• Diabetic ketoacidosis
• Type 1 (insulin-dependent) diabetes mellitus
Precautions
Use cautiously in:
• renal or hepatic impairment, adrenal or pituitary insufficiency
• elderly or malnourished patients
• pregnant or breastfeeding patients.
Administration
• Give 30 minutes before meals. If meal is missed, don't give dose.
• Know that drug may be given alone or with metformin.
Adverse reactions
CNS: dizziness
GI: diarrhea
Metabolic: hypoglycemia
Musculoskeletal: back pain, joint pain
Respiratory: upper respiratory tract infection, bronchitis, coughing
Other: flulike symptoms, trauma
Interactions
Drug-drug. Beta-adrenergic blockers, MAO inhibitors, nonsteroidal antiinflammatory drugs, salicylates: increased hypoglycemic effect
Corticosteroids, sympathomimetics, thiazides, thyroid products: reduced hypoglycemic effect
Drug-diagnostic tests. Glucose: decreased level
Patient monitoring
• Monitor blood glucose and HbA1c levels.
• Assess pulmonary status for bronchitis, upper respiratory infection, and flulike signs and symptoms.
• Monitor musculoskeletal status. Check for back pain and arthropathy.
• Note GI complaints, and identify nutritional deficiencies.
Patient teaching
• Instruct patient to take dose up to 30 minutes before each main meal.
• Advise patient not to skip a meal. If he does, tell him to also skip accompanying nateglinide dose, to prevent hypoglycemia.
• Teach patient how to monitor blood and urine for glucose and ketones, as prescribed.
• Instruct patient to report adverse CNS effects and signs and symptoms of respiratory infection.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects sensation and balance.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.