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PrandiMet Disease Interactions

There are 9 disease interactions with PrandiMet (metformin / repaglinide).

Major

Meglitinides (applies to PrandiMet) type I diabetes

Major Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Type 1, Diabetic Ketoacidosis

The use of meglitinides is contraindicated in patients with type I diabetes or for the treatment of diabetic ketoacidosis, with or without coma.

References

  1. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc PROD (2001):
  2. "Product Information. Starlix (nateglinide)." Novartis Pharmaceuticals PROD (2001):
Major

Metformin (applies to PrandiMet) lactic acidosis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure, Myocardial Infarction, Shock, Anemia, Dehydration, Alcoholism, Liver Disease, Renal Dysfunction, Diarrhea, Asphyxia, Vomiting

Metformin is contraindicated in patients with acute or chronic metabolic acidosis (including diabetic ketoacidosis) with or without coma. Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias; the onset is often subtle and accompanied by nonspecific symptoms (e.g., malaise, myalgias, abdominal pain, respiratory distress, increased somnolence). Risk factors include renal dysfunction, age 65 years and older, hypoxic states, excessive alcohol intake, and liver dysfunction. Lactic acidosis has been associated with metformin accumulation in plasma at levels generally exceeding 5 mcg/mL. The risk of metformin-associated lactic acidosis increases with the patient's age because patients 65 years and older have a greater likelihood of having hepatic, renal, or cardiac impairment than younger patients; renal function should be assessed more frequently in older adult patients. Several postmarketing cases of metformin-associated lactic acidosis occurred in the setting of acute congestive heart failure, especially when accompanied by hypoperfusion and hypoxemia; cardiovascular collapse (shock), acute myocardial infarction, sepsis, and other conditions associated with hypoxemia (e.g., severe anemia, asphyxia) have been associated with lactic acidosis and may cause prerenal azotemia. When such an event occurs, metformin should be discontinued. Dehydration (e.g., severe diarrhea or vomiting) may increase the risk for volume depletion, hypotension, and renal impairment; such patients may be at increased risk for lactic acidosis. Alcohol potentiates the effect of metformin on lactate metabolism; patients should be advised against excessive alcohol intake while receiving metformin. All patients treated with metformin should have renal function monitored regularly (at least annually or more frequently if necessary). If metformin-associated lactic acidosis is suspected, general supportive measures should be instituted promptly in a hospital setting, as well as immediate discontinuation of metformin. If lactic acidosis is diagnosed or strongly suspected, prompt hemodialysis is recommended to correct the acidosis and remove accumulated metformin. Patients and their families should be educated about the symptoms of lactic acidosis and, if these symptoms occur, they should be instructed to discontinue metformin and report these symptoms to their health care provider.

References

  1. "Product Information. Glucophage (metFORMIN)." EMD Serono Inc SUPPL-34 (2018):
Major

Metformin (applies to PrandiMet) liver disease

Major Potential Hazard, Moderate plausibility.

Metformin is not recommended in patients with clinical or laboratory evidence of liver disease. Patients with liver dysfunction have developed cases of metformin-associated lactic acidosis. Metformin decreases liver uptake of lactate increasing lactate blood levels which may increase the risk of lactic acidosis, especially in at-risk patients.

References

  1. "Product Information. Glucophage (metFORMIN)." EMD Serono Inc SUPPL-34 (2018):
Major

Metformin (applies to PrandiMet) renal dysfunction

Major Potential Hazard, Moderate plausibility.

The use of metformin is contraindicated in patients with severe renal dysfunction (estimated GFR [eGFR] less than 30 mL/min/1.73 m2). Metformin is substantially excreted by the kidney; the risk of metformin accumulation and lactic acidosis increases with the degree of renal dysfunction. Before starting metformin, an eGFR should be obtained. Initiation of metformin is not recommended in patients with eGFR between 30 and 45 mL/min/1.73 m2. An eGFR should be obtained at least annually in all patients; in those at risk of developing renal dysfunction (e.g., older adult patients), renal function should be assessed more frequently. In patients whose eGFR falls below 45 mL/min/1.73 m2, the benefit/risk of continuing therapy should be assessed. Postmarketing cases of metformin-associated lactic acidosis primarily occurred with significant renal dysfunction; metformin plasma levels generally exceeded 5 mcg/mL.

References

  1. "Product Information. Glucophage (metFORMIN)." EMD Serono Inc SUPPL-34 (2018):
Major

Oral hypoglycemic agents (applies to PrandiMet) cardiovascular risk

Major Potential Hazard, Moderate plausibility. Applicable conditions: Cardiovascular Disease

The use of oral hypoglycemic agents may be associated with an increased risk of cardiovascular mortality compared to treatment with diet alone or diet with insulin. This warning is based on the University Group Diabetes Program (UGDP) study, a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. Patients treated with diet plus a fixed dosage of either tolbutamide (a sulfonylurea) or phenformin (a biguanide) for 5 to 8 years had a cardiovascular mortality rate approximately 2.5 times that of patients treated with diet alone, resulting in discontinuation of both these treatments in the study. Despite controversy regarding interpretation of these results, clinicians and patients should be aware of the potential risk when making treatment decisions for diabetes, particularly in the presence of underlying cardiovascular disease. Data are not available for other sulfonylureas or biguanides, nor for hypoglycemic agents belonging to other classes. However, given the similarities in chemical structure and/or mode of action, the same caution should be applied.

References

  1. "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  2. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  3. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Amaryl (glimepiride)." Hoechst Marion Roussel PROD (2001):
  5. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc PROD (2001):
  6. "Product Information. Tolinase (tolazamide)." Pharmacia and Upjohn PROD (2001):
  7. "Product Information. Orinase (tolbutamide)." Pharmacia and Upjohn PROD (2001):
  8. "Product Information. Dymelor (acetohexamide)." Lilly, Eli and Company PROD (2001):
View all 8 references
Moderate

Insulin/oral hypoglycemic agents (applies to PrandiMet) hypoglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Adrenal Insufficiency, Malnourished, Autonomic Neuropathy, Panhypopituitarism, Anorexia/Feeding Problems, Adrenal Insufficiency, Malnourished, Panhypopituitarism, Autonomic Neuropathy, Anorexia/Feeding Problems

Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including those who are debilitated or malnourished, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those receiving beta-adrenergic blocking agents.

References

  1. "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  2. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  3. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Micronase (glyburide)." Pharmacia and Upjohn PROD (2002):
  5. "Product Information. Humulin BR (insulin)." Lilly, Eli and Company, Indianapolis, IN.
  6. "Product Information. Amaryl (glimepiride)." Hoechst Marion Roussel PROD (2001):
  7. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc PROD (2001):
  8. "Product Information. Tolinase (tolazamide)." Pharmacia and Upjohn PROD (2001):
  9. "Product Information. Dymelor (acetohexamide)." Lilly, Eli and Company PROD (2001):
  10. "Product Information. Lantus (insulin glargine)." Aventis Pharmaceuticals PROD (2001):
  11. "Product Information. NovoLOG (insulin aspart)." Novo Nordisk Pharmaceuticals Inc (2022):
  12. "Product Information. Starlix (nateglinide)." Novartis Pharmaceuticals PROD (2001):
  13. "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals (2004):
  14. "Product Information. Levemir (insulin detemir)." Novo Nordisk Pharmaceuticals Inc (2005):
  15. "Product Information. Tresiba FlexTouch (insulin degludec)." Novo Nordisk Pharmaceuticals Inc (2015):
  16. "Product Information. Glucophage (metFORMIN)." EMD Serono Inc SUPPL-34 (2018):
View all 16 references
Moderate

Metformin (applies to PrandiMet) B12 deficiency

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Folic Acid/Cyanocobalamin Deficiency, Anemia Associated with Vitamin B12 Deficiency

Metformin may interfere with vitamin B12 absorption from the B12-intrinsic factor complex. A decrease to subnormal levels of previously normal serum vitamin B12 levels was reported in about 7% of patients treated with metformin during clinical trials. Such decrease may be associated with anemia but appears to be rapidly reversible with metformin discontinuation or vitamin B12 supplementation. Certain patients (those with inadequate vitamin B12 or calcium intake or absorption) appear to be predisposed to developing subnormal levels of vitamin B12; caution may be warranted when metformin is administered to these patients. It is recommended to measure vitamin B12 every 2 to 3 years and hematologic parameters annually in patients on metformin. Any abnormalities should be managed.

References

  1. "Product Information. Glucophage (metFORMIN)." EMD Serono Inc SUPPL-34 (2018):
Moderate

Repaglinide (applies to PrandiMet) liver disease

Moderate Potential Hazard, Moderate plausibility.

Repaglinide is almost completely metabolized in the liver to pharmacologically inactive substances. Patients with impaired liver function may be exposed to higher concentrations of repaglinide and its associated metabolites. Higher serum drug levels, in addition to diminished gluconeogenic capacity secondary to hepatic insufficiency, may increase the potential for severe hypoglycemic episodes. Therapy with repaglinide should be administered cautiously in patients with liver disease. Longer intervals between dosage adjustments may be required.

References

  1. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc PROD (2001):
Moderate

Repaglinide (applies to PrandiMet) renal impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction, Diabetes Mellitus

Patients with severely reduced renal function treated with repaglinide had elevated plasma drug concentrations. Patients with type 2 diabetes who have severe renal function impairment should initiate repaglinide therapy with the 0.5 mg dose and subsequently, patients should be carefully titrated.

References

  1. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc PROD (2001):

PrandiMet drug interactions

There are 585 drug interactions with PrandiMet (metformin / repaglinide).

PrandiMet alcohol/food interactions

There are 2 alcohol/food interactions with PrandiMet (metformin / repaglinide).


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.