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metformin and repaglinide

Generic Name: metformin and repaglinide (met FOR min and re PAG li nide)
Brand Name: PrandiMet

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.

Metformin and repaglinide is a combination medicine used to treat type 2 diabetes in adults. This medicine is not for treating type 1 diabetes.

Metformin and repaglinide may also be used for purposes not listed in this medication guide.

What is the most important information I should know about metformin and repaglinide?

You should not use this medicine if you are allergic to metformin or repaglinide, if you have severe kidney disease or type 1 diabetes, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

You should not use metformin and repaglinide together with gemfibrozil or NPH insulin (such as isophane insulin).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and repaglinide.

This medicine may cause a serious condition called lactic acidosis. Get emergency medical help if you have even mild symptoms such as: 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.

What should I discuss with my doctor before taking metformin and repaglinide?

You should not use this medication if you are allergic to metformin (Actoplus Met, Avandamet, Fortamet, Glucophage, Glumetza, Glucovance, Invokamet, Janumet, Jentadueto, Kazano, Kombiglyze, Metaglip, PrandiMet, Riomet, Synjardy, Xigduo, and others) or repaglinide (Prandin), or if you have:

  • severe kidney disease;

  • if you also use gemfibrozil or NPH insulin (such as isophane insulin); or

  • if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Some people taking metformin and repaglinide develop a serious condition called lactic acidosis. This may be more likely if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your risk.

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and repaglinide.

To make sure metformin and repaglinide is safe for you, tell your doctor if you have:

  • liver disease; or

  • a history of heart disease.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine

It is not known whether metformin and repaglinide passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using metformin and repaglinide.

How should I take metformin and repaglinide?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

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.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, confusion, irritability, dizziness, or feeling shaky. Always keep a source of sugar with you in case you have low blood sugar. Sugar sources include fruit juice, hard candy, crackers, raisins, and non-diet soda. Be sure your family and close friends know how to help you in an emergency.

If you have severe hypoglycemia and cannot eat or drink, use a glucagon injection. Your doctor can prescribe a glucagon emergency injection kit and tell you how to use it.

Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals. These things can affect your glucose levels and your dose needs may also change. Do not change your medication dose or schedule without your doctor's advice.

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.

Metformin and repaglinide is only part of a complete treatment program that may also include diet, exercise, weight control, and special medical care. Follow your doctor's instructions very closely.

Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember, but only if you are getting ready to eat a meal. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A metformin and repaglinide overdose can cause life-threatening hypoglycemia. Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

What should I avoid while taking metformin and repaglinide?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis while taking metformin and repaglinide.

Metformin and repaglinide side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Early symptoms of lactic acidosis may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms: 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.

Hypoglycemia, or low blood sugar, is the most common side effect of metformin and repaglinide. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar.

Common side effects may include:

  • headache;

  • nausea, vomiting; or

  • diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Metformin and repaglinide dosing information

Usual Adult Dose for Diabetes Type 2:

Individualize based on current therapy, effectiveness, and tolerability

Initial dose:
Patients inadequately controlled on metformin monotherapy: repaglinide 1 mg/metformin 500 mg orally twice a day with meals
Patients inadequately controlled on meglitinide monotherapy: current meglitinide dose with metformin 500 mg orally twice a day with meals
Patients receiving individual components concomitantly: current or similar dose of individual components without exceeding current dose

Titrate gradually based on glycemic control and tolerability
Maximum single dose: repaglinide 4 mg/metformin 1000 mg
Maximum daily dose: repaglinide 10 mg/metformin 2500 mg

Comments:
-To be given 2 to 3 times a day within 15 minutes prior to meal; if a meal is skipped, a dose should not be given for that meal.
-Patients who have not been previously treated with a meglitinide should be started on the lowest dose of repaglinide to reduce the risk of hypoglycemia.
-Blood glucose monitoring should be performed to assess therapeutic response.

Use: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are already being treated with a meglitinide and metformin or who have inadequate glycemic control on a meglitinide alone or metformin alone.

What other drugs will affect metformin and repaglinide?

There are many other medicines that can increase or decrease the effects of metformin and repaglinide on lowering your blood sugar. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about metformin and repaglinide.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.01.

Last reviewed: April 20, 2016
Date modified: November 30, 2016

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