Prandin (Repaglinide): Uses, Dosage & Side Effects

Rapid-acting prandial glucose regulator for adults with type 2 diabetes

 Prescription only Meglitinide ATC A10BX02
Active substance
Repaglinide
Form
Tablet
Strength
0.5 mg
Route
Oral
Also known as
NovoNorm
Generic available
Yes
Medically reviewed by the iMedic Medical Review Board Last reviewed: Published: Evidence: Level 1A (SmPC, EMA, FDA, RCTs)

Prandin is the brand name for repaglinide, an oral prescription medicine used to improve blood-glucose control in adults with type 2 diabetes mellitus. Repaglinide belongs to the meglitinide class of drugs, sometimes called prandial glucose regulators, because they are taken with meals to stimulate a rapid, short-lived burst of insulin release from the pancreas. Prandin 0.5 mg is the lowest commercial strength and is usually where treatment begins.

Prandin is prescribed when diet, weight reduction and exercise alone are not enough to keep blood sugar within target, either as monotherapy or – more commonly – as add-on therapy to metformin. Compared with sulfonylureas such as glibenclamide or glimepiride, repaglinide has a faster onset and much shorter duration of action. That makes it particularly useful in people with irregular meal patterns, older adults, and patients with chronic kidney disease, where the risk of prolonged hypoglycaemia matters most.

Quick Facts

Active ingredient
Repaglinide
Drug class
Meglitinide (prandial glucose regulator)
ATC code
A10BX02
Main use
Type 2 diabetes mellitus (ICD-10 E11)
Available form
Oral tablet, 0.5 mg
Prescription status
Prescription only (Rx)

Key Takeaways

  • What it is: Prandin (repaglinide) is a fast, short-acting oral antidiabetic taken with meals to control post-meal blood glucose in adults with type 2 diabetes.
  • How it works: It closes ATP-sensitive potassium channels on pancreatic beta-cells, triggering a quick pulse of insulin release within about 30 minutes.
  • The golden rule: One meal – one dose. No meal – no dose. Skipping a meal means skipping that dose to avoid low blood sugar.
  • Main risk: Hypoglycaemia. Risk rises with higher doses, in older adults, with liver impairment, and in combination with other glucose-lowering drugs.
  • Key interaction: Gemfibrozil is contraindicated – it can increase repaglinide exposure up to eightfold and cause dangerous hypoglycaemia.

What Is Prandin and What Is It Used For?

Quick answerPrandin (repaglinide) is a prescription oral tablet used to lower blood glucose in adults with type 2 diabetes. It works rapidly around mealtimes, making it useful when meal patterns are irregular, and is commonly combined with metformin.

Prandin is an oral antidiabetic tablet containing the active substance repaglinide. It is classified by the World Health Organization under ATC code A10BX02 in the group of "other blood-glucose lowering drugs", and is the prototype drug of the meglitinide class. The brand name Prandin is used predominantly in the United States; in Europe the same molecule is most often sold under the brand name NovoNorm, and a wide range of generic repaglinide products is also available worldwide.

The medicine is indicated for the treatment of type 2 diabetes mellitus in adults whose hyperglycaemia cannot be controlled satisfactorily by diet, weight reduction and exercise. In clinical practice Prandin is used either as monotherapy – typically for people who cannot tolerate metformin – or in combination with metformin when metformin alone is no longer sufficient. It is not indicated for type 1 diabetes, for patients in diabetic ketoacidosis, or for children under 18 years of age, because these situations require insulin and a different pharmacological approach.

How Prandin works (mechanism of action)

Repaglinide binds to a specific site on the sulfonylurea receptor 1 (SUR1) on pancreatic beta-cells. This binding closes ATP-dependent potassium channels, depolarises the cell membrane, opens voltage-gated calcium channels and triggers the release of stored insulin granules. The result is a rapid, meal-related pulse of insulin that mimics – to a limited extent – the physiological first-phase insulin response that is lost in type 2 diabetes.

Pharmacokinetically, repaglinide is absorbed quickly after oral administration, reaching peak plasma concentration within about one hour and having a plasma half-life of approximately one hour. It is extensively metabolised in the liver by cytochrome P450 enzymes (mainly CYP2C8 and CYP3A4) and is excreted largely via bile into the faeces, with minimal renal excretion. This renal-sparing elimination profile is one of the reasons repaglinide remains an option in patients with chronic kidney disease, where metformin and some sulfonylureas may be limited.

Where Prandin fits in the treatment of type 2 diabetes

International guidelines – including the ADA/EASD consensus and NICE guidance – place metformin as the first-line oral therapy for type 2 diabetes. When additional glucose-lowering is needed, options include SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, pioglitazone, and meglitinides such as Prandin. Repaglinide is often chosen when cost is a concern, when post-meal glucose excursions are the dominant problem, or when flexible dosing around irregular meals is needed.

Because Prandin only works when food is eaten, it is particularly suited to people who sometimes skip meals – for example due to shift work, travel or religious fasting. In these situations, sulfonylureas with once-daily dosing carry a higher hypoglycaemia risk between meals, while repaglinide's short action means the effect fades in time for the next meal.

What Should You Know Before Taking Prandin?

Quick answerBefore starting Prandin, your doctor will review other medications, liver and kidney function, and whether you are pregnant or breastfeeding. Do not combine Prandin with gemfibrozil, and do not take it if you have severe liver disease or type 1 diabetes.

Prandin is generally well tolerated, but like every glucose-lowering medicine it has situations in which it must not be used and others that require caution. Before a first prescription is written, a doctor will typically review current medications, kidney and liver function tests, HbA1c, current symptoms and – in women of child-bearing potential – the possibility of pregnancy. Understanding these considerations helps you use Prandin safely.

Contraindications

Do not take Prandin if any of the following apply to you:

Warnings and Precautions

Talk to your doctor or pharmacist before taking Prandin if you have any of the following, because the dose or choice of medicine may need to be adjusted:

Hypoglycaemia warning: Prandin stimulates insulin release and can cause low blood sugar, especially if a meal is skipped, delayed or contains few carbohydrates. Symptoms include sweating, shaking, hunger, weakness, dizziness, palpitations and confusion. Always carry a source of rapidly absorbed sugar (glucose tablets, juice or sugary sweets) and wear or carry medical identification stating that you have diabetes.

Pregnancy and Breastfeeding

Prandin is not recommended during pregnancy. Human data are limited, and animal studies have shown embryotoxic effects at very high doses. Uncontrolled maternal hyperglycaemia itself increases the risk of congenital malformations, macrosomia and neonatal hypoglycaemia, so glucose control remains essential – but it should be achieved with insulin, which is the standard therapy for diabetes in pregnancy. Women with type 2 diabetes who are planning a pregnancy should be switched to insulin before conception whenever possible.

It is not known whether repaglinide passes into human breast milk, but animal studies suggest exposure of the nursing infant is possible. Because neonatal hypoglycaemia is a serious risk, Prandin should not be used while breastfeeding. Discuss alternative treatment with your diabetes team.

Driving and operating machinery

Prandin itself does not directly impair attention or reaction time. However, hypoglycaemia does. You should not drive or operate machinery if you feel the warning signs of low blood sugar, and you should learn how to recognise and treat symptoms before driving longer distances. Some countries require drivers with insulin-like secretagogue therapy to notify their driving authority – check local regulations.

How Does Prandin Interact with Other Drugs?

Quick answerRepaglinide is metabolised by CYP3A4 and CYP2C8 in the liver, so many medicines can raise or lower its concentration. The most important interactions are with gemfibrozil (contraindicated), clopidogrel, strong CYP3A4 inhibitors, rifampicin, and other glucose-lowering drugs.

Because repaglinide is metabolised by two major cytochrome P450 enzymes – CYP2C8 and CYP3A4 – and is a substrate for the OATP1B1 liver uptake transporter, it is subject to a considerable number of pharmacokinetic drug–drug interactions. In addition, any medicine that affects blood glucose will interact pharmacodynamically with Prandin. Always inform every prescriber and pharmacist about all prescription drugs, over-the-counter medicines, supplements and herbal products you take.

Major Interactions

Major clinically relevant interactions with Prandin (repaglinide)
Medicine / group Effect on repaglinide Clinical action
Gemfibrozil (fibrate) Up to 8-fold increase in repaglinide AUC; severe, prolonged hypoglycaemia. Contraindicated. Do not combine.
Clopidogrel Strong CYP2C8 inhibition; repaglinide AUC increased ~3–5-fold. Combination generally not recommended. If unavoidable, strict glucose monitoring and lower repaglinide dose.
Strong CYP3A4 inhibitors (e.g. clarithromycin, itraconazole, ketoconazole, ritonavir) Increased repaglinide exposure and hypoglycaemia risk. Use with caution; consider temporary dose reduction and close glucose monitoring.
Rifampicin, phenytoin, carbamazepine, St John's wort Potent CYP enzyme induction; repaglinide levels and effect reduced. May need higher repaglinide dose or alternative therapy; re-titrate if inducer is started or stopped.
Other glucose-lowering drugs (insulin, sulfonylureas, GLP-1 RA, SGLT2 inhibitors) Additive glucose-lowering; increased risk of hypoglycaemia. Combine only under medical supervision; may need to lower one or both doses.
Non-selective beta-blockers (e.g. propranolol) May mask warning symptoms of hypoglycaemia; prolong recovery. Prefer cardioselective beta-blockers; patient education on atypical hypo symptoms.

Minor and Pharmacodynamic Interactions

A number of medicines can enhance the glucose-lowering effect of Prandin without a direct metabolic interaction. These include ACE inhibitors, salicylates at high dose, monoamine oxidase inhibitors, octreotide, anabolic steroids and alcohol. Conversely, several drugs may raise blood glucose and reduce the apparent effect of Prandin, including oral contraceptives, thiazide diuretics, systemic corticosteroids, danazol, thyroid hormones, sympathomimetics and certain antipsychotics.

Patients should be advised to check glucose more often whenever a new medicine is started or stopped, and to report any pattern change (more frequent hypoglycaemia, or unexplained hyperglycaemia) to their diabetes team. Even apparently benign substances such as grapefruit juice, which inhibits intestinal CYP3A4, can modestly raise repaglinide levels and are worth mentioning.

What Is the Correct Dosage of Prandin?

Quick answerThe usual starting dose is 0.5 mg before each main meal (typically 2–4 times daily). The dose is titrated upward weekly based on blood glucose, to a maximum of 4 mg per meal and 16 mg per day. Skip the dose if you skip the meal.

Prandin dosing is highly individualised. Because the aim is to blunt the rise in blood glucose after meals, the dose is tied to eating rather than to the clock. Your doctor will set a starting dose based on your previous treatment (if any), current HbA1c and kidney and liver function, and will then adjust the dose at intervals of one to two weeks until glucose targets are met. Standard targets in adults with type 2 diabetes are an HbA1c below 7% (53 mmol/mol) for most, individualised to 7.5–8% in frail or older patients.

Prandin (repaglinide) dosing summary in adults
Situation Starting dose Titration / maximum
Not previously treated or HbA1c < 8% 0.5 mg before each main meal Double dose at 1–2 week intervals; max 4 mg/meal, 16 mg/day
Previously treated with another oral antidiabetic 1 mg before each main meal Adjust based on glucose; max 4 mg/meal, 16 mg/day
Add-on to metformin 0.5 mg before each main meal Continue metformin; titrate repaglinide weekly
Mild/moderate hepatic impairment 0.5 mg before each main meal Longer intervals between dose increases; more frequent monitoring

Adults

Standard adult dosing

The usual starting dose in adults is 0.5 mg repaglinide within 15 minutes before each main meal. For most people this means two, three or four doses a day corresponding to the number of meals eaten. The dose can be doubled at weekly or two-weekly intervals based on fasting and post-meal blood glucose readings, to a maximum single dose of 4 mg and a maximum total daily dose of 16 mg. The 0.5 mg strength is typically used during initiation and in patients needing fine titration.

Children and adolescents

Under 18 years of age

Prandin is not recommended for use in children and adolescents under 18 years. Safety and efficacy in this age group have not been established. Paediatric type 2 diabetes, which is increasing globally, should be managed according to specialist guidelines, usually with metformin and, if needed, insulin or GLP-1 receptor agonists licensed for children.

Elderly patients

Adults 75 years and older

Clinical experience with Prandin in adults aged 75 years and older is limited, and no specific dose recommendations exist for this group. Because the consequences of hypoglycaemia – falls, fractures, cognitive impairment and cardiovascular events – are more serious in older adults, treatment should start at the lowest dose (0.5 mg), be titrated slowly, and aim for an individualised, slightly higher HbA1c target if frailty, cognitive decline or limited life expectancy are present.

Patients with liver or kidney impairment

Hepatic and renal impairment

In mild to moderate hepatic impairment repaglinide exposure is increased; start at 0.5 mg and titrate carefully. Severe hepatic impairment is a contraindication. In renal impairment (including CKD stages 3–4), repaglinide can often be continued – since it is not significantly excreted by the kidneys – but clearance may still be slightly reduced, so cautious titration is advised. In dialysis patients, specialist advice is required.

Missed Dose

If you forget a dose

If you realise you have forgotten your dose during a meal, take the dose if you are still eating or have just finished. If the meal was completed some time ago, skip that dose and take the next dose with the next meal. Never take a double dose to make up for a forgotten one – this significantly increases the risk of hypoglycaemia. If you are unsure, check your blood glucose and contact your pharmacist or diabetes team.

Overdose

If you take too much Prandin

An overdose of Prandin causes hypoglycaemia, which may be prolonged and severe. Mild hypoglycaemia without loss of consciousness can usually be managed at home with 15–20 g of rapidly absorbed carbohydrate (e.g. glucose tablets, fruit juice or non-diet cola), followed by a longer-acting carbohydrate such as bread or pasta. Severe hypoglycaemia with loss of consciousness, seizures or inability to swallow requires emergency treatment with intravenous glucose or intramuscular glucagon and urgent transfer to hospital. Always call your local emergency number in this situation.

What Are the Side Effects of Prandin?

Quick answerThe most common side effect is hypoglycaemia, usually mild. Gastrointestinal symptoms such as abdominal pain and diarrhoea also occur. Serious allergic reactions and liver enzyme abnormalities are rare but can happen.

Like all medicines, Prandin can cause side effects, although not everybody gets them. The side-effect profile of repaglinide has been well characterised in clinical trials and post-marketing surveillance reported in the European Medicines Agency (EMA) Summary of Product Characteristics and the FDA prescribing information. Frequencies below follow the standard convention used in medical literature: very common (> 1/10), common (1/100–1/10), uncommon (1/1000–1/100), rare (1/10000–1/1000) and very rare (< 1/10000).

Very common side effects

More than 1 in 10 people
  • Hypoglycaemia (low blood sugar): sweating, shaking, hunger, weakness, dizziness, palpitations, confusion. Most episodes are mild and respond to carbohydrate.

Common side effects

Between 1 in 100 and 1 in 10 people
  • Abdominal pain
  • Diarrhoea
  • Nausea (uncommon to common depending on dose)

Uncommon side effects

Between 1 in 1 000 and 1 in 100 people
  • Vomiting
  • Constipation
  • Visual disturbances, particularly at start of treatment or after dose changes, due to fluctuating blood glucose
  • Skin rash, itching

Rare & very rare side effects

Fewer than 1 in 1 000 people
  • Severe, prolonged hypoglycaemia – medical emergency
  • Abnormal liver enzyme tests (elevated ALT/AST)
  • Acute pancreatitis (very rare)
  • Hypersensitivity reactions, including angioedema; anaphylaxis (very rare)
  • Severe cutaneous reactions such as Stevens–Johnson syndrome (very rare)
  • Cardiovascular events – overall cardiovascular risk of repaglinide has been studied and is not considered greater than other oral antidiabetics, but patients with established cardiovascular disease should be monitored carefully

Recognising and managing hypoglycaemia

Hypoglycaemia is by far the most important and most common adverse effect of Prandin. Warning symptoms are typically "adrenergic" – sweating, shaking, hunger, palpitations and anxiety – followed by "neuroglycopenic" symptoms if glucose falls further, including weakness, blurred vision, difficulty concentrating, speech changes, and eventually confusion, seizures and loss of consciousness. Any patient on Prandin should be trained to:

Reporting side effects

If you experience any side effect, speak to your doctor, pharmacist or diabetes nurse. You can also help improve medicine safety by reporting side effects directly to your country's pharmacovigilance authority (e.g. the MHRA Yellow Card scheme in the UK, the EMA system in the EU, or MedWatch in the US). Reporting suspected reactions – even those not listed above – allows regulators to monitor the benefit–risk balance of medicines.

How Should You Store Prandin?

Quick answerStore Prandin below 25 °C (77 °F) in the original packaging to protect from moisture. Keep out of sight and reach of children. Do not use after the expiry date and dispose of unused tablets through a pharmacy take-back scheme.

Correct storage preserves both the potency and the safety of Prandin. The repaglinide molecule is sensitive to moisture, so tablets should stay in their original blister pack and carton until use. General storage recommendations from the EMA and FDA summaries of product characteristics include the following:

What Does Prandin Contain?

Quick answerEach Prandin 0.5 mg tablet contains 0.5 mg of the active substance repaglinide, plus inactive excipients including microcrystalline cellulose, calcium hydrogen phosphate, starch, povidone, glycerol, magnesium stearate, meglumine and poloxamer.

Prandin 0.5 mg tablets are small, round, white to off-white uncoated tablets scored for identification and typically embossed with the manufacturer's code. The exact appearance and imprint vary between the originator product (Prandin in the US, NovoNorm in Europe) and generic versions, but the active substance and strength are the same.

Active substance

Inactive ingredients (typical excipients)

Generic repaglinide products may contain slightly different excipients, including colorants for higher strengths. The package leaflet for the specific brand you receive lists the complete formulation. If you have a known allergy to any excipient (for example, a starch intolerance), always ask your pharmacist to check before you take a new brand.

Pack sizes

Prandin 0.5 mg tablets are supplied in aluminium/aluminium blister packs. Typical pack sizes are 30, 90, 120 or 270 tablets, although not all pack sizes are marketed in every country. Hospital packs of 500 tablets may also be available.

Frequently Asked Questions About Prandin

Is Prandin the same as NovoNorm?

Yes. Prandin and NovoNorm are two brand names for the same active substance, repaglinide. Prandin is used primarily in the United States, while NovoNorm is the European trade name. A wide range of generic repaglinide products is also available and is therapeutically equivalent in most jurisdictions.

Can I drink alcohol while taking Prandin?

Moderate alcohol with a meal is generally tolerated, but alcohol – especially on an empty stomach – can cause hypoglycaemia that may be delayed by several hours and may be mistaken for intoxication. Do not binge drink while on Prandin, and always eat when you drink. If you regularly consume alcohol, discuss safe limits with your doctor.

Will Prandin make me gain weight?

A modest weight gain of one to three kilograms is possible, especially early in treatment. This reflects improved glucose control, reduced glycosuria and the anabolic effect of increased insulin. Weight gain with repaglinide is generally smaller than with sulfonylureas. Healthy eating, portion control and regular physical activity help keep weight stable. If weight gain is a concern, ask your doctor about alternatives such as SGLT2 inhibitors or GLP-1 receptor agonists, which can promote weight loss.

What if I need to fast – for example during Ramadan or before a medical procedure?

Prandin is actually one of the more flexible agents for fasting, because no meal means no dose. For planned fasts, discuss a dose schedule with your doctor: you will typically omit doses while fasting and take them only with meals that are eaten. For medical procedures requiring extended fasting, omit morning Prandin and resume with your first meal after the procedure. Monitor glucose regularly during any fast.

How long will I need to take Prandin?

Type 2 diabetes is a chronic, progressive condition, so Prandin is usually taken long-term. However, substantial weight loss, major lifestyle change or bariatric surgery can improve insulin resistance enough that antidiabetic medicines can be reduced or stopped. Any change in therapy must be guided by HbA1c, glucose monitoring and your doctor's review – never stop Prandin on your own.

Does Prandin protect against heart attacks or strokes?

Repaglinide lowers HbA1c by approximately 1–1.5 percentage points, similar to sulfonylureas, and indirect cardiovascular benefit from improved glucose control is expected. However, unlike SGLT2 inhibitors and certain GLP-1 receptor agonists, repaglinide has not been shown to reduce cardiovascular events in dedicated outcome trials. In patients with established cardiovascular disease, heart failure or chronic kidney disease, drugs with proven cardiovascular benefit are generally preferred as add-on to metformin according to current ADA/EASD and ESC guidelines.

Can Prandin be cut or crushed?

Prandin 0.5 mg tablets are usually score-lined and can be split if a half dose is required. Crushing is not routinely recommended because the tablet is designed for immediate release and crushing may alter absorption. If you have difficulty swallowing tablets, ask your pharmacist whether a different formulation or drug would suit you better.

References

  1. European Medicines Agency. NovoNorm (repaglinide) – Summary of Product Characteristics. EMA, most recent revision. Available at: ema.europa.eu/en/medicines/human/EPAR/novonorm
  2. U.S. Food and Drug Administration. Prandin (repaglinide) – Prescribing Information. FDA-approved label. Available at: accessdata.fda.gov/scripts/cder/daf/
  3. World Health Organization. ATC/DDD Index – A10BX02 Repaglinide. WHO Collaborating Centre for Drug Statistics Methodology. Available at: whocc.no/atc_ddd_index
  4. American Diabetes Association. Standards of Care in Diabetes – 2025. Diabetes Care 2025;48(Suppl. 1). doi:10.2337/dc25-Sint
  5. Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the ADA and EASD. Diabetes Care 2022;45(11):2753–2786. doi:10.2337/dci22-0034
  6. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management (NG28). NICE guideline, latest update. Available at: nice.org.uk/guidance/ng28
  7. Hatorp V. Clinical pharmacokinetics and pharmacodynamics of repaglinide. Clinical Pharmacokinetics 2002;41(7):471–483. doi:10.2165/00003088-200241070-00002
  8. Niemi M, Backman JT, Neuvonen PJ. Effects of gemfibrozil, itraconazole, and their combination on the pharmacokinetics and pharmacodynamics of repaglinide. Clinical Pharmacology & Therapeutics 2003;74(4):380–387. doi:10.1016/S0009-9236(03)00227-X
  9. Black C, Donnelly P, McIntyre L, et al. Meglitinide analogues for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004654. doi:10.1002/14651858.CD004654.pub2
  10. British National Formulary (BNF). Repaglinide monograph. Joint Formulary Committee, current online edition. Available at: bnf.nice.org.uk/drugs/repaglinide

Our Editorial Team

This article has been written and reviewed by the iMedic Medical Editorial Team, a panel of licensed specialist physicians in endocrinology and clinical pharmacology, together with a clinical pharmacist specialised in diabetes care. All iMedic content follows the iMedic Editorial Standards and the GRADE evidence framework.

Content is based on primary regulatory sources – the EMA Summary of Product Characteristics, the FDA prescribing information and WHO ATC classification – alongside peer-reviewed clinical literature and current international guidelines (ADA/EASD, NICE, IDF). iMedic does not accept commercial funding from pharmaceutical manufacturers. Articles are reviewed at least every 12 months or whenever a significant safety signal is issued by a regulatory authority.

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