Posology : מינונים

4.2      Posology and method of administration

Posology
Repaglinide is given preprandially and is titrated individually to optimise glycaemic control. In addition to the usual self-monitoring by the patient of blood and/or urinary glucose, the patient’s blood glucose must be monitored periodically by the physician to determine the minimum effective dose for the patient. Glycosylated haemoglobin levels are also of value in monitoring the patient’s response to therapy. Periodic monitoring is necessary to detect inadequate lowering of blood glucose at the recommended maximum dose level (i.e. primary failure) and to detect loss of adequate blood glucose- lowering response after an initial period of effectiveness (i.e. secondary failure).

Short-term administration of repaglinide may be sufficient during periods of transient loss of control in type 2 diabetic patients usually controlled well on diet.

Initial dose
The dosage should be determined by the physician, according to the patient’s requirements.
The recommended starting dose is 0.5 mg. One to two weeks should elapse between titration steps (as 
determined by blood glucose response).
If patients are transferred from another oral hypoglycaemic medicinal product, the recommended starting dose is 1 mg.

Maintenance

The recommended maximum single dose is 4 mg taken with main meals.
The total maximum daily dose should not exceed 16 mg.
Special populations

Elderly
No clinical studies have been conducted in patients >75 years of age.

Renal impairment
Repaglinide is not affected by renal disorders (see section 5.2).
Eight percent of one dose of repaglinide is excreted through the kidneys and total plasma clearance of the product is decreased in patients with renal impairment. As insulin sensitivity is increased in diabetic patients with renal impairment, caution is advised when titrating these patients.

Hepatic impairment
No clinical studies have been conducted in patients with hepatic insufficiency.

Debilitated or malnourished patients
In debilitated or malnourished patients the initial and maintenance dosage should be conservative and careful dose titration is required to avoid hypoglycaemic reactions.

Patients receiving other oral hypoglycaemic medicinal products
Patients can be transferred directly from other oral hypoglycaemic medicinal products to repaglinide.
However, no exact dosage relationship exists between repaglinide and the other oral hypoglycaemic medicinal products. The recommended maximum starting dose of patients transferred to repaglinide is 1 mg given before main meals.

Repaglinide can be given in combination with metformin, when the blood glucose is insufficiently controlled with metformin alone. In this case, the dosage of metformin should be maintained and repaglinide administered concomitantly. The starting dose of repaglinide is 0.5 mg, taken before main meals; titration is according to blood glucose response as for monotherapy.

Paediatric population
The safety and efficacy of repaglinide in children below 18 years have not been established. No data are available.

Method of administration

Repaglinide should be taken before main meals (i.e. preprandially).
Doses are usually taken within 15 minutes of the meal but time may vary from immediately preceding the meal to as long as 30 minutes before the meal (i.e. preprandially 2, 3, or 4 meals a day). Patients who skip a meal (or add an extra meal) should be instructed to skip (or add) a dose for that meal.

In the case of concomitant use with other active substances refer to sections 4.4 and 4.5 to assess the dosage.