Repaglinide: what it treats, how to take it, side effects
Last updated September 3, 2026.
Repaglinide is a fast-acting oral diabetes medicine taken before each meal to lower after-meal blood sugar. It prompts the pancreas to release insulin for a few hours at a time, which is why doses are tied to meals instead of the clock. It was sold under the brand name Prandin.
What does it treat?
Repaglinide treats type 2 diabetes alongside diet and exercise, alone or with other agents such as metformin. It is not for type 1 diabetes or diabetic ketoacidosis. Because each dose works briefly, it can suit people whose meal schedules vary: you take it when you eat and skip it when you do not.
How do you take it?
Take repaglinide within 30 minutes before each meal, anywhere from half an hour ahead to just before eating. The usual starting dose is 0.5 mg before each meal if your A1c is below 8%, or 1 to 2 mg if it is 8% or higher; doses are then adjusted at intervals of at least a week, up to 4 mg per meal and a maximum of 16 mg per day. The rule that prevents lows: if you skip a meal, skip that dose, and if you add a meal, add a dose. If you realize you forgot a dose once you have started eating, take it then; if the meal is over, skip it and never double up.
Side effects to know
- Common: low blood sugar (shakiness, sweating, hunger, headache, confusion), upper respiratory symptoms, headache, and joint or back pain.
- Serious: severe hypoglycemia needing help from another person, especially after skipped meals, strenuous exercise, or alcohol, and rare serious allergic reactions.
Who should not take it?
Repaglinide must not be taken with gemfibrozil, a cholesterol drug that sharply raises repaglinide levels, or by anyone allergic to it. Clopidogrel should be avoided if possible; if it cannot be, dosing starts at 0.5 mg per meal with a 4 mg daily cap. People with severe kidney impairment also start at 0.5 mg per meal. It is not for type 1 diabetes, and data in pregnancy are limited, so insulin is usually preferred. Tell your prescriber about every medicine you use, because several common drugs raise or lower its effect.
When is it an emergency?
Call 911 if low blood sugar leaves someone unconscious, seizing, or too confused to swallow; give glucagon if available. Swelling of the face or throat, trouble breathing, or a spreading rash after a dose also means call 911. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
If I skip a meal, do I still take repaglinide?
No. Repaglinide works by triggering insulin release for the meal you are about to eat, so the label directs you to skip the dose when you skip a meal. Taking it without eating is exactly how low blood sugar happens on this drug.
How fast does repaglinide work?
It acts quickly and briefly. You take it within 30 minutes before eating, insulin release rises with the meal, and the effect fades within a few hours. That short window is what allows meal-by-meal dosing.
What is the maximum dose of repaglinide?
Per the label, individual doses range from 0.5 mg to 4 mg before each meal, with a maximum of 16 mg per day. Lower caps apply with certain interacting drugs, such as a 4 mg daily maximum when clopidogrel cannot be avoided.
Can I drink alcohol while taking repaglinide?
Alcohol can lower blood sugar and blunt your ability to notice a low coming on, and the label lists drugs that blunt hypoglycemia warning signs as a concern. If you drink, keep it modest, pair it with food, and monitor your glucose.
Is repaglinide the same as metformin?
No. Metformin reduces the liver's glucose output and rarely causes lows. Repaglinide pushes the pancreas to release insulin at meals and can cause hypoglycemia. They work differently and are sometimes prescribed together.
Can I take repaglinide with kidney disease?
Often yes, which is one reason it is chosen for people with kidney impairment, but the label recommends starting at 0.5 mg before each meal in severe renal impairment. Your prescriber sets the dose from your kidney function.