Recommended Dosing

The dosage of PrandiMet should be individualized on the basis of the patient’s current regimen, effectiveness and tolerability. PrandiMet can be administered 2 to 3 times a day up to a maximum daily dose of 10 mg repaglinide/2500 mg metformin HCl. No more than 4 mg repaglinide/1000 mg metformin HCl should be taken per meal. Initiation and maintenance of combination therapy with PrandiMet should be individualized to the patient, and at the discretion of the health care provider. Blood glucose monitoring should be performed to determine the therapeutic response to PrandiMet.

PrandiMetdoses should usually be taken within 15 minutes prior to the meal but the timing can vary from immediately preceding the meal up to 30 minutes before the meal. Patients who skip a meal should be instructed to skip the PrandiMetdose for that meal.

Patients Inadequately Controlled with Metformin HCl Monotherapy

If therapy with a combination tablet containing repaglinide and metformin HCl is considered appropriate for a patient with type 2 diabetes mellitus inadequately controlled with metformin HCl alone, the recommended starting dose of PrandiMet is 1 mg repaglinide/500 mg metformin HCl administered twice daily with meals, with gradual dose escalation (based on glycemic response) to reduce the risk of hypoglycemia with repaglinide.

Patients Inadequately Controlled with Meglitinide Monotherapy

If therapy with a combination tablet containing repaglinide and metformin HCl is considered appropriate for a patient with type 2 diabetes mellitus inadequately controlled with repaglinide alone, the recommended starting dose of the metformin HCl component of PrandiMet should be 500 mg metformin HCl twice a day, with gradual dose escalation (based on glycemic response) to reduce gastrointestinal side effects associated with metformin HCl.

Patients Currently Using Repaglinide and Metformin HCl Concomitantly

For patients switching from repaglinide co-administered with metformin HCl, PrandiMet can be initiated at the dose of repaglinide and metformin HCl similar to (but not exceeding) the patient’s current doses, then may be titrated to the maximum daily dose as necessary to achieve targeted glycemic control.

No studies have been performed examining the safety and efficacy of PrandiMet in patients previously treated with other oral antihyperglycemic agents and switched to PrandiMet. Any change in therapy should be undertaken with care and with appropriate monitoring as changes in glycemic control can occur.

Recommendations for Use in Renal Impairment

​Assess renal function with an estimated glomerular filtration rate (eGFR) prior to initiation of PrandiMet and periodically thereafter.

​PrandiMet is contraindicated in patients with an eGFR below 30 mL/min/1.73 m2.

​Initiation of PrandiMet in patients with an eGFR between 30 – 45 mL/min/1.73 m2 is not recommended.

​In patients taking PrandiMet whose eGFR later falls below 45 mL/min/1.73 m2, assess the benefit-risk of continuing therapy.

​Discontinue PrandiMet if the patient’s eGFR later falls below 30 mL/min/1.73 m2 [see Contraindications (4) and Warnings and Precautions (5.1)].

Discontinuation for Iodinated Contrast Imaging Procedures

Discontinue PrandiMet at the time or, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m2; in patients with a history of liver disease, alcoholism or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart PrandiMet if renal function is stable [See Warnings and Precautions (5.1)].