Researchers have observed a drug-drug interaction between repaglinide (Prandin generic, Novo Nordisk), a short-acting insulin secretagogue, and gemfibrozil (Drug Lopid®, Pfizer) a lipid-lowering agent used to treat dyslipidemia.
Co-administration of gemfibrozil with repaglinide in healthy volunteers resulted in significant elevations of repaglinide levels, and co-administration of itraconazole (Sporanox®, Janssen), an antifungal agent, with medication gemfibrozil and repag-linide further increased such effects. Changes in the pharmacokinetics of repaglinide were attributed to inhibition of the cytochrome P-450 enzyme system by gemfibrozil and itraconazole. Alterations in blood glucose levels were also affected by these concomitant medications, with enhanced and prolonged pharmacodynamic effects of repaglinide canadian.
Although the study involved healthy volunteers, Novo Nordisk considers these results to be important, because an increased risk of hypoglycemia cannot be ruled out for patients with type-2 (non-insulin-dependent) diabetes. According to what is now known about the metabolism of other lipid-lowering fibrate derivates, a similar interaction between repaglinide and other agents within the class is not expected.
The European Agency for the Evaluation of Medicinal Products (EMEA) has issued a public statement and has pointed out the following information to physicians:
1. Because of the documented interaction and risk of hypo-glycemia, the concomitant use of the two agents is contra-indicated.
2. For patients already receiving the two drugs, an alternative combinaton treatment should be considered along with close monitoring of diabetic status.