Neoral and Prandin

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

CycloSPORINE may significantly increase the blood levels and effects of repaglinide, which can lead to severe hypoglycemia, or low blood sugar. Symptoms of hypoglycemia include headache, dizziness, drowsiness, nervousness, weakness, tremor, nausea, hunger, sweating, and palpitation. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSE: Coadministration with cyclosporine may significantly increase the plasma concentrations of repaglinide. The proposed mechanism is cyclosporine inhibition of the hepatic uptake of repaglinide via organic anion transporting polypeptide (OATP) 1B1 and also its metabolism via CYP450 3A4. In 12 healthy, nonsmoking male volunteers, administration of a single 0.25 mg oral dose of repaglinide one hour after the second dose of cyclosporine given at 100 mg orally 12 hours apart increased mean repaglinide peak plasma concentration (Cmax) and systemic exposure (AUC) by 75% and 144%, respectively, compared to administration after placebo. An increase in repaglinide AUC was observed in every subject (range 19% to 433%), and there was a linear relationship between cyclosporine AUC and the increase in repaglinide AUC caused by cyclosporine. Although there were no detectable differences in mean blood glucose response between the placebo and cyclosporine phases, the blood glucose response of individual subjects correlated with the degree of pharmacokinetic interaction between cyclosporine and repaglinide, and the subject with the greatest increase in repaglinide AUC also had the greatest increase in blood glucose-lowering effect. No subject developed symptomatic hypoglycemia as a result of the interaction. However, the lack of clinical adverse effects may be explained, at least partially, by frequent carbohydrate intake during the study and the use of a subtherapeutic dose of repaglinide.

MANAGEMENT: Because the antidiabetic effect of repaglinide is dose- and concentration-dependent, close monitoring for the development of hypoglycemia is recommended if repaglinide is coadministered with cyclosporine. Patients should be advised to regularly monitor their blood sugar and counseled on how to recognize and treat hypoglycemia, which may include symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, and palpitations. The manufacturers recommend limiting the total daily dose of repaglinide to 6 mg when coadministered with cyclosporine.

Neoral

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Neoral (Capsules, Modified)

What is Neoral?

Prandin

Generic Name: repaglinide

Brand name: Prandin

Synonyms: n.a.

What is Prandin?