nateglinide

Nateglinide is an oral antidiabetic agent of the meglitinide class used to improve glycemic control in type 2 diabetes mellitus. It stimulates pancreatic insulin secretion by binding to ATP-sensitive potassium channels on beta cells, causing rapid depolarization and calcium influx in response to meals. The drug is fast-acting and short-lived, helping to blunt postprandial glucose spikes with a lower risk of prolonged hypoglycemia than some other secretagogues.

Nateglinide is indicated for adults with type 2 diabetes as monotherapy or in combination with other antidiabetic agents such as metformin or thiazolidinediones. It is taken orally just before meals, with the dose adjusted to meal size and glycemic response. Typical starting dosing is 60 mg before each meal, with possible increases to 120 mg per meal if additional control is needed. Do not take it if a planned meal is skipped, to minimize hypoglycemia risk.

Pharmacokinetics: Nateglinide is rapidly absorbed, producing insulin release within minutes to about an hour and has a short duration of action. It is predominantly metabolized in the liver, mainly by CYP2C9 and CYP3A4 pathways, with metabolites excreted in urine and feces.

Safety and contraindications: The major adverse effect is hypoglycemia, especially when used with other glucose-lowering agents or with irregular meals. Weight change is typically modest; other possible effects include headache and nausea. Contraindications include type 1 diabetes and diabetic ketoacidosis. Caution is advised in hepatic or renal impairment, and in pregnancy or with concomitant use of other secretagogues or potent CYP inhibitors or inducers.