Starlix is an oral hypoglycemic agent derived from phenylalanine. It differs from other hypoglycemic agents in its chemical and pharmacological properties. It restores early insulin secretion, which contributes to a decrease in postprandial blood glucose and glycated hemoglobin levels.
Is Stralix prescribed for type 2 diabetes?
Yes, it is. This drug is intended for the treatment of diabetes mellitus type 2 (non-insulin dependent) if there is an ineffectiveness of diet therapy and physical activity (in the form of monotherapy or in combination with other hypoglycemic drugs).
How long doesn it take to excrete from the body system?
Nateglinide is excreted from the body rather quickly – during the first 6 hours after ingestion. About 75% of the dose taken is excreted in the urine mainly in the form of metabolites. About 10% is excreted in the feces. In the studied dose range (up to 240 mg 3 times/day), no cumulation was observed. T1/2 is 1.5 hours.
When nateglinide is prescribed after a meal, a slowdown in its absorption is noted. The Tmax lengthens, the Cmax value decreases, while the completeness of absorption (AUC value) does not change. In connection with the above, it is recommended to use Starlix before meals.
There were no clinically significant differences in the pharmacokinetic parameters of nateglinide in male and female patients.
Starlix should be taken before meals. The time interval between taking the drug and eating should not exceed 30 minutes. As a rule, the drug is taken immediately before meals.
When using this drug as monotherapy, the recommended dose is 120 mg 3 times/day (before breakfast, lunch and dinner). If this dosing regimen fails to achieve the desired effect, a single dose can be increased to 180 mg. Correction of the dosage regimen is carried out on the basis of regularly determined indicators of glycosylated hemoglobin (HbA1c).
Considering that the main therapeutic effect of this drug is to reduce the prandial concentration of glucose in the blood (it is this concentration that determines the value of the HbA1c indicator), to assess the therapeutic drug efficacy, you can also use such an indicator as the concentration of glucose in the blood 1-2 hours after eating.
Patients receiving monotherapy and requiring the addition of another hypoglycemic drug may additionally be prescribed metformin. On the contrary, for patients already receiving metformin therapy, Starlix at a dose of 120 mg 3 times/day (before meals) can be prescribed as an additional agent. If, during treatment with metformin, the HbA1c value approaches the desired one (less than 7.5%), the dose of the described drug may be less – 60 mg 3 times/day.
What are possible side effects?
There may be observed symptoms presumably characteristic for the development of hypoglycemia – increased sweating, tremors, dizziness, increased appetite, palpitations, nausea, weakness, malaise (usually these phenomena were weak and easily stopped by taking carbohydrates).
Rareside effects are increased activity of liver enzymes in the blood (usually mild and transient), rash, itching, urticaria.
Contraindications for use
- Type 1 diabetes mellitus (insulin-dependent);
- Diabetic ketoacidosis;
- Severe liver dysfunction;
- Lactation (breastfeeding);
- Hypersensitivity to nateglinide.
What are interactions of this medication with other drugs?
Concomitant use of beta-blockers can mask manifestations of hypoglycemia.
The risk of developing hypoglycemia while taking nateglinide (as well as other hypoglycemic drugs) is higher in elderly patients with reduced body weight, in the presence of adrenal or pituitary insufficiency. A decrease in the concentration of glucose in the blood can be triggered by alcohol intake, increased physical activity, as well as the simultaneous intake of another hypoglycemic drug.
Can Starlix cause an overdose?
Cases of an overdose have not been described to date.
Symptoms: based on knowledge of the drug mechanism of action, it can be assumed that the main consequence of an overdose will be hypoglycemia with clinical manifestations of varying severity.
Treatment: the pattern of treating hypoglycemia is determined by the severity of the symptoms. With preserved consciousness and the absence of neurological manifestations, the intake of a glucose/sugar solution orally is indicated, as well as a correction of the dose of the drug and/or meals. In severe hypoglycemia, accompanied by neurological manifestations (coma, convulsions), intravenous administration of glucose solution is indicated. The use of hemodialysis to remove nateglinide from the bloodstream is ineffective due to its high binding to plasma proteins.
Starlix in children and during pregancy
This drug is contraindicated in patients aged under 18 years old (due to the lack of clinical trial data for this age group of patients). It is also contraindicated during pregancy and breastfeeding.