Issues for Surgery
Increased risk of post-operative infection and delayed wound healing due to poor glycaemic control if omitted.
Hypoglycaemia if continued during nil by mouth (NBM) period.
Advice in the Perioperative period
Meglitinides should be taken as normal the day prior to surgery1.
In the event of emergency surgery and the patient has already taken their meglitinide dose monitor capillary blood glucose (CBG) levels closely and treat any hypoglycaemia accordingly.
Commence variable rate intravenous insulin infusion (VRIII) perioperatively where indicated (see Further Information) and omit meglitinide during VRIII treatment1.
Ensure emergency treatment of hypoglycaemia is prescribed i.e. Glucogel® and 20% dextrose. Rapid acting insulin should also be prescribed1, 2.
Restart once eating and drinking normally and VRIII (where applicable) has been stopped1.
Interaction(s) with Common Anaesthetic Agents
None2, 3, 4, 5, 6.
Interaction(s) with other Common Medicines used in the Perioperative Period
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
Caution with concomitant use of NSAIDs – may enhance the hypoglycaemic effect of meglitinides3, 4.
Clarithromycin and trimethoprim slightly increase the exposure to repaglinide2, 4, 5, 6. As infections can increase blood glucose concentrations this is not thought to be clinically significant; however, there are case reports of hypoglycaemia with concurrent use6. If concurrent use of clarithromycin, erythromycin, trimethoprim or co-trimoxazole is deemed necessary – monitor CBG closely and adjust repaglinide dose if necessary6.
Patients with a planned short starvation period (no more than one missed meal in total) should be managed by modification of their usual diabetes medication, avoiding VRIII wherever possible (although VRIII may be necessary if emergency surgery or in people with poorly controlled diabetes (HbA1c >69mmol/mol))1. Patients with type 2 diabetes who are expected to miss more than one meal should have VRIII if they develop hyperglycaemia (CBG >12mmol/L)1.