Meglitinides

Nateglinide, Repaglinide

  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

Elective Surgery

Meglitinides should be taken as normal the day prior to surgery¹.

Morning Surgery
Omit morning dose if nil by mouth^{1, 2}.

Afternoon Surgery
Take morning dose if eating^{1, 2}.

Emergency Surgery

In the event of emergency surgery and the patient has already taken their meglitinide dose monitor blood glucose levels closely and treat any hypoglycaemia accordingly.

Perioperative Considerations

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 prescribed^{1, 2}.

Post-operative Advice

Restart once eating and drinking normally and VRIII (where applicable) has been stopped¹.

  Interaction(s) with Common Anaesthetic Agents

None^{2, 3, 4}.

  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 meglitinides^{3, 4, 5}.

  Further Information

VRIII

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. Patients expected to miss more than one meal should have VRIII¹.

  References

1. Joint British Diabetes Societies for Inpatient Care. Management of adults with diabetes undergoing surgery and elective procedures: improving standards (Revised March 2016). Available at: www.diabetes.org.uk [Accessed 12th March 2019]
2. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12^th March 2019]
3. Summary of Product Characteristics - Starlix^® (nateglinide). Novartis Pharmaceutical UK Ltd. Accessed via www.medicines.org.uk 08/04/2019 [date of revision of the text June 2018]
4. Summary of Product Characteristics - Prandin^® (repaglinide). Novo Nordisk Limited. Accessed via www.medicines.org.uk 08/04/2019 [date of revision of the text June 2016]
5. Meglitinides (Antidiabetics – Antidiabetic Drug Groups). In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 30^th March 2019]