PRANDIN 2 MG TABLETS - patient leaflet, side effects, dosage

1. what prandin® is and what it is used for

Prandin® is an oral antidiabetic medicine containing repaglinide which helps your pancreas produce more insulin and thereby lower your blood sugar (glucose).

Type 2 diabetes is a disease in which your pancreas does not make enough insulin to control the sugar in your blood or where your body does not respond normally to the insulin it produces.

Prandin® is used to control type 2 diabetes in adults as an add-on to diet and exercise: treatment is usually started if diet, exercise and weight reduction alone have not been able to control (or lower) your blood sugar. Prandin® can also be given with metformin, another medicine for diabetes.

Prandin® has been shown to lower the blood sugar, which helps to prevent complications from your diabetes.

2. what you need to know before you take prandin® do not take prandin®

• If you are allergic to repaglinide or any of the other ingredients in this medicine (listed in section 6).
• If you have type 1 diabetes.
• If the acid level in your blood is raised (diabetic ketoacidosis).
• If you have a severe liver disease.
• If you take gemfibrozil

(a medicine used to lower increased fat levels in the blood).

Warnings and precautions Talk to your doctor before taking Prandin®:

• If you have liver problems. Prandin® is not recommended in patients with moderate liver disease. Prandin® should not be taken if you have a severe liver disease (see Do not take Prandin®).
• If you have kidney problems. Prandin® should be taken with caution.
• If you are about to have major surgery or you have recently suffered a severe illness or infection. At such times diabetic control may be lost.
• If you are under 18 or over

75 years of age. Prandin® is not recommended. It has not been studied in these age groups.

Talk to your doctor if any of the above applies to you. Prandin® may not be suitable for you. Your doctor will advise you.

Children and adolescents

Do not take this medicine if you are under 18 years of age.

If you get a hypo (low blood sugar)

• You may get a hypo (short for hypoglycaemia) if your blood sugar gets too low. This may happen: If you take too much Prandin® If you exercise more than usual If you take other medicines or suffer from liver or kidney problems (see other sections of 2. What you need to know before you take Prandin®).

The warning signs of a hypo may come on suddenly and can include: cold sweat; cool pale skin; headache; rapid heart beat; feeling sick; feeling very hungry; temporary changes in vision; drowsiness; unusual tiredness and weakness; nervousness or tremor; feeling anxious; feeling confused; difficulty in concentrating.

If your blood sugar is low or you feel a hypo coming on: eat glucose tablets or a high sugar snack or drink, then rest.

When symptoms of hypoglycaemia have disappeared or when blood sugar levels are stabilised continue Prandin® treatment.

Tell people you have diabetes and that if you pass out (become unconscious) due to a hypo, they must turn you on your side and get medical help straight away. They must not give you any food or drink. It could choke you.

• If severe hypoglycaemia is not treated, it can cause brain damage (temporary or permanent) and even death.
• If you have a hypo that makes you pass out, or a lot of hypos, talk to your doctor. The amount of Prandin®, food or exercise may need to be adjusted.
• If your blood sugar gets too high Your blood sugar may get too high (hyperglycaemia). This may happen: If you take too little Prandin® If you have an infection or a fever If you eat more than usual If you exercise less than usual.

The warning signs of too high blood sugar appear gradually. They include: increased urination; feeling thirsty; dry skin and dry mouth. Talk to your doctor. The amount of Prandin®, food or exercise may need to be adjusted.

Other medicines and Prandin®

• Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. You can take Prandin® with metformin, another medicine for diabetes, if your doctor prescribes it. If you take gemfibrozil (used to lower increased fat levels in the blood) you should not take Prandin®. Your body’s response to Prandin® may change if you take other medicines, especially these: Monoamine oxidase inhibitors
• (MAOI) (used to treat depression) Beta blockers (used to treat high blood pressure or heart conditions)
• ACE-inhibitors (used to treat heart conditions)
• Salicylates (e.g. aspirin)
• Octreotide (used to treat cancer)
• Nonsteroidal anti-inflammatory drugs (NSAID) (a type of painkillers)
• Steroids (anabolic steroids and corticosteroids – used for anemia or to treat inflammation)
• Oral contraceptives (birth control pills)
• Thiazides (diuretics or ‘water pills’)
• Danazol (used to treat breast cysts and endometriosis)
• Thyroid products (used to treat low levels of thyroid hormones)
• Sympathomimetics (used to treat asthma)
• Clarithromycin, trimethoprim, rifampicin (antibiotic medicines)
• Itraconazole, ketokonazole (antifungal medicines)
• Gemfibrozil (used to treat high blood fats)
• Ciclosporin (used to suppress the immune system)
• Deferasirox (used to reduce chronic iron overload)
• Clopidogrel (prevents blood clots) Phenytoin, carbamazepine, phenobarbital (used to treat epilepsy)
• St. John’s wort (herbal medicine).

Prandin® with alcohol

Alcohol can change the ability of Prandin® to reduce the blood sugar. Watch for signs of a hypo.

Pregnancy and breast-feeding If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.

You should not take Prandin® if you are pregnant or you are planning to become pregnant.

You should not take Prandin® if you are breast-feeding.

Driving and using machines

Your ability to drive or use a machine may be affected if your blood sugar is low or high. Bear in mind that you could endanger yourself or others. Please ask your doctor whether you can drive a car if you:

• Have frequent hypos
• Have few or no warning signs of hypos.

3. how to take prandin®

Always take this medicine exactly as your doctor has told you. Check with your doctor if you are not sure.

Your doctor will work out your dose.

• The normal starting dose is

0.5 mg before each main meal. Swallow the tablets with a glass of water immediately before or up to 30 minutes before each main meal.

• The dose may be adjusted by your doctorbyupto4mgto­betaken immediately before or up to 30 minutes before each main meal. The maximum recommended daily dose is 16 mg.

Do not take more Prandin® than your doctor has recommended.

If you take more Prandin® than you should

If you take too many tablets, your blood sugar may become too low, leading to a hypo. Please see If you get a hypo on what a hypo is and how to treat it.

If you forget to take Prandin®

If you miss a dose, take the next dose as usual – do not double the dose.

If you stop taking Prandin®

Be aware that the desired effect is not achieved if you stop taking Prandin®. Your diabetes may get worse. If any change of your treatment is necessary contact your doctor first.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Hypoglycaemia

The most frequent side effect is hypoglycaemia which may affect up to 1 in 10 patients (see If you get a hypo in section 2). Hypoglycaemic reactions are generally mild/moderate but may occasionally develop into hypoglycaemic unconsciousness or coma. If this happens, medical assistance is needed immediately.

Allergy

Allergy is very rare (may affect up to 1 in 10,000 patients). Symptoms such as swelling, difficulty in breathing, rapid heartbeat, feeling dizzy and sweating could be signs of anaphylactic reaction. Contact a doctor immediately.

Other side effects

Common (may affect up to 1 in 10 patients)

• Stomach pain
• Diarrhoea.

Rare (may affect up to 1 in 1,000 patients)

• Acute coronary syndrome (but it may not be due to the medicine).

Very rare (may affect up to 1 in 10,000 patients)

• Vomiting
• Constipation
• Visual disturbances
• Severe liver problems, abnormal liver function such as increased liver enzymes in your blood.
• Hypersensitivity (such as rash, itchy skin, redening of the skin, swelling of the skin)
• Feeling sick (nausea).

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via

Malta

ADR Reporting

Website:

adrportal

United Kingdom Yellow Card Scheme Website:

www://yellowcar­d.mhra.gov.uk

By reporting side effects you can help provide more information on the safety of this medicine.

5. how to store prandin®

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and the blister foil after EXP. The expiry date refers to the last date of that month.

Store in the original package in order to protect from moisture.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. contents of the pack and other information

What Prandin® contains

• – The active substance is repaglinide.

• – The other ingredients are microcrystalline cellulose (E460), calcium hydrogen phosphate anhydrous, maize starch, polacrilin potassium, povidone (polyvidone), glycerol 85%, magnesium stearate, meglumine, poloxamer, iron oxide yellow (E172) only in the 1 mg tablets and iron oxide red (E172) only in the 2 mg tablets.

Ilium