A patient with type 2 diabetes is started on repaglinide, a meglitinide analog. Which pharmacokinetic property distinguishes it from sulfonylureas and dictates its dosing schedule?

• A Long half-life allowing once-daily dosing
• B Rapid onset and short duration requiring dosing before each meal ✓
• C Renal excretion requiring dose reduction when eGFR <30
• D Hepatic metabolism via CYP2C9 making it prone to drug interactions

Explanation

Repaglinide (and nateglinide) are meglitinides that rapidly stimulate insulin secretion with a short duration of action (about 4 hours). They are taken 15-30 minutes before meals and skipped if a meal is missed, reducing fasting hypoglycemia risk. Unlike sulfonylureas, they have a rapid onset and short duration, making them ideal for controlling postprandial glucose with flexible dosing.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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