A 72-year-old man with type 2 diabetes and diabetic nephropathy (eGFR 25 mL/min/1.73 m2) has marked postprandial hyperglycemia. Which oral agent can be used safely without dose adjustment in renal failure?
- A Glibenclamide
- B Repaglinide ✓
- C Metformin
- D Glipizide
Correct answer: B. Repaglinide
Explanation
Repaglinide, a meglitinide, is metabolized by hepatic CYP3A4 to inactive products and has a short half-life of about one hour, so it can be used in renal impairment. Glibenclamide is contraindicated here because its active metabolites are renally cleared and cause severe prolonged hypoglycemia in the elderly. Glipizide is relatively safer among sulfonylureas but still carries more hypoglycemia risk than repaglinide, and metformin is contraindicated at this eGFR.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
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