A 72-year-old woman with type 2 diabetes and diabetic nephropathy (eGFR 24 mL/min/1.73 m2) needs a pre-meal insulin secretagogue. Which agent can be prescribed without renal dose adjustment?
- A Glibenclamide
- B Repaglinide ✓
- C Glimepiride
- D Chlorpropamide
Correct answer: B. Repaglinide
Explanation
Repaglinide, a meglitinide, is almost completely metabolised by hepatic CYP enzymes and its inactive metabolites are excreted mainly in bile, so no dose adjustment is required in renal failure. Glibenclamide and glimepiride have active or partially active metabolites cleared by the kidney, producing severe prolonged hypoglycaemia in uraemic patients, and chlorpropamide is renally excreted with a very long half-life.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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