A 65-year-old man with type 2 diabetes and diabetic nephropathy (eGFR 22 mL/min/1.73 m2) needs a post-prandial glucose-lowering agent that does not require dose adjustment in severe renal impairment. The best choice is:
- A Repaglinide ✓
- B Glibenclamide
- C Glimepiride
- D Chlorpropamide
Correct answer: A. Repaglinide
Explanation
Repaglinide is a meglitinide metabolized almost entirely by hepatic CYP3B4 and biliary excretion, so inactive metabolites do not accumulate in renal failure and it can be used safely in advanced CKD. Its short duration also limits hypoglycemia when taken just before meals. Glibenclamide, glimepiride, and chlorpropamide have active metabolites or parent drug cleared renally, accumulate in uremia, and carry a high risk of prolonged hypoglycemia.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.