6 Repaglinide Side Effects You Should Know About

Repaglinide is a medication used to help manage Type 2 diabetes. In Type 2 diabetes, the body either doesn’t make enough insulin or doesn’t respond normally to insulin. Usually, insulin helps glucose (sugar) move from the blood into cells to be used for energy.

Repaglinide is part of a group of medications called meglitinides (“glinides”). It works by stimulating the pancreas to release more insulin. This helps lower your blood glucose. It isn’t usually a first-choice medication for treating Type 2 diabetes. But your healthcare provider will always consider your medical history and personal preferences. 

Like all medications, repaglinide has a number of possible side effects. Here, we’ll cover seven of the most important repaglinide side effects and how to manage them.

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1. Low blood glucose

Like many diabetes medications, repaglinide can cause low blood glucose (hypoglycemia). In fact, it’s the most common side effect of repaglinide. Common symptoms of hypoglycemia include:

• Increased feeling of hunger

• Fast heartbeat

• Shakiness or weakness

• Drowsiness or sleepiness

• Blurred vision

You may not always feel symptoms of hypoglycemia, especially if it’s mild. So checking your blood glucose at home is important if you take repaglinide. If your blood glucose is less than 70 mg/dL, or you have hypoglycemia symptoms, it’s important to treat it quickly. This can prevent more serious side effects, like confusion, seizures, or even death. A fast-acting sugar source with 15 grams of carbohydrates can do the trick. Examples include 4 glucose tablets or a half cup of fruit juice or regular soda.

Hypoglycemia from repaglinide is more common if you change how you eat or increase physical activity. It's also more common if you take certain other medications, including other diabetes medications.

Repaglinide is meant to be taken before a meal to control blood sugar spikes that occur after eating. To avoid hypoglycemia with repaglinide, skip your dose of repaglinide if you skip a meal. And let your healthcare provider know if you make any changes to your exercise routine or medication regimen.

2. Upper respiratory infections

Upper respiratory infections can happen when using repaglinide. This includes infections of the nose, throat, and ears. If you notice cold symptoms when starting your medication it may be due to repaglinide. In most cases, upper respiratory infections go away on their own.

Depending on your symptoms, over-the-counter (OTC) medications may help. Some helpful medications might include:

• Decongestants, like pseudoephedrine (Sudafed) amd oxymetazoline (Afrin) nasal spray

• Cough medications, like dextromethorphan (Delsym) or guaifenesin (Mucinex)

• Pain relievers, like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol)

Talk to your healthcare provider if your symptoms haven’t improved after a week, or if they worsen at any point. This may be a sign of a bacterial infection that requires prescription antibiotics.

3. Diarrhea

Diarrhea may be a side effect of repaglinide. To manage this side effect, you can try making changes to your diet. Avoid foods that may worsen diarrhea, like fatty or fried foods. And if needed, certain OTC medications may help relieve diarrhea symptoms. But talk to your healthcare provider first before trying any new medication.

If you’re having diarrhea from repaglinide, make sure to stay hydrated. Diarrhea can cause you to lose more water than usual. If your diarrhea lasts longer than a few days or you have more serious symptoms — like a fever or blood in your stool — contact your healthcare provider.

4. Joint pain

Joint pain (arthralgia) can happen while using repaglinide. Joint pain can be bothersome and impact your daily life. For minor pain, OTC pain relievers like ibuprofen or acetaminophen may help. Certain creams, patches, and gels may also help. If you’re experiencing joint pain, talk to your healthcare provider about the best option for you.

5. Weight gain

Repaglinide may cause weight gain in some people. This is because it increases insulin levels in the body, which can lead to weight gain. In certain studies, some people gained up to 7 pounds during the first few months of treatment with glinides.

It can be frustrating to gain weight from your diabetes medications. But it may be preventable through a healthy diet and exercise. These habits can help you lower your blood sugar, too. If you experience weight gain from repaglinide, speak to your healthcare provider. They can help you take a look at what lifestyle changes you can make. They may also lower your dose. Or they may recommend switching to a different diabetes medication.

6. Heart problems when combined with NPH insulin

Repaglinide shouldn’t be combined with a certain type of insulin called NPH insulin. This combination can cause a serious heart problem called myocardial ischemia. This is when the heart doesn’t receive enough blood. It can lead to serious health problems like a heart attack or abnormal heart rhythm (arrhythmia).

Brand-names of NPH insulin include Humulin N and Novolin N. It’s also part of combination insulin products like Humulin 70/30 and Novolin 70/30. Repaglinide shouldn’t be used with any of these products.

When should I contact my healthcare provider about repaglinide side effects?

As your body gets used to repaglinide, some of its side effects may go away on their own. But if you notice side effects that continue or get worse, let your healthcare provider know. They may change your dose or switch you to another medication.

If you experience mild hypoglycemia from repaglinide, treat it immediately. Then call your healthcare provider. They may ask you to check your blood glucose more often at home. If you experience symptoms of serious hypoglycemia, like severe confusion, drowsiness, or loss of consciousness, seek emergency care.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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