The Pharmaceutical Journal Vol 267 No 7159 p151-153
4 August 2001

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Diabetes

Repaglinide not a sulphonylurea derivative

From Dr A. J. Bragg, MFPM

In your article “New diabetes drug targets postprandial glucose” (PJ, 5 May), nateglinide is described as an amino acid derivative and repaglinide as a sulphonylurea derivative. Whereas your description of nateglinide is correct, I would like to point out that the description of repaglinide as a sulphonylurea derivative is incorrect.

Repaglinide does not contain the sulphonylurea moiety that characterises the sulphonylurea class.^1,2

It is important to clarify this for your readers, because there are implications in terms of the pharmacology of the drug. Repaglinide has a unique pharmacology arising from the action of the drug at a site distinct from the common site used by both nateglinide and sulphonylureas.^1,3,4 Repaglinide, like nateglinide and sulphonylureas, causes insulin release by closure of ATP-sensitive potassium channels in pancreatic beta cells.^1–4 However, repaglinide, in contrast to nateglinide and sulphonylureas, does not cause unwanted direct exocytosis of glucagon and growth hormone.^3,5

The pharmacological differences between repaglinide and nateglinide/sulphonylureas will be presented at the forthcoming meeting of the American Diabetes Association in Philadelphia.

References

1. Landgraf R. Meglitinide analogues in the treatment of type 2 diabetes mellitus. Drugs and Aging 2000;17: 411–25.

2. Lebovitz HE. Insulin secretagogues: old and new. Diabetes Rev 1999;7:139–53.

3. Bokvist K, Hoy M, Buschard K, Holst JJ, Thomsen MK, Gromada J. Selectivity of prandial glucose regulators: nateglinide, but not repa-glinide, accelerated exocytosis in rat pancreatic A-calls. Eur J Pharmacol 1999; 386:105–11.

4. M Massi-Benedetti M, Damsbo P. Pharmacology and clinical expertise with repaglinide. Exp Opin Invest Drugs 2000;9:885–98.

5. Bokvist K, Gromada J, Hoy M, Olsen HI, Lindström P, Hansen BS et al. Diabetologia 2000;43(Suppl 1):A187.

A. J. Bragg
Medical Director, Novo Nordisk Ltd

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