Starlix

Starlix - an oral synthetic hypoglycemic drug. A medicine based on nateglinide for the treatment of diabetes, which helps to control blood sugar levels. This medicine helps your body to react better to the insulin produced by your pancreas. Starlix is used in conjunction with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.

Product dosage: 120mg
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Synonyms Glinate Nateglinida Nateglinidum Incuria Meglitinide Fastic Nopik Nateglinid Senaglinide

Starlix (nateglinide) is a modern meglitinide analog oral antihyperglycemic agent specifically designed to address the critical challenge of postprandial hyperglycemia in type 2 diabetes mellitus. By offering a rapid, short-acting insulinotropic effect, it facilitates physiological mealtime insulin secretion, thereby enabling superior glycemic control without prolonged hypoglycemic risk. Its pharmacokinetic profile supports flexible dosing aligned with meal patterns, making it a valuable therapeutic option for patients struggling with post-meal glucose spikes. This agent represents a targeted approach in the comprehensive management of diabetes, complementing lifestyle modifications and other antihyperglycemic therapies.

Features

• Active pharmaceutical ingredient: Nateglinide 60 mg or 120 mg per tablet
• Rapid onset of action, typically within 20 minutes of oral administration
• Short duration of effect, approximately 4 hours, minimizing interprandial hypoglycemia risk
• Administered orally, available as scored tablets for dose flexibility
• Metabolized primarily in the liver via CYP2C9 and CYP3A4 isoenzymes
• Excreted predominantly in urine (approximately 85%) and feces (10%)
• Requires no titration for hepatic or mild-to-moderate renal impairment
• Compatible with most other oral antihyperglycemic agents except sulfonylureas

Benefits

• Significantly reduces postprandial glucose excursions, lowering HbA1c by 0.5%–1.0%
• Minimizes risk of prolonged hypoglycemia due to short pharmacokinetic half-life
• Offers dosing flexibility, taken 1–30 minutes before meals, accommodating variable eating schedules
• Provides physiological insulin secretion pattern, mimicking natural beta-cell response
• May be used as monotherapy or in combination with metformin or thiazolidinediones
• Suitable for elderly patients and those with renal impairment (with caution in severe cases)

Common use

Starlix is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is particularly beneficial for patients who experience pronounced postprandial hyperglycemia or have irregular meal patterns. It may be used as monotherapy or in combination with metformin when glycemic control is not achieved with metformin alone. It is not indicated for type 1 diabetes mellitus or diabetic ketoacidosis.

Dosage and direction

The recommended dose is 120 mg three times daily, taken 1–30 minutes before each main meal. For patients near HbA1c target at initiation, 60 mg three times daily may be sufficient. The dose should be administered immediately before each meal; if a meal is skipped, the corresponding dose should be omitted. Dosage adjustment may be necessary when used with other glucose-lowering agents. No initial dosage adjustment is required for elderly patients or those with mild to moderate hepatic or renal impairment.

Precautions

• Hypoglycemia may occur, particularly when meals are missed, delayed, or inadequate
• Use with caution in patients with moderate to severe hepatic impairment
• Monitor renal function periodically; caution advised in severe renal impairment
• Not recommended during pregnancy (Category C) unless potential benefit justifies potential risk
• Should not be used in nursing mothers; discontinue nursing or discontinue drug
• May cause dizziness or visual disturbances; caution when driving or operating machinery
• Regular monitoring of blood glucose and HbA1c is essential
• Discontinue if hypersensitivity reactions occur

Contraindications

• Hypersensitivity to nateglinide or any excipients in the formulation
• Type 1 diabetes mellitus
• Diabetic ketoacidosis
• Concomitant use with gemfibrozil
• Severe hepatic impairment
• Concurrent therapy with sulfonylureas

Possible side effects

Common (≥1/100 to <1/10):

• Hypoglycemia
• Upper respiratory tract infection
• Flu-like symptoms
• Dizziness
• Weight gain

Uncommon (≥1/1,000 to <1/100):

• Gastrointestinal disturbances (nausea, diarrhea, constipation)
• Elevated liver enzymes
• Arthralgia
• Back pain
• Allergic skin reactions

Rare (<1/1,000):

• Hepatitis
• Visual disturbances
• Thrombocytopenia
• Vasculitis

Drug interaction

• Strong CYP2C9 inhibitors (e.g., fluconazole) may increase nateglinide exposure
• CYP2C9 inducers (e.g., rifampicin) may decrease efficacy
• Gemfibrozil is contraindicated due to significant interaction risk
• Beta-blockers may mask hypoglycemia symptoms
• NSAIDs, salicylates, MAO inhibitors may enhance hypoglycemic effect
• Thiazides, corticosteroids, thyroid products may reduce efficacy
• Alcohol may either potentiate or impair glucose metabolism

Missed dose

If a dose is missed and the meal has been consumed, skip the missed dose and take the next scheduled dose with the subsequent meal. Do not double the dose to make up for a missed dose. If the meal is delayed, take the dose immediately before eating.

Overdose

Symptoms primarily include hypoglycemia (sweating, tremor, dizziness, hunger, tachycardia). Management consists of glucose administration (oral or intravenous depending on severity). Liver function should be monitored as nateglinide is extensively metabolized hepatically. Dialysis is not effective due to high protein binding. Supportive care and frequent glucose monitoring are essential.

Storage

Store at room temperature (15°–30°C) in the original container. Protect from moisture and light. Keep out of reach of children. Do not use after the expiration date printed on the packaging. Do not store in bathroom or near kitchen sink.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any treatment regimen. Individual patient responses may vary. Proper diagnosis and therapeutic monitoring are essential for safe and effective use. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.

Reviews

Clinical studies demonstrate Starlix effectively reduces postprandial glucose excursions by 40–50 mg/dL compared to placebo. In combination trials with metformin, HbA1c reductions of 1.5%–2.0% have been observed. Patients appreciate the flexible dosing schedule, though some report weight gain (average 1–2 kg) and occasional hypoglycemia. Healthcare providers value its targeted action profile and safety in elderly populations. Long-term cardiovascular safety data continue to be collected in post-marketing surveillance.