Nateglinide, Oral na-teh-GLY-nide

What are other names for this medicine?

Type of medicine: antidiabetic

Generic and brand names: nateglinide, oral; Starlix

What is this medicine used for?

This medicine is taken by mouth to treat type 2 diabetes and control blood sugar levels. Usually you will take this medicine while you follow a diet and exercise program prescribed by your healthcare provider. This medicine may be taken alone or along with another diabetes medicine by mouth.

This medicine does not treat type 1 (insulin dependent) diabetes.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• diabetic ketoacidosis
• adrenal or pituitary disease
• kidney disease
• liver disease

Tell your healthcare provider if you get sick or injured, or if you are scheduled to have surgery.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Talk to your healthcare provider about whether you will need to use insulin to control your blood sugar during pregnancy. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less medicine or take it more often than prescribed. Do not stop taking this medicine without your healthcare provider's approval.

The dosage that is best for you will be determined after you have taken some of this medicine for a week or longer. Your dosage may be adjusted several times based on the results of blood tests. Keep all your appointments for these tests.

You will usually take this medicine 3 times a day up to 30 minutes before meals.

If you skip a meal, also skip the dose that you would have taken before that meal. If you are not sure of your dosage, ask your healthcare provider or pharmacist to explain.

Be sure to take any other diabetes medicine that your healthcare provider prescribes for you exactly as directed.

What if I miss a dose?

If you miss a dose, take it as soon as you remember (with a meal) unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: hunger, nausea, anxiety, cold sweats, weakness, drowsiness, fainting, seizures, coma.

What should I watch out for?

Follow the diet and exercise program prescribed for you. Also, have your blood sugar tested regularly. If your healthcare provider wants you to test your blood or urine sugar at home, follow directions carefully. Depending on the severity of your diabetes, your healthcare provider may want you to check your blood sugar daily using a blood glucose meter.

Talk to your healthcare provider before you take other medicines, including nonprescription products. Do not drink alcohol unless your healthcare provider approves.

Low blood sugar (hypoglycemia) can occur if you miss or delay meals, drink too much alcohol, take too much medicine, or exercise more than usual. Symptoms of low blood sugar include confusion, shaking, weakness, strong hunger, cold sweats, headache, nausea, vision problems, and feeling faint. Treat the condition quickly by eating or drinking something with sugar in it such as candy, juice, or nondiet soda. Taking glucose tablets or gels (available in drug stores) is another quick way to treat hypoglycemia.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your health care provider right away. If you are unable to reach your health care provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives, itching, rash, tightness in your chest, trouble breathing, swelling of your lips, tongue or throat).

Serious (report these to your healthcare provider right away): Frequent cases of low blood sugar (confusion, shaking, weakness, strong hunger, cold sweats, headache, nausea, vision problems, and feeling faint); yellow eyes or skin.

Other: Chest infection, dizziness, diarrhea, cough, headache, sinus infection, nausea, runny nose, muscle or joint pain, back pain, vomiting, constipation, mild rash.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• androgens such as methyltestosterone (Methitest) or testosterone (Androderm)
• antibiotics such as chloramphenicol (Chloromycetin), clarithromycin (Biaxin), erythromycin (Ery-Tabs, E.E.S.), isoniazid, rifampin (Rifadin, Rimactane), trimethoprim (Primsol), and trimethoprim/sulfamethoxazole (Bactrim, Septra)
• antifungal medicines such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), and miconazole (Monistat)
• anti-HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), delavirdine (Rescriptor), ritonavir (Norvir), and saquinavir (Invirase)
• antipsychotic medicines such as olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and clozapine (Clozaril)
• antiseizure medicines such as carbamazepine (Tegretol), phenobarbital, primidone (Mysoline), and phenytoin (Dilantin)
• beta blockers such as acebutolol (Sectral), atenolol (Tenormin), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), pindolol, propranolol (Inderal LA), and sotalol (Betapace)
• birth control pills and hormones such as estradiol (Estrace, Estratab), conjugated estrogens (Premarin), norethindrone (Aygestin, Micronor), and norgestrel (Ovrette)
• calcium channel blockers such as diltiazem (Cardizem, Tiazac), felodipine, isradipine (DynaCirc CR), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), and verapamil (Calan, Covera-HS, Isoptin SR, Verelan)
• corticosteroids such as betamethasone (Celestone), cortisone, dexamethasone, fludrocortisone (Florinef), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisolone (Orapred), prednisone, and triamcinolone (Aristospan, Kenalog)
• cyclosporine (Gengraf, Neoral, Sandimmune)
• imatinib (Gleevec)
• MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• medicine to lower triglycerides such as fenofibrate (TriCor) and gemfibrozil (Lopid)
• natural remedies such as alfalfa, aloe, bilberry, bitter melon, chromium, fenugreek, garlic, ginseng, ginger, St. John's wort, stinging nettle, and willow bark
• nefazodone
• nicotinic acid
• nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), diclofenac (Voltaren, Cataflam), ibuprofen (Motrin, Motrin IB, Advil), indomethacin (Indocin), ketoprofen, ketorolac (Toradol), nabumetone (Relafen), naproxen (Naprosyn, Anaprox, Aleve, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• other diabetes medicines such as insulin, chlorpropamide, glimepiride (Amaryl), glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab), rosiglitazone (Avandia), tolbutamide, and troglitazone (Rezulin)
• phenothiazines such as chlorpromazine and trifluoperazine
• salicylates, including aspirin
• probenecid
• quinidine
• somatropin (Norditropin)
• sulfa medicines such as sulfadiazine and sulfisoxazole
• sympathomimetic drugs such as albuterol (Airet, Proventil, Ventolin, Volmax), ephedrine, epinephrine (Adrenalin, Sus-Phrine, Asthma-Nefrin, Primatene Mist), isoproterenol (Isuprel), metaproterenol, and terbutaline (Brethine, Bricanyl)
• thiazide diuretics such as chlorothiazide (Diuril), chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), hydroflumethiazide (Saluron), and metolazone (Zaroxolyn)
• thyroid medicines such as levothyroxine (Levothroid, Levoxyl, Synthroid), liothyronine (Cytomel, Triostat), and liotrix (Thyrolar)
• warfarin (Coumadin)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicines in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.