Cinoxacin
Severe
Database
Drug interaction classified as: antagonism
Source: DDInter
Drug reference
Nateglinide
Meglitinide (D-phenylalanine derivative) prandial insulin secretagogue · Antidiabetic
START
120 mg PO TID, 1–30 min before main meals (60 mg if near goal); omit if meal skipped
TYPICAL MAX
360 mg/day (120 mg pre-meal ×3)
STOP IF
Recurrent/severe hypoglycaemia, severe hepatic impairment, hypersensitivity
WATCH
Postprandial glucose/HbA1c, hypoglycaemia (meal-dose matching), hepatic enzymes; counsel skip-dose-if-skip-meal
CDSCO approvedSchedule HATC A10BX03
KDIGO 2024 + manufacturer label
- ONSET
- 18min · insulin-release onset
- PEAK
- 1h · Cmax
- t½
- 1.5h · plasma t½
- DURATION
- 4h · prandial effect
EXCRETION
Hepatic CYP2C9; ~83% renal metabolites
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid — insulin preferred in pregnancy
FDA category + note
Top interactionssee all 12 →
- CinoxacinSevereDatabaseDDInter
- CiprofloxacinSevereDatabaseDDInter
- DelafloxacinSevereDatabaseDDInter
- EnoxacinSevereDatabaseDDInter
Available in India
10 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Rapid, short-acting closure of pancreatic beta-cell ATP-sensitive K+ channels → glucose-dependent prandial insulin release; faster on/off than sulfonylureas (targets postprandial glucose, lower interprandial hypoglycaemia).
Indications
Type 2 diabetes mellitus — postprandial glucose control (monotherapy or with metformin/TZD)
Dosing
- Adult
- 120 mg PO three times daily, 1–30 minutes before main meals (60 mg if near HbA1c goal). Skip dose if a meal is skipped.
- Pediatric
- Not established.
- Renal adjustment
- No adjustment (active metabolites minor; caution in severe — limited data, accumulation of weak metabolites).
- Hepatic adjustment
- Mild–moderate: no adjustment. Severe: caution/avoid.
- Geriatric
- No specific adjustment; hypoglycaemia awareness.
- Max dose
- 360 mg/day (120 mg before each of 3 meals)
Pharmacokinetics
Onset
~15–20 min
Peak effect
~1 h
Duration
~4 h (short — prandial)
Half-life
~1.5 h
Bioavailability
~73%
Protein binding
~98%
Metabolism
Hepatic CYP2C9 (major) and CYP3A4
Excretion
Renal (~83% metabolites) and faecal
Contraindications
- Type 1 diabetes / diabetic ketoacidosis
- Severe hepatic impairment
- Hypersensitivity to nateglinide
Side effects
Common
Hypoglycaemia (less interprandial than sulfonylureas)Weight gain (modest)Upper respiratory symptomsDizziness
Serious
- Severe hypoglycaemia (esp. with potentiating drugs/missed-meal mismatch)
- Hypersensitivity reactions
- Hepatic enzyme elevation (rare)
Pregnancy & lactation
Pregnancy
Avoid — insulin preferred in pregnancy
Lactation
Avoid (excreted in animal milk)
Drug interactions
Ciprofloxacin
Severe
Database
Drug interaction classified as: antagonism
Source: DDInter
Delafloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Enoxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Gatifloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Gemfibrozil
Severe
Database
CYP2C9 inhibition → raised nateglinide → hypoglycaemia (less marked than with repaglinide but caution)
Monitor glucose closely; consider alternative
Source: Kimi deep-research + Cla
Gemifloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Grepafloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Levofloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Lomefloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Moxifloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Nalidixic Acid
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Ask House about Nateglinide
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19