NATEGLINIDE- nateglinide tablet, coated 
American Health Packaging

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HIGHLIGHTS OF PRESCRIBING INFORMATION

These highlights do not include all the information needed to use NATEGLINIDE TABLETS safely and effectively. See full prescribing information for NATEGLINIDE TABLETS.
NATEGLINIDE tablets, for oral use
Initial U.S. Approval: 2000

INDICATIONS AND USAGE

Nateglinide is a glinide indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. ( 1)

Limitation of use: Not for treating type 1 diabetes mellitus or diabetes ketoacidosis ( 1)

DOSAGE AND ADMINISTRATION

  • Recommended dose is 120 mg three times daily.
  • In patients who are near glycemic goal when treatment is initiated, 60 mg three times daily may be administered. ( 2)
  • Administer 1 to 30 minutes before meals. ( 2)
    • If a meal is skipped, skip the scheduled dose to reduce the risk of hypoglycemia. ( 2, 5.1)

DOSAGE FORMS AND STRENGTHS

Tablets: 60 mg and 120 mg ( 3)

CONTRAINDICATIONS

  • History of hypersensitivity to nateglinide or its inactive ingredients ( 4)

WARNINGS AND PRECAUTIONS

  • Hypoglycemia: Nateglinide may cause hypoglycemia. Administer before meals to reduce the risk of hypoglycemia. Skip the scheduled dose of nateglinide if a meal is skipped to reduce the risk of hypoglycemia. ( 5.1)
  • Macrovascular outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with nateglinide. ( 5.2)

ADVERSE REACTIONS

  • Common adverse reactions associated with nateglinide (3% or greater incidence) were upper respiratory tract infection, back pain, flu symptoms, dizziness, arthropathy, diarrhea. ( 6.1)

To report SUSPECTED ADVERSE REACTIONS, contact Par Pharmaceutical at 1-800-828-9393 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

DRUG INTERACTIONS

  • Drugs That May Increase the Potential for Hypoglycemia: Nateglinide dose reductions and increased frequency of glucose monitoring may be required when coadministered ( 7)
  • Drugs That May Increase the Potential for Hyperglycemia: Nateglinide dose increases and increased frequency of glucose monitoring may be required when coadministered ( 7)
  • Drugs That May Blunt Signs and Symptoms of Hypoglycemia: Increased frequency of glucose monitoring may be required when coadministered ( 7)

USE IN SPECIFIC POPULATIONS

  • Nursing Mothers: Discontinue nateglinide or nursing ( 8.3)

See 17 for PATIENT COUNSELING INFORMATION.

Revised: 8/2020

FULL PRESCRIBING INFORMATION: CONTENTS*

1 INDICATIONS AND USAGE

2 DOSAGE AND ADMINISTRATION

3 DOSAGE FORMS AND STRENGTHS

4 CONTRAINDICATIONS

5 WARNINGS AND PRECAUTIONS

5.1 Hypoglycemia

5.2 Macrovascular Outcomes

6 ADVERSE REACTIONS

6.1 Clinical Trials Experience

6.2 Postmarketing Experience

7 DRUG INTERACTIONS

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

8.3 Nursing Mothers

8.4 Pediatric Use

8.5 Geriatric Use

8.6 Renal Impairment

8.7 Hepatic Impairment

10 OVERDOSAGE

11 DESCRIPTION

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

12.2 Pharmacodynamics

12.3 Pharmacokinetics

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

14 CLINICAL STUDIES

14.1 Monotherapy

14.2 Monotherapy Compared to Glyburide

14.3 Monotherapy and In Combination With Metformin

14.4 Add-On Combination Therapy With Rosiglitazone

14.5 Add-On Combination Therapy With Glyburide

16 HOW SUPPLIED/STORAGE AND HANDLING

17 PATIENT COUNSELING INFORMATION

*
Sections or subsections omitted from the full prescribing information are not listed.

FULL PRESCRIBING INFORMATION

1 INDICATIONS AND USAGE

Nateglinide is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Limitations of Use:
Nateglinide should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.

2 DOSAGE AND ADMINISTRATION

The recommended dose of nateglinide is 120 mg orally three times daily before meals.

The recommended dose of nateglinide is 60 mg orally three times daily before meals in patients who are near glycemic goal when treatment is initiated.

Instruct patients to take nateglinide 1 to 30 minutes before meals.

In patients who skip meals, instruct patients to skip the scheduled dose of nateglinide to reduce the risk of hypoglycemia [see Warnings and Precautions (5.1)].

3 DOSAGE FORMS AND STRENGTHS

4 CONTRAINDICATIONS

Nateglinide tablets are contraindicated in patients with a history of hypersensitivity to nateglinide or its inactive ingredients.

5 WARNINGS AND PRECAUTIONS

5.1 Hypoglycemia

All glinides, including nateglinide, can cause hypoglycemia [see Adverse Reactions (6.1)]. Severe hypoglycemia can cause seizures, may be life-threatening, or cause death. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving or operating other machinery).

Hypoglycemia can happen suddenly and symptoms may differ in each individual and change over time in the same individual. Symptomatic awareness of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic neuropathy (nerve disease), in patients using medications that block the sympathetic nervous system (e.g., beta-blockers) [see Drug Interactions (7)], or in patients who experience recurrent hypoglycemia.

Factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content), changes in level of physical activity, changes to coadministered medication [see Drug Interactions (7)], and concomitant use with other antidiabetic agents. Patients with renal or hepatic impairment may be at higher risk of hypoglycemia [see Use in Specific Populations (8.6, 8.7)], Clinical Pharmacology (12.3)]

Patients should take nateglinide before meals and be instructed to skip the dose of nateglinide if a meal is skipped [see Dosage and Administration (2)]. Patients and caregivers must be educated to recognize and manage hypoglycemia. Self-monitoring of blood glucose plays an essential role in the prevention and management of hypoglycemia. In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, increased frequency of blood glucose monitoring is recommended.

5.2 Macrovascular Outcomes

There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with nateglinide.

6 ADVERSE REACTIONS

The following serious adverse reaction is also described elsewhere in the labeling:
 Hypoglycemia [see Warnings and Precautions (5.1)]

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In clinical trials, approximately 2,600 patients with type 2 diabetes mellitus were treated with nateglinide. Of these, approximately 1,335 patients were treated for 6 months or longer and approximately 190 patients for one year or longer. Table 1 shows the most common adverse reactions associated with nateglinide.

Table 1. Adverse Reactions other than Hypoglycemia (%) occurring Greater than or Equal to 2% in Nateglinide-Treated Patients from Pool of 12 to 64 week Placebo Controlled Trials

Placebo

N=458

Nateglinide

N=1441

Preferred Term

Upper Respiratory Infection

8.1

10.5

Back Pain

3.7

4.0

Flu Symptoms

2.6

3.6

Dizziness

2.2

3.6

Arthropathy

2.2

3.3

Diarrhea

3.1

3.2

Accidental Trauma

1.7

2.9

Bronchitis

2.6

2.7

Coughing

2.2

2.4

Hypoglycemia
Episodes of severe hypoglycemia (plasma glucose less than 36 mg/dL) were reported in two patients treated with nateglinide. Non-severe hypoglycemia occurred in 2.4 % of nateglinide treated patients and 0.4 % of placebo treated patients [see Warnings and Precautions ( 5.1)].

Weight Gain
Patients treated with nateglinide had statistically significant mean increases in weight compared to placebo. In clinical trials, the mean weight increases with nateglinide 60 mg (3 times daily) and nateglinide 120 mg (3 times daily) compared to placebo were 1.0 kg and 1.6 kg respectively.

Laboratory Test
Increases in Uric Acid: There were increases in mean uric acid levels for patients treated with nateglinide alone, nateglinide in combination with metformin, metformin alone, and glyburide alone. The respective differences from placebo were 0.29 mg/dL, 0.45 mg/dL, 0.28 mg/dL, and 0.19 mg/dL.

6.2 Postmarketing Experience

The following adverse reactions have been identified during post-approval use of nateglinide. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

  • Hypersensitivity reactions: Rash, itching, and urticaria
  • Hepatobiliary Disorders: Jaundice, cholestatic hepatitis, and elevated liver enzymes

7 DRUG INTERACTIONS

Table 2 includes a list of drugs with clinically important drug interactions when concomitantly administered or withdrawn with nateglinide and instructions for managing or preventing them.

Table 2. Clinically Significant Drug Interactions with Nateglinide

Drugs That May Increase the Blood-Glucose-Lowering Effect of Nateglinide and Susceptibility to Hypoglycemia

Drugs:

Nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, monoamine oxidase inhibitors, non-selective beta-adrenergic-blocking agents, anabolic hormones (e.g. methandrostenolone), guanethidine, gymnema sylvestre, glucomannan, thioctic acid, and inhibitors of CYP2C9 (e.g. amiodarone, fluconazole, voriconazole, sulfinpyrazone), or in patients known to be poor metabolizers of CYP2C9 substrates, alcohol.

Intervention:

Dose reductions and increased frequency of glucose monitoring may be required when nateglinide is coadministered with these drugs.

Drugs and Herbals That May Reduce the Blood-Glucose-Lowering Effect of Nateglinide and Increase Susceptibility to Hyperglycemia

Drugs:

Thiazides, corticosteroids, thyroid products, sympathomimetics, somatropin, somatostatin analogues (e.g. lanreotide, octreotide), and CYP inducers (e.g. rifampin, phenytoin and St John’s Wort).

Intervention:

Dose increases and increased frequency of glucose monitoring may be required when nateglinide is coadministered with these drugs.

Drugs That May Blunt Signs and Symptoms of Hypoglycemia

Drugs:

beta-blockers, clonidine, guanethidine, and reserpine

Intervention:

Increased frequency of glucose monitoring may be required when nateglinide is coadministered with these drugs.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category C
There are no adequate and well-controlled studies of nateglinide in pregnant women. It is unknown whether nateglinide can cause fetal harm when administered to a pregnant woman. Nateglinide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

In the rabbit, embryonic development was adversely affected and the incidence of gall bladder agenesis or small gallbladder was increased at a dose of 500 mg/kg (approximately 27 times the human therapeutic exposure of 120 mg three times daily, based on body surface area). Nateglinide was not teratogenic in rats at doses up to 1,000 mg/kg (approximately 27 times the human therapeutic exposure based on body surface area).

8.3 Nursing Mothers

It is not known whether nateglinide is excreted in human milk. Nateglinide is excreted in rat milk. Offspring of rats exposed to 1,000 mg/kg nateglinide (approximately 27 times the human therapeutic exposure of 120 mg three times daily, based on body surface area) had lower body weight. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made as to whether nateglinide should be discontinued in nursing mothers, or if mothers should discontinue nursing.

8.4 Pediatric Use

The safety and effectiveness of nateglinide have not been established in pediatric patients.

8.5 Geriatric Use

436 patients 65 years and older, and 80 patients 75 years and older were exposed to nateglinide in clinical studies. No differences were observed in safety or efficacy of nateglinide between patients age 65 and over, and those under age 65. However, greater sensitivity of some older individuals to nateglinide therapy cannot be ruled out.

8.6 Renal Impairment

No dosage adjustment is recommended in patients with mild to severe renal impairment [see Clinical Pharmacology (12.3)].

8.7 Hepatic Impairment

No dose adjustment is recommended for patients with mild hepatic impairment. Use of nateglinide in patients with moderate-to-severe hepatic impairment has not been studied and therefore, should be used with caution in these patients [see Clinical Pharmacology (12.3)].

10 OVERDOSAGE

There have been no instances of overdose with nateglinide in clinical trials. However, an overdose may result in an exaggerated glucose-lowering effect with the development of hypoglycemic symptoms. Hypoglycemic symptoms without loss of consciousness or neurological findings should be treated with oral glucose and adjustments in dosage and/or meal patterns. Severe hypoglycemic reactions with coma, seizure, or other neurological symptoms should be treated with intravenous glucose. As nateglinide is highly protein bound, dialysis is not an efficient means of removing it from the blood.

11 DESCRIPTION

Nateglinide Tablets, USP are an oral blood glucose-lowering drug of the glinide class. Nateglinide, (-)-N-[(trans-4-isopropylcyclohexane)carbonyl]-D-phenylalanine, is structurally unrelated to the oral sulfonylurea insulin secretagogues.

The structural formula is as shown:

Structural Formula

Nateglinide is a white powder with a molecular weight of 317.43. It is freely soluble in methanol, ethanol, and chloroform, soluble in ether, sparingly soluble in acetonitrile and octanol, and practically insoluble in water. Nateglinide biconvex tablets contain 60 mg, or 120 mg, of nateglinide for oral administration.

Inactive Ingredients: colloidal silicon dioxide, croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, pregelatinized starch (starch 1500 ®). Starch 1500 ® is partially pregelatinized maize starch. The 60 mg also contains iron oxide red, polyethylene glycol, polyvinyl alcohol, talc, and titanium dioxide. In addition, the 120 mg contains FD&C Yellow #6/Sunset Yellow Aluminum Lake, iron oxide yellow.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Nateglinide lowers blood glucose levels by stimulating insulin secretion from the pancreas. This action is dependent upon functioning beta-cells in the pancreatic islets. Nateglinide interacts with the ATP-sensitive potassium (K +ATP) channel on pancreatic beta-cells. The subsequent depolarization of the beta cell opens the calcium channel, producing calcium influx and insulin secretion. The extent of insulin release is glucose dependent and diminishes at low glucose levels. Nateglinide is highly tissue selective with low affinity for heart and skeletal muscle.

12.2 Pharmacodynamics

Nateglinide stimulates pancreatic insulin secretion within 20 minutes of oral administration. When nateglinide is dosed before meals, the peak rise in plasma insulin occurs approximately 1 hour after dosing and falls to baseline by 4 hours after dosing.

12.3 Pharmacokinetics

In patients with Type 2 diabetes, multiple dose administration of nateglinide over the dosage range of 60 mg to 240 mg shows linear pharmacokinetics for both AUC and C max. In patients with Type 2 diabetes, there is no apparent accumulation of nateglinide upon multiple dosing of up to 240 mg three times daily for 7 days.

Absorption
Absolute bioavailability of nateglinide is approximately 73%. Plasma profiles are characterized by multiple plasma concentration peaks when nateglinide is administered under fasting conditions. This effect is diminished when nateglinide is taken prior to a meal. Following oral administration immediately prior to a meal, the mean peak plasma nateglinide concentrations (C max) generally occur within 1 hour (T max) after dosing. T max is independent of dose.

The pharmacokinetics of nateglinide are not affected by the composition of a meal (high protein, fat, or carbohydrate). However, peak plasma levels are significantly reduced when nateglinide is administered 10 minutes prior to a liquid meal as compared to solid meal. When given with or after meals, the extent of nateglinide absorption (AUC) remains unaffected. However, there is a delay in the rate of absorption characterized by a decrease in C max and a delay in time to peak plasma concentration (T max).

Nateglinide did not have any effect on gastric emptying in healthy subjects as assessed by acetaminophen testing.

Distribution
Following intravenous (IV) administration of nateglinide, the steady-state volume of distribution of nateglinide is estimated to be approximately 10 L in healthy subjects. Nateglinide is extensively bound (98%) to serum proteins, primarily serum albumin, and to a lesser extent α 1 acid glycoprotein. The extent of serum protein binding is independent of drug concentration over the test range of 0.1 to 10 mcg/mL.

Elimination
In healthy volunteers and patients with type 2 diabetes mellitus, nateglinide plasma concentrations declined with an average elimination half-life of approximately 1.5 hours.

Metabolism
In vitro drug metabolism studies indicate that nateglinide is predominantly metabolized by the cytochrome P450 isozyme CYP2C9 (70%) and to a lesser extent CYP3A4 (30%).

The major routes of metabolism are hydroxylation followed by glucuronide conjugation. The major metabolites are less potent antidiabetic agents than nateglinide. The isoprene minor metabolite possesses potency similar to that of the parent compound nateglinide.

Excretion
Nateglinide and its metabolites are rapidly and completely eliminated following oral administration. Eighty-three percent of the 14 C-nateglinide was excreted in the urine with an additional 10% eliminated in the feces. Approximately 16% of the 14 C-nateglinide was excreted in the urine as parent compound.

Specific Populations
Renal Impairment
No pharmacokinetic data are available in subjects with mild renal impairment (CrCl 60 to 89 mL/min). Compared to healthy matched subjects, patients with type 2 diabetes mellitus and moderate and severe renal impairment (CrCl 15-50 mL/min) not on dialysis displayed similar apparent clearance, AUC, and C max. Patients with type 2 diabetes and renal failure on dialysis exhibited reduced overall drug exposure (C max decreased by 49%; not statistically significant). However, hemodialysis patients also experienced reductions in plasma protein binding compared to the matched healthy volunteers.

In a cohort of 8 patients with type 2 diabetes and end-stage renal disease (ESRD) (eGFR <15 mL/min/1.73 m 2) M1 metabolite accumulation up to 1.2 ng/mL occurred with a dosage of 90 mg once daily for 1 to 3 months. In another cohort of 8 patients with type 2 diabetes on hemodialysis, M1 concentration decreased after a single session of hemodialysis. Although the hypoglycemic activity of the M1 metabolite is approximately 5 times lower than nateglinide, metabolite accumulation may increase the hypoglycemic effect of the administered dose.

Hepatic Impairment
In patients with mild hepatic impairment, the mean increase in C max and AUC of nateglinide were 37% and 30 % respectively, as compared to healthy matched control subjects. There is no data on pharmacokinetics of nateglinide in patients with moderate-to-severe hepatic impairment.

Gender
No clinically significant differences in nateglinide pharmacokinetics were observed between men and women.

Race
Results of a population pharmacokinetic analysis including subjects of Caucasian, Black, and other ethnic origins suggest that race has little influence on the pharmacokinetics of nateglinide.

Age
Age does not influence the pharmacokinetic properties of nateglinide.

Drug Interactions:
In vitro assessment of drug interactions
Nateglinide is a potential inhibitor of the CYP2C9 isoenzyme in vivo as indicated by its ability to inhibit the in vitro metabolism of tolbutamide. Inhibition of CYP3A4 metabolic reactions was not detected in in vitro experiments.

In vitro displacement studies with highly protein-bound drugs such as furosemide, propranolol, captopril, nicardipine, pravastatin, glyburide, warfarin, phenytoin, acetylsalicylic acid, tolbutamide, and metformin showed no influence on the extent of nateglinide protein binding. Similarly, nateglinide had no influence on the serum protein binding of propranolol, glyburide, nicardipine, warfarin, phenytoin, acetylsalicylic acid, and tolbutamide in vitro. However, prudent evaluation of individual cases is warranted in the clinical setting.

In vivo assessment of drug interactions
The effect of coadministered drugs on the pharmacokinetics of nateglinide and the effect of nateglinide on pharmacokinetics of coadministered drugs are shown in Tables 3 and 4. No clinically relevant change in pharmacokinetic parameters of either agent was reported when nateglinide was coadministered with glyburide, metformin, digoxin, warfarin, and diclofenac.

Table 3. Effect of Coadministered drugs on Pharmacokinetics of Nateglinide

Coadministered Drug

Dosing regimen of coadministered drug

Dosing regimen of nateglinide

Change in C max

Change in AUC

Glyburide

10 mg once daily for 3 weeks

120 mg three times a day, single dose

8.78% ↓

3.53% ↓

Metformin

500 mg three times a day for 3 weeks

120 mg three times a day, single dose

AM: 7.14% ↑

PM: 11.4% ↓

AM: 1.51% ↑

PM: 5.97% ↑

Digoxin

1 mg, single dose

120 mg three times a day, single dose

AM: 2.17% ↓

PM: 3.19% ↑

AM: 7.62% ↑

PM: 2.22% ↑

Warfarin

30 mg, single dose

120 mg three times a day for 4 days

2.65% ↑

3.72% ↓

Diclofenac

75 mg, single dose

120 mg twice daily, single dose

AM: 13.23% ↓

*PM: 3.76% ↑

AM: 2.2% ↓

*PM: 7.5% ↑

AM: after morning dose; PM: after evening dose; * after second dose; ↑: increase in the parameter; ↓: decrease in the parameter

Table 4. Effect of Nateglinide on Pharmacokinetics of Coadministered Drugs

Coadministered Drug

Dosing regimen of coadministered drug

Dosing regimen of nateglinide

Change in C max

Change in AUC

Glyburide

10 mg once daily for 3 weeks

120 mg three times a day, single dose

3.18% ↓

7.34% ↓

Metformin

500 mg three times a day for 3 weeks

120 mg three times a day, single dose

AM: 10.7% ↑

PM: 0.40% ↑

AM: 13.3% ↑

PM: 2.27% ↓

Digoxin

1 mg, single dose

120 mg three times a day, single dose

5.41% ↓

6.58% ↑

Warfarin

30 mg, single dose

120 mg three times a day for 4 days

R-warfarin: 1.03% ↓

S-warfarin: 0.85% ↓

R-warfarin: 0.74% ↑

S-warfarin: 7.23% ↑

Diclofenac

75 mg, single dose

120 mg twice daily, single dose

2.19% ↑

7.97% ↑

AM: after morning dose; PM: after evening dose; SD: single dose; ↑: increase in the parameter; ↓: decrease in the parameter

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenicity: Nateglinide did not increase tumors in two year carcinogenicity studies conducted in mice and rats. Oral doses of Nateglinide up to 900 mg/kg in rats and 400 mg/kg in mice were tested, which produced exposures in rats approximately 30 to 40 times and in mice 10 to 30 times the human therapeutic exposure of nateglinide at a dose of 120 mg three times daily, based on AUC.

Mutagenesis: Nateglinide was not genotoxic in the in vitro Ames test, mouse lymphoma assay, chromosome aberration assay or in the in vivo mouse micronucleus test.

Impairment of Fertility: Fertility was unaffected by administration of nateglinide to rats at doses up to 600 mg/kg (approximately 16 times the human therapeutic exposure with a recommended nateglinide dose of 120 mg three times daily before meals).

14 CLINICAL STUDIES

14.1 Monotherapy

In a 24-week, double-blind, placebo-controlled study, patients with type 2 diabetes were randomized to receive either nateglinide (60 mg or 120 mg three times daily before meals) or placebo. Patients previously treated with antidiabetic medications were required to discontinue that medication for at least 2 months before randomization.

At Week 24, treatment with nateglinide before meals resulted in statistically significant reductions in mean HbA 1C and mean fasting plasma glucose (FPG) compared to placebo (see Table 5). The reductions in HbA 1C and FPG were similar for patients naïve to, and those previously exposed to, antidiabetic medications.

Table 5. Endpoint Results for a 24-week, Fixed Dose Study of Nateglinide Monotherapy

*
p-value ≤ 0.004

HbA 1c (%)

Placebo

N=168

Nateglinide

60 mg

three times daily before meals

N=167

Nateglinide

120 mg

three times daily before meals

N=168

Baseline (mean)

Change from baseline (mean)

Difference from placebo (mean)

FPG (mg/dL)

8.0

+0.2

N=172

7.9

-0.3

-0.5 *

N=171

8.1

-0.5

-0.7 *

N=169

Baseline (mean)

Change from baseline (mean)

Difference from placebo (mean)

167.9

+9.1

161.0

+0.4

-8.7 *

166.5

-4.5

-13.6 *

14.2 Monotherapy Compared to Glyburide

In a 24-week, double-blind, active-controlled trial, patients with type 2 diabetes who had been on a sulfonylurea for 3 or more months and who had a baseline HbA 1C greater than or equal to 6.5% were randomized to receive nateglinide (60 mg or 120 mg three times daily before meals) or glyburide 10 mg once daily. Patients randomized to nateglinide had statistically significant increases in mean HbA 1C and mean FPG at endpoint compared to patients randomized to glyburide.

Table 6. Endpoint Results for a 24-week Study of Nateglinide Monotherapy Compared to Glyburide

*
p-Value ≤ 0.001

Glyburide

10 mg

Once daily

Nateglinide

60 mg

three times daily before meals

Nateglinide

120 mg

three times daily before meals

HbA 1c (%)

N=183

N=178

N=179

Baseline (mean)

7.8

8.0

7.9

Change from baseline (mean)

0.3

1.3

1.1

Difference from glyburide

1.0 *

0.9 *

FPG (mmol/L)

N=184

N=182

N=180

Baseline (mean)

9.44

9.67

9.61

Change from baseline (mean)

0.19

3.06

2.84

Difference from glyburide

2.87 *

2.66 *

14.3 Monotherapy and In Combination With Metformin

In a 24-week, double-blind, active- and placebo-controlled study, patients with type 2 diabetes were randomized to receive either nateglinide alone (120 mg three times daily before meals), metformin alone (500 mg three times daily), a combination of nateglinide 120 mg (three times daily before meals) and metformin (500 mg three times daily), or placebo. Fifty-seven percent of patients were previously untreated with oral antidiabetic therapy. Patients previously treated with antidiabetic medications were required to discontinue medication for at least 2 months before randomization.

At Week 24, statistically significant reductions in mean HbA 1C and FPG were observed with metformin monotherapy compared to nateglinide monotherapy, and the combination of nateglinide and metformin compared to either nateglinide or metformin monotherapy (see Table 7).

Compared to placebo, nateglinide monotherapy was associated with a statistically significant increase in mean body weight, while no significant change in body weight was observed with metformin monotherapy or combination of nateglinide and metformin therapy (see Table 7). Among the subset of patients previously treated with other antidiabetic agents, primarily glyburide, HbA 1C in the nateglinide monotherapy group increased slightly from baseline, whereas HbA 1C was reduced in the metformin monotherapy group (see Table 7).

Table 7. Endpoint Results for a 24-week Study of Nateglinide Monotherapy and Combination with Metformin

*
Metformin was administered three times daily
p-value ≤0.03 vs. metformin
p-value ≤0.05 vs. combination
§
p-value ≤0.05 vs. placebo

HbA 1c (%)

All

Placebo

N=160

Nateglinide

120 mg

three times daily before meals

N=171

Metformin

500 mg

three times daily

N=172

Nateglinide

120 mg

before meals plus Metformin*

N=162

Baseline (mean)

Change from baseline (mean)

Difference from placebo

Naïve

8.3

+0.4

N=98

8.3

-0.4

-0.8 §

N=99

8.4

-0.8

-1.2 §

N=98

8.4

-1.5

-1.9 §

N=81

Baseline (mean)

Change from baseline (mean)

Difference from placebo

Non-Naïve

8.2

+0.3

N=62

8.1

-0.7

-1.0 §

N=72

8.3

-0.8

-1.1 §

N=74

8.2

-1.6

-1.9 §

N=81

Baseline (mean)

Change from baseline (mean)

Difference from placebo

FPG (mg/dL)

All

8.3

+0.6

N=166

8.5

+0.004

-0.6 §

N=173

8.7

-0.8

-1.4 §

N=174

8.7

-1.4

-2.0 §

N=167

Baseline (mean)

Change from baseline (mean)

Difference from placebo

194.0

+8.0

196.5

-13.1

-21.1 §

196.0

-30.0

-38.0 §

197.7

-44.9

-52.9 §

In another 24-week, double-blind, placebo-controlled trial, patients with type 2 diabetes with HbA 1C greater than or equal to 6.8% after treatment with metformin (greater than or equal to 1500 mg daily for at least 1 month) were first entered into a four week run-in period of metformin monotherapy (2000 mg daily) and then randomized to receive either nateglinide (60 mg or 120 mg three times daily before meals) or placebo as add-on to metformin. At the end of treatment, nateglinide 60 mg and 120 mg three times daily resulted in a statistically significantly greater reductions in HbA 1C compared to placebo when added to metformin (-0.4% and -0.6% for nateglinide 60 mg and nateglinide 120 mg plus metformin, respectively).

Table 8. Endpoint Results for a 24-week Study of Nateglinide Monotherapy as Add-on to Metformin

*
p-value 0.003 vs. metformin
p-value < 0.001 vs. metformin

HbA 1c (%)

Placebo

+ metformin

N=150

Nateglinide

60 mg

+

metformin

N=152

Nateglinide

120 mg

+

metformin

N=154

Baseline (mean)

Change from baseline (mean)

Difference from metformin

8.2

0.01

8.0

-0.4

-0.4 *

8.2

-0.6

-0.6

14.4 Add-On Combination Therapy With Rosiglitazone

A 24-week, double blind, multicenter, placebo-controlled trial was performed in patients with type 2 diabetes not adequately controlled on rosiglitazone 8 mg daily. The addition of nateglinide (120 mg three times per day with meals) was associated with statistically significantly greater reductions in HbA 1C compared to placebo as add-on to rosiglitazone. The mean change in weight from baseline was +3 kg for patients treated with nateglinide compared to +1 kg for patients treated with placebo when added to rosiglitazone.

Table 9. Endpoint Results for a 24-week Study of the Effect of Adding Nateglinide or Placebo to Rosiglitazone

*
p-value < 0.0001

HbA 1c (%)

Placebo

+ rosiglitazone 8 mg once daily

N=191

Nateglinide

120 mg before meals +

rosiglitazone 8 mg once daily

N=194

Baseline (mean)

Change from baseline (mean)

Difference from rosiglitazone (mean)

8.4

0.03

8.3

-0.7

-0.7 *

14.5 Add-On Combination Therapy With Glyburide

In a 12-week study of patients with type 2 diabetes inadequately controlled on glyburide 10 mg once daily, the addition of nateglinide (60 mg or 120 mg three times daily before meals) did not produce any additional benefit.

Table 10. Endpoint Results for a 12-week Study of the Effect of Adding Nateglinide or Placebo to Glyburide

*
p-value 0.6959
p-value 0.1246

HbA 1c (%)

Placebo + glyburide 10 mg once daily

N=58

Nateglinide

60 mg before meals +

glyburide 10 mg once daily

N=55

Nateglinide

120 mg before meals +

glyburide 10 mg once daily

N=54

Baseline (mean)

Change from baseline (mean)

Difference from glyburide (mean)

8.7

0.3

8.7

0.2

-0.1 *

8.7

-0.02

-0.3

16 HOW SUPPLIED/STORAGE AND HANDLING

How Supplied
Nateglinide Tablets, USP are supplied in the following package and dose strength forms:

60 mg
Pink color coated, round biconvex, beveled edge tablet debossed with “P 984” on one side and plain on the other side.
Unit dose packages of 30 (3x10) NDC 68084-458-21

120 mg
Orange color coated, oval shaped biconvex, tablet debossed with “P 985” on one side and plain on the other side.
Unit dose packages of 30 (3x10) NDC 68084-459-21

Storage and Handling
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP Controlled Room Temperature]

FOR YOUR PROTECTION: Do not use if blister is torn or broken.

17 PATIENT COUNSELING INFORMATION

Administration
Instruct patients to take nateglinide 1 to 30 minutes before meals. Instruct patients that skip meals to skip their dose of nateglinide [see Dosage and Administration (2)].

Hypoglycemia
Inform patients that nateglinide can cause hypoglycemia and instruct patients and their caregivers on self-management procedures including glucose monitoring and management of hypoglycemia. Inform patients that their ability to concentrate and react may be impaired as a result of hypoglycemia. In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, increased frequency of blood glucose monitoring is recommended [see Warnings and Precautions (5.1)].

Drug Interactions
Discuss potential drug interactions with patients and inform them of potential drug-drug interactions with nateglinide.

PACKAGING INFORMATION

American Health Packaging unit dose blisters (see How Supplied section) contain drug product from Par Pharmaceutical as follows:
(60 mg / 30 UD) NDC 68084-458-21 packaged from NDC 49884-984
(120 mg / 30 UD) NDC 68084-459-21 packaged from NDC 49884-985

Distributed by:
American Health Packaging
Columbus, OH 43217

8245821/0820

Package/Label Display Panel – Carton – 60 mg

60mg Nateglinide Tablets Carton

NDC 68084- 458-21

Nateglinide
Tablets, USP

60 mg

30 Tablets (3 x 10)              Rx Only

Each Tablet Contains:
Nateglinide, USP..................................................60 mg

Usual Dosage: See package insert for full prescribing
information.

Store at 20º to 25ºC (68º to 77ºF); excursions permitted
between 15º to 30ºC (59º to 86ºF) [see USP Controlled
Room Temperature].

Keep this and all drugs out of reach of children.

FOR YOUR PROTECTION: Do not use if blister is torn
or broken.

The drug product contained in this package is from
NDC # 49884-984, Par Pharmaceutical.

Distributed by:
American Health Packaging
Columbus, Ohio 43217

045821
0245821/0721

Package/Label Display Panel – Blister – 60 mg

60mf nateglinide Tablets Blister

Nateglinide
Tablet, USP

60 mg

Package/Label Display Panel – Carton – 120 mg

120 mg Nateglinide Tablets Carton

NDC 68084- 459-21

Nateglinide
Tablets, USP

120 mg

30 Tablets (3 x 10)                Rx Only

Each Tablet Contains:
Nateglinide, USP................................................120 mg

Usual Dosage: See package insert for full prescribing
information.

Store at 20º to 25ºC (68º to 77ºF); excursions permitted
between 15º to 30ºC (59º to 86ºF) [see USP Controlled
Room Temperature].

Keep this and all drugs out of reach of children.

FOR YOUR PROTECTION: Do not use if blister is torn or
broken.

The drug product contained in this package is from
NDC # 49884-985, Par Pharmaceutical.

Distributed by:
American Health Packaging
Columbus, Ohio 43217

045921
0245921/0119OS

Package/Label Display Panel – Blister – 120 mg

120mg Nateglinide Tablets Blister

Nateglinide
Tablet, USP

120 mg

NATEGLINIDE 
nateglinide tablet, coated
Product Information
Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:68084-458(NDC:49884-984)
Route of AdministrationORAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
NATEGLINIDE (UNII: 41X3PWK4O2) (NATEGLINIDE - UNII:41X3PWK4O2) NATEGLINIDE60 mg
Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)  
LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X)  
MAGNESIUM STEARATE (UNII: 70097M6I30)  
MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
POVIDONE, UNSPECIFIED (UNII: FZ989GH94E)  
STARCH, CORN (UNII: O8232NY3SJ)  
FERRIC OXIDE RED (UNII: 1K09F3G675)  
POLYETHYLENE GLYCOL, UNSPECIFIED (UNII: 3WJQ0SDW1A)  
POLYVINYL ALCOHOL, UNSPECIFIED (UNII: 532B59J990)  
TALC (UNII: 7SEV7J4R1U)  
TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
Product Characteristics
ColorpinkScoreno score
ShapeROUNDSize1mm
FlavorImprint Code P;984
Contains    
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:68084-458-2130 in 1 BOX, UNIT-DOSE01/05/2011
1NDC:68084-458-111 in 1 BLISTER PACK; Type 0: Not a Combination Product
Image of Product
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA07746301/05/2011
NATEGLINIDE 
nateglinide tablet, coated
Product Information
Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:68084-459(NDC:49884-985)
Route of AdministrationORAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
NATEGLINIDE (UNII: 41X3PWK4O2) (NATEGLINIDE - UNII:41X3PWK4O2) NATEGLINIDE120 mg
Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)  
LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X)  
MAGNESIUM STEARATE (UNII: 70097M6I30)  
MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
POVIDONE, UNSPECIFIED (UNII: FZ989GH94E)  
STARCH, CORN (UNII: O8232NY3SJ)  
FD&C YELLOW NO. 6 (UNII: H77VEI93A8)  
FERRIC OXIDE YELLOW (UNII: EX438O2MRT)  
Product Characteristics
ColororangeScoreno score
ShapeOVALSize6mm
FlavorImprint Code P;985
Contains    
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:68084-459-2130 in 1 BOX, UNIT-DOSE01/05/2011
1NDC:68084-459-111 in 1 BLISTER PACK; Type 0: Not a Combination Product
Image of Product
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA07746301/05/2011
Labeler - American Health Packaging (929561009)
Establishment
NameAddressID/FEIBusiness Operations
American Health Packaging929561009repack(68084-458, 68084-459)

Revised: 12/2021
Document Id: d3d0ae2b-62d3-d35c-e053-2995a90ab2ad
Set id: 78679aac-28ba-4828-8189-4a2fc8de2b71
Version: 10
Effective Time: 20211223
 
American Health Packaging