NovoNorm

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ANNEX I 
 

SUMMARY OF PRODUCT CHARACTERISTICS 
 
 



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1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 0.5 mg tablets 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Each tablet contains 0.5 mg of repaglinide. 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Tablet 
 
Repaglinide tablets are white, round and convex and engraved with Novo Nordisk logo (Apis bull). 
 
 
4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Repaglinide is indicated in adults with type 2 diabetes mellitus whose hyperglycaemia can no longer 
be controlled satisfactorily by diet, weight reduction and exercise. Repaglinide is also indicated in 
combination with metformin in adults with type 2 diabetes mellitus who are not satisfactorily 
controlled on metformin alone. 
 
Treatment should be initiated as an adjunct to diet and exercise to lower the blood glucose in relation 
to meals. 
 
4.2 Posology and method of administration 
 
Posology 
 
Repaglinide is given preprandially and is titrated individually to optimise glycaemic control. In 
addition to the usual self-monitoring by the patient of blood and/or urinary glucose, the patient’s 
blood glucose must be monitored periodically by the physician to determine the minimum effective 
dose for the patient. Glycosylated haemoglobin levels are also of value in monitoring the patient’s 
response to therapy. Periodic monitoring is necessary to detect inadequate lowering of blood glucose 
at the recommended maximum dose level (i.e. primary failure) and to detect loss of adequate blood 
glucose-lowering response after an initial period of effectiveness (i.e. secondary failure). 
 
Short-term administration of repaglinide may be sufficient during periods of transient loss of control 
in type 2 diabetic patients usually controlled well on diet. 
 
Initial dose 
 
The dosage should be determined by the physician, according to the patient’s requirements. 
The recommended starting dose is 0.5 mg. One to two weeks should elapse between titration steps (as 
determined by blood glucose response). 
If patients are transferred from another oral hypoglycaemic medicinal product, the recommended 
starting dose is 1 mg. 
 
Maintenance 
 



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The recommended maximum single dose is 4 mg taken with main meals. 
The total maximum daily dose should not exceed 16 mg. 
 
Special populations 
 
Elderly 
No clinical studies have been conducted in patients >75 years of age. 
 
Renal impairment 
Repaglinide is not affected by renal disorders (see section 5.2). 
Eight percent of one dose of repaglinide is excreted through the kidneys and total plasma clearance of 
the product is decreased in patients with renal impairment. As insulin sensitivity is increased in 
diabetic patients with renal impairment, caution is advised when titrating these patients. 
 
Hepatic impairment 
No clinical studies have been conducted in patients with hepatic insufficiency. 
 
Debilitated or malnourished patients 
In debilitated or malnourished patients the initial and maintenance dosage should be conservative and 
careful dose titration is required to avoid hypoglycaemic reactions. 
 
Patients receiving other oral hypoglycaemic medicinal products 
Patients can be transferred directly from other oral hypoglycaemic medicinal products to repaglinide. 
However, no exact dosage relationship exists between repaglinide and the other oral hypoglycaemic 
medicinal products. The recommended maximum starting dose of patients transferred to repaglinide is 
1 mg given before main meals. 
 
Repaglinide can be given in combination with metformin, when the blood glucose is insufficiently 
controlled with metformin alone. In this case, the dosage of metformin should be maintained and 
repaglinide administered concomitantly. The starting dose of repaglinide is 0.5 mg, taken before main 
meals; titration is according to blood glucose response as for monotherapy. 
 
Paediatric population 
The safety and efficacy of repaglinide in children below 18 years have not been established. No data 
are available. 
 
Method of administration 
 
Repaglinide should be taken before main meals (i.e. preprandially). 
 
Doses are usually taken within 15 minutes of the meal but time may vary from immediately preceding 
the meal to as long as 30 minutes before the meal (i.e. preprandially 2, 3, or 4 meals a day). Patients 
who skip a meal (or add an extra meal) should be instructed to skip (or add) a dose for that meal. 
 
In the case of concomitant use with other active substances refer to sections 4.4 and 4.5 to assess the 
dosage. 
 
4.3 Contraindications 
 
• Hypersensitivity to repaglinide or to any of the excipients listed in section 6.1. 
• Diabetes mellitus type 1, C-peptide negative. 
• Diabetic ketoacidosis, with or without coma. 
• Severe hepatic function disorder. 
• Concomitant use of gemfibrozil (see section 4.5). 
 
4.4 Special warnings and precautions for use 



4 

 
General 
 
Repaglinide should only be prescribed if poor blood glucose control and symptoms of diabetes persist 
despite adequate attempts at dieting, exercise and weight reduction. 
 
When a patient stabilised on any oral hypoglycaemic medicinal product is exposed to stress such as 
fever, trauma, infection or surgery, a loss of glycaemic control may occur. At such times, it may be 
necessary to discontinue repaglinide and treat with insulin on a temporary basis. 
 
Hypoglycaemia 
 
Repaglinide, like other insulin secretagogues, is capable of producing hypoglycaemia. 
 
Combination with insulin secretagogues 
 
The blood glucose-lowering effect of oral hypoglycaemic medicinal products decreases in many 
patients over time. This may be due to progression of the severity of the diabetes or to diminished 
responsiveness to the medicinal product. This phenomenon is known as secondary failure, to 
distinguish it from primary failure, where the medicinal product is ineffective in an individual patient 
when first given. Adjustment of dose and adherence to diet and exercise should be assessed before 
classifying a patient as a secondary failure. 
 
Repaglinide acts through a distinct binding site with a short action on the β-cells. Use of repaglinide 
in case of secondary failure to insulin secretagogues has not been investigated in clinical trials. 
Trials investigating the combination with other insulin secretagogues have not been performed. 
 
Combination with Neutral Protamine Hagedorn (NPH) insulin or thiazolidinediones 
 
Trials of combination therapy with NPH insulin or thiazolidinediones have been performed. However, 
the benefit risk profile remains to be established when comparing to other combination therapies. 
 
Combination with metformin 
 
Combination treatment with metformin is associated with an increased risk of hypoglycaemia. 
 
Acute coronary syndrome 
 
The use of repaglinide might be associated with an increased incidence of acute coronary syndrome 
(e.g. myocardial infarction), see sections 4.8 and 5.1. 
 
Concomitant use 
 
Repaglinide should be used with caution or be avoided in patients receiving medicinal products which 
influence repaglinide metabolism (see section 4.5). If concomitant use is necessary, careful 
monitoring of blood glucose and close clinical monitoring should be performed. 
 
4.5 Interaction with other medicinal products and other forms of interaction 
 
A number of medicinal products are known to influence repaglinide metabolism. Possible interactions 
should therefore be taken into account by the physician: 
 
In vitro data indicate that repaglinide is metabolised predominantly by CYP2C8, but also by CYP3A4. 
Clinical data in healthy volunteers support CYP2C8 as being the most important enzyme involved in 
repaglinide metabolism with CYP3A4 playing a minor role, but the relative contribution of CYP3A4 
can be increased if CYP2C8 is inhibited. Consequently metabolism, and by that clearance of 



5 

repaglinide, may be altered by substances which influence these cytochrome P-450 enzymes via 
inhibition or induction. Special care should be taken when inhibitors of both CYP2C8 and 3A4 are 
co-administered simultaneously with repaglinide. 
 
Based on in vitro data, repaglinide appears to be a substrate for active hepatic uptake (organic anion 
transporting protein OATP1B1). Substances that inhibit OATP1B1 may likewise have the potential to 
increase plasma concentrations of repaglinide, as has been shown for ciclosporin (see below). 
 
The following substances may enhance and/or prolong the hypoglycaemic effect of repaglinide: 
Gemfibrozil, clarithromycin, itraconazole, ketokonazole, trimethoprim, ciclosporin, deferasirox, 
clopidogrel, other antidiabetic substances, monoamine oxidase inhibitors (MAOI), non selective beta 
blocking substances, angiotensin converting enzyme (ACE)-inhibitors, salicylates, NSAIDs, 
octreotide, alcohol, and anabolic steroids. 
 
Co-administration of gemfibrozil (600 mg twice daily), an inhibitor of CYP2C8, and repaglinide (a 
single dose of 0.25 mg) increased the repaglinide AUC 8.1-fold and Cmax 2.4-fold in healthy 
volunteers. Half-life was prolonged from 1.3 hr to 3.7 hr, resulting in possibly enhanced and 
prolonged blood glucose-lowering effect of repaglinide, and plasma repaglinide concentration at 7 hr 
was increased 28.6-fold by gemfibrozil. The concomitant use of gemfibrozil and repaglinide is 
contraindicated (see section 4.3). 
 
Co-administration of trimethoprim (160 mg twice daily), a moderate CYP2C8 inhibitor, and 
repaglinide (a single dose of 0.25 mg) increased the repaglinide AUC, Cmax and t½ (1.6-fold, 1.4-fold 
and 1.2-fold respectively) with no statistically significant effects on the blood glucose levels. This 
lack of pharmacodynamic effect was observed with a sub-therapeutic dose of repaglinide. Since the 
safety profile of this combination has not been established with dosages higher than 0.25 mg for 
repaglinide and 320 mg for trimethoprim, the concomitant use of trimethoprim with repaglinide 
should be avoided. If concomitant use is necessary, careful monitoring of blood glucose and close 
clinical monitoring should be performed (see section 4.4). 
 
Rifampicin, a potent inducer of CYP3A4, but also CYP2C8, acts both as an inducer and inhibitor of 
the metabolism of repaglinide. Seven days pre-treatment with rifampicin (600 mg), followed by co-
administration of repaglinide (a single dose of 4 mg) at day seven resulted in a 50% lower AUC 
(effect of a combined induction and inhibition). When repaglinide was given 24 hours after the last 
rifampicin dose, an 80% reduction of the repaglinide AUC was observed (effect of induction alone). 
Concomitant use of rifampicin and repaglinide might therefore induce a need for repaglinide dose 
adjustment which should be based on carefully monitored blood glucose concentrations at both 
initiation of rifampicin treatment (acute inhibition), following dosing (mixed inhibition and 
induction), withdrawal (induction alone) and up to approximately two weeks after withdrawal of 
rifampicin where the inductive effect of rifampicin is no longer present. It cannot be excluded that 
other inducers, e.g. phenytoin, carbamazepine, phenobarbital, St John’s wort, may have a similar 
effect. 
 
The effect of ketoconazole, a prototype of potent and competitive inhibitors of CYP3A4, on the 
pharmacokinetics of repaglinide has been studied in healthy subjects. Co-administration of 200 mg 
ketoconazole increased the repaglinide (AUC and Cmax) by 1.2-fold with profiles of blood glucose 
concentrations altered by less than 8% when administered concomitantly (a single dose of 4 mg 
repaglinide). Co-administration of 100 mg itraconazole, an inhibitor of CYP3A4, has also been 
studied in healthy volunteers, and increased the AUC by 1.4-fold. No significant effect on the glucose 
level in healthy volunteers was observed. In an interaction study in healthy volunteers, co-
administration of 250 mg clarithromycin, a potent mechanism-based inhibitor of CYP3A4, slightly 
increased the repaglinide (AUC) by 1.4-fold and Cmax by 1.7-fold and increased the mean incremental 
AUC of serum insulin by 1.5-fold and the maximum concentration by 1.6-fold. The exact mechanism 
of this interaction is not clear. 
 
In a study conducted in healthy volunteers, the concomitant administration of repaglinide (a single 



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dose of 0.25 mg) and ciclosporin (repeated dose at 100 mg) increased repaglinide AUC and Cmax 
about 2.5-fold and 1.8-fold respectively. Since the interaction has not been established with dosages 
higher than 0.25 mg for repaglinide, the concomitant use of ciclosporin with repaglinide should be 
avoided. If the combination appears necessary, careful clinical and blood glucose monitoring should 
be performed (see section 4.4). 
 
In an interaction study with healthy volunteers, co-administration of deferasirox (30 mg/kg/day, 
4 days), a moderate inhibitor of CYP2C8 and CYP3A4, and repaglinide (single dose, 0.5 mg) resulted 
in an increase in repaglinide systemic exposure (AUC) to 2.3-fold (90% CI [2.03-2.63]) of control, a 
1.6-fold (90% CI [1.42-1.84]) increase in Cmax, and a small, significant decrease in blood glucose 
values. Since the interaction has not been established with dosages higher than 0.5 mg for repaglinide, 
the concomitant use of deferasirox with repaglinide should be avoided. If the combination appears 
necessary, careful clinical and blood glucose monitoring should be performed (see section 4.4). 
 
In an interaction study with healthy volunteers, co-administration of clopidogrel (300 mg loading 
dose), a CYP2C8 inhibitor, increased repaglinide exposure (AUC0–∞) 5.1-fold and continued 
administration (75 mg daily dose) increased repaglinide exposure (AUC0–∞) 3.9-fold. A small, 
significant decrease in blood glucose values was observed. Since the safety profile of the co-treatment 
has not been established in these patients, the concomitant use of clopidogrel and repaglinide should 
be avoided. If concomitant use is necessary, careful monitoring of blood glucose and close clinical 
monitoring should be performed (see section 4.4). 
 
β-blocking medicinal products may mask the symptoms of hypoglycaemia. 
 
Co-administration of cimetidine, nifedipine, oestrogen, or simvastatin with repaglinide, all CYP3A4 
substrates, did not significantly alter the pharmacokinetic parameters of repaglinide. 
 
Repaglinide had no clinically relevant effect on the pharmacokinetic properties of digoxin, 
theophylline or warfarin at steady state, when administered to healthy volunteers. Dosage adjustment 
of these compounds when co-administered with repaglinide is therefore not necessary. 
 
The following substances may reduce the hypoglycaemic effect of repaglinide: 
Oral contraceptives, rifampicin, barbiturates, carbamazepine, thiazides, corticosteroids, danazol, 
thyroid hormones and sympathomimetics. 
 
When these medications are administered to or withdrawn from a patient receiving repaglinide, the 
patient should be observed closely for changes in glycaemic control. 
 
When repaglinide is used together with other medicinal products that are mainly secreted by the bile, 
like repaglinide, any potential interaction should be considered. 
 
Paediatric population 
 
No interaction studies have been performed in children and adolescents. 
 
4.6 Fertility, pregnancy and lactation 
 
Pregnancy 
 
There are no studies of repaglinide in pregnant women. Repaglinide should be avoided during 
pregnancy. 
 
Breast-feeding 
 
There are no studies in breast-feeding women. Repaglinide should not be used in breast-feeding 
women. 



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Fertility 
 
Data from animal studies investigating effects on embryofetal and offspring development as well as 
excretion in milk is described in section 5.3. 
 
4.7 Effects on ability to drive and use machines 
 
NovoNorm has no direct influence on the ability to drive and use machines but may cause 
hypoglycaemia.  
 
Patients should be advised to take precautions to avoid hypoglycaemia whilst driving. This is 
particularly important in those who have reduced or absent awareness of the warning signs of 
hypoglycaemia or have frequent episodes of hypoglycaemia. The advisability of driving should be 
considered in these circumstances. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
 
The most frequently reported adverse reactions are changes in blood glucose levels, i.e. 
hypoglycaemia. The occurrence of such reactions depends on individual factors, such as dietary 
habits, dosage, exercise and stress. 
 
Tabulated list of adverse reactions 
 
Based on the experience with repaglinide and with other hypoglycaemic medicinal products the 
following adverse reactions have been seen: Frequencies are defined as: common (≥1/100 to <1/10); 
uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000) and not known 
(cannot be estimated from the available data). 
 
Immune system disorders Allergic reactions* Very rare  

Metabolism and nutrition 
disorders 

Hypoglycaemia Common 

Hypoglycaemic coma and 
hypoglycaemic 
unconsciousness 

Not known 

Eye disorders Refraction disorder* Very rare 

Cardiac disorders Cardiovascular disease Rare 

Gastrointestinal disorders Abdominal pain, diarrhoea Common 

Vomiting, constipation Very rare 

Nausea Not known 

Hepatobiliary disorders Abnormal hepatic 
function, increased liver 
enzymes* 

Very rare 

Skin and subcutaneous tissue 
disorders 

Hypersensitivity* Not known 

* see section Description of selected adverse reactions below 
 
Description of selected adverse reactions 
 
Allergic reactions 



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Generalised hypersensitivity reactions (e.g. anaphylactic reaction), or immunological reactions such 
as vasculitis. 
 
Refraction disorders 
Changes in blood glucose levels have been known to result in transient visual disturbances, especially 
at the commencement of treatment. Such disturbances have only been reported in very few cases after 
initiation of repaglinide treatment. No such cases have led to discontinuation of repaglinide treatment 
in clinical trials. 
 
Abnormal hepatic function, increased liver enzymes 
Isolated cases of increased liver enzymes have been reported during treatment with repaglinide. Most 
cases were mild and transient, and very few patients discontinued treatment due to increased liver 
enzymes. In very rare cases, severe hepatic dysfunction has been reported. 
 
Hypersensitivity 
Hypersensitivity reactions of the skin may occur as erythema, itching, rashes and urticaria. There is no 
reason to suspect cross-allergenicity with sulphonylurea due to the difference in chemical structure. 
 
Reporting of suspected adverse reactions 
 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V. 
 
4.9 Overdose 
 
Repaglinide has been given with weekly escalating doses from 4 - 20 mg four times daily in a 6 week 
period. No safety concerns were raised. As hypoglycaemia in this study was avoided through 
increased calorie intake, a relative overdose may result in an exaggerated glucose-lowering effect with 
development of hypoglycaemic symptoms (dizziness, sweating, tremor, headache etc.). Should these 
symptoms occur, adequate action should be taken to correct the low blood glucose (oral 
carbohydrates). More severe hypoglycaemia with seizure, loss of consciousness or coma should be 
treated with intravenous glucose. 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1 Pharmacodynamic properties 
 
Pharmaco-therapeutic group: Drugs used in diabetes, other blood glucose lowering drugs, excl. 
insulins, ATC code: A10BX02 
 
Mechanism of action 
 
Repaglinide is a short-acting oral secretagogue. Repaglinide lowers the blood glucose levels acutely 
by stimulating the release of insulin from the pancreas, an effect dependent upon functioning β-cells 
in the pancreatic islets. 
Repaglinide closes ATP-dependent potassium channels in the β-cell membrane via a target protein 
different from other secretagogues. This depolarises the β-cell and leads to an opening of the calcium 
channels. The resulting increased calcium influx induces insulin secretion from the β-cell. 
 
Pharmacodynamic effects 
 
In type 2 diabetic patients, the insulinotropic response to a meal occurred within 30 minutes after an 
oral dose of repaglinide. This resulted in a blood glucose-lowering effect throughout the meal period. 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


9 

The elevated insulin levels did not persist beyond the time of the meal challenge. Plasma repaglinide 
levels decreased rapidly, and low concentrations were seen in the plasma of type 2 diabetic patients 
4 hours post-administration. 
 
Clinical efficacy and safety 
 
A dose-dependent decrease in blood glucose was demonstrated in type 2 diabetic patients when 
administered in doses from 0.5 to 4 mg repaglinide. 
Clinical study results have shown that repaglinide is optimally dosed in relation to main meals 
(preprandial dosing). 
Doses are usually taken within 15 minutes of the meal, but the time may vary from immediately 
preceding the meal to as long as 30 minutes before the meal. 
 
One epidemiological study suggested an increased risk of acute coronary syndrome in repaglinide 
treated patients as compared to sulfonylurea treated patients (see sections 4.4 and 4.8). 
 
5.2 Pharmacokinetic properties 
 
Absorption 
 
Repaglinide is rapidly absorbed from the gastrointestinal tract, which leads to a rapid increase in the 
plasma concentration of the active substance. The peak plasma level occurs within one hour post 
administration. After reaching a maximum, the plasma level decreases rapidly. 
Repaglinide pharmacokinetics are characterised by a mean absolute bioavailability of 63% (CV 11%). 
 
No clinically relevant differences were seen in the pharmacokinetics of repaglinide, when repaglinide 
was administered 0, 15 or 30 minutes before a meal or in fasting state. 
 
A high interindividual variability (60%) in repaglinide plasma concentrations has been detected in the 
clinical trials. Intraindividual variability is low to moderate (35%) and as repaglinide should be 
titrated against the clinical response, efficacy is not affected by interindividual variability. 
 
Distribution 
 
Repaglinide pharmacokinetics are characterised by low volume of distribution, 30 L (consistent with 
distribution into intracellular fluid) and is highly bound to plasma proteins in humans (greater than 
98%). 
 
Elimination 
 
Repaglinide is eliminated rapidly within 4 - 6 hours from the blood. The plasma elimination half-life 
is approximately one hour. 
 
Repaglinide is almost completely metabolised, and no metabolites with clinically relevant 
hypoglycaemic effect have been identified. 
 
Repaglinide metabolites are excreted primarily via the bile. A small fraction (less than 8%) of the 
administered dose appears in the urine, primarily as metabolites. Less than 1% of repaglinide is 
recovered in faeces. 
 
Special patient groups 
 
Repaglinide exposure is increased in patients with hepatic insufficiency and in the elderly type 2 
diabetic patients. The AUC (SD) after 2 mg single dose exposure (4 mg in patients with hepatic 
insufficiency) was 31.4 ng/ml x hr (28.3) in healthy volunteers, 304.9 ng/ml x hr (228.0) in patients 
with hepatic insufficiency, and 117.9 ng/ml x hr (83.8) in the elderly type 2 diabetic patients. 



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After a 5 day treatment of repaglinide (2 mg x 3/day) in patients with a severe impaired renal function 
(creatinine clearance: 20-39 ml/min.), the results showed a significant 2-fold increase of the exposure 
(AUC) and half-life (t1/2) as compared to patients with normal renal function. 
 
Paediatric population 
No data are available. 
 
5.3 Preclinical safety data 
 
Non-clinical data revealed no special hazard for humans based on conventional studies of safety 
pharmacology, repeated dose toxicity, genotoxicity and carcinogenic potential. 
 
Repaglinide was shown not to be teratogenic in animal studies. Embryotoxicity, abnormal limb 
development in rat foetuses and new born pups, was observed in female rats exposed to high doses in 
the last stage of pregnancy and during the lactation period. Repaglinide was detected in the milk of 
animals. 
 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Microcrystalline cellulose (E460) 
Calcium hydrogen phosphate, anhydrous 
Maize starch 
Polacrilin potassium 
Povidone (polyvidone) 
Glycerol 85% 
Magnesium stearate 
Meglumine 
Poloxamer 
 
6.2 Incompatibilities 
 
Not applicable. 
 
6.3 Shelf life 
 
5 years. 
 
6.4 Special precautions for storage 
 
Store in the original package in order to protect from moisture. 
 
6.5 Nature and contents of container 
 
The blister pack (aluminium/aluminium) contains 30, 90, 120 or 270 tablets, respectively. 
Not all pack sizes may be marketed. 
 
6.6 Special precautions for disposal 
 
No special requirements. 
 
 
7. MARKETING AUTHORISATION HOLDER 
 



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Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
8. MARKETING AUTHORISATION NUMBERS 
 
EU/1/98/076/004-006, EU/1/98/076/023 
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
Date of first authorisation: 17 August 1998 
Date of last renewal: 23 July 2008 
 
 
10. DATE OF REVISION OF THE TEXT 
 
 
 
Detailed information on this medicinal product is available on the website of the European Medicines 
Agency http://www.ema.europa.eu. 
 

http://www.ema.europa.eu/


12 

1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 1 mg tablets 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Each tablet contains 1 mg of repaglinide. 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Tablet 
 
Repaglinide tablets are yellow, round and convex and engraved with Novo Nordisk logo (Apis bull). 
 
 
4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Repaglinide is indicated in adults with type 2 diabetes mellitus whose hyperglycaemia can no longer 
be controlled satisfactorily by diet, weight reduction and exercise. Repaglinide is also indicated in 
combination with metformin in adults with type 2 diabetes mellitus who are not satisfactorily 
controlled on metformin alone. 
 
Treatment should be initiated as an adjunct to diet and exercise to lower the blood glucose in relation 
to meals. 
 
4.2 Posology and method of administration 
 
Posology 
 
Repaglinide is given preprandially and is titrated individually to optimise glycaemic control. In 
addition to the usual self-monitoring by the patient of blood and/or urinary glucose, the patient’s 
blood glucose must be monitored periodically by the physician to determine the minimum effective 
dose for the patient. Glycosylated haemoglobin levels are also of value in monitoring the patient’s 
response to therapy. Periodic monitoring is necessary to detect inadequate lowering of blood glucose 
at the recommended maximum dose level (i.e. primary failure) and to detect loss of adequate blood 
glucose-lowering response after an initial period of effectiveness (i.e. secondary failure). 
 
Short-term administration of repaglinide may be sufficient during periods of transient loss of control 
in type 2 diabetic patients usually controlled well on diet. 
 
Initial dose 
 
The dosage should be determined by the physician, according to the patient’s requirements. 
The recommended starting dose is 0.5 mg. One to two weeks should elapse between titration steps (as 
determined by blood glucose response). 
If patients are transferred from another oral hypoglycaemic medicinal product, the recommended 
starting dose is 1 mg. 
 
Maintenance 
 



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The recommended maximum single dose is 4 mg taken with main meals. 
The total maximum daily dose should not exceed 16 mg. 
 
Special populations 
 
Elderly 
No clinical studies have been conducted in patients >75 years of age. 
 
Renal impairment 
Repaglinide is not affected by renal disorders (see section 5.2). 
Eight percent of one dose of repaglinide is excreted through the kidneys and total plasma clearance of 
the product is decreased in patients with renal impairment. As insulin sensitivity is increased in 
diabetic patients with renal impairment, caution is advised when titrating these patients. 
 
Hepatic impairment 
No clinical studies have been conducted in patients with hepatic insufficiency. 
 
Debilitated or malnourished patients 
In debilitated or malnourished patients the initial and maintenance dosage should be conservative and 
careful dose titration is required to avoid hypoglycaemic reactions. 
 
Patients receiving other oral hypoglycaemic medicinal products 
Patients can be transferred directly from other oral hypoglycaemic medicinal products to repaglinide. 
However, no exact dosage relationship exists between repaglinide and the other oral hypoglycaemic 
medicinal products. The recommended maximum starting dose of patients transferred to repaglinide is 
1 mg given before main meals. 
 
Repaglinide can be given in combination with metformin, when the blood glucose is insufficiently 
controlled with metformin alone. In this case, the dosage of metformin should be maintained and 
repaglinide administered concomitantly. The starting dose of repaglinide is 0.5 mg, taken before main 
meals; titration is according to blood glucose response as for monotherapy. 
 
Paediatric population 
The safety and efficacy of repaglinide in children below 18 years have not been established. No data 
are available. 
 
Method of administration 
 
Repaglinide should be taken before main meals (i.e. preprandially). 
 
Doses are usually taken within 15 minutes of the meal but time may vary from immediately preceding 
the meal to as long as 30 minutes before the meal (i.e. preprandially 2, 3, or 4 meals a day). Patients 
who skip a meal (or add an extra meal) should be instructed to skip (or add) a dose for that meal. 
 
In the case of concomitant use with other active substances refer to sections 4.4 and 4.5 to assess the 
dosage. 
 
4.3 Contraindications 
 
• Hypersensitivity to repaglinide or to any of the excipients listed in section 6.1. 
• Diabetes mellitus type 1, C-peptide negative. 
• Diabetic ketoacidosis, with or without coma. 
• Severe hepatic function disorder. 
• Concomitant use of gemfibrozil (see section 4.5). 
 
4.4 Special warnings and precautions for use 



14 

 
General 
 
Repaglinide should only be prescribed if poor blood glucose control and symptoms of diabetes persist 
despite adequate attempts at dieting, exercise and weight reduction. 
 
When a patient stabilised on any oral hypoglycaemic medicinal product is exposed to stress such as 
fever, trauma, infection or surgery, a loss of glycaemic control may occur. At such times, it may be 
necessary to discontinue repaglinide and treat with insulin on a temporary basis. 
 
Hypoglycaemia 
 
Repaglinide, like other insulin secretagogues, is capable of producing hypoglycaemia. 
 
Combination with insulin secretagogues 
 
The blood glucose-lowering effect of oral hypoglycaemic medicinal products decreases in many 
patients over time. This may be due to progression of the severity of the diabetes or to diminished 
responsiveness to the medicinal product. This phenomenon is known as secondary failure, to 
distinguish it from primary failure, where the medicinal product is ineffective in an individual patient 
when first given. Adjustment of dose and adherence to diet and exercise should be assessed before 
classifying a patient as a secondary failure. 
 
Repaglinide acts through a distinct binding site with a short action on the β-cells. Use of repaglinide 
in case of secondary failure to insulin secretagogues has not been investigated in clinical trials. 
Trials investigating the combination with other insulin secretagogues have not been performed. 
 
Combination with Neutral Protamine Hagedorn (NPH) insulin or thiazolidinediones 
 
Trials of combination therapy with NPH insulin or thiazolidinediones have been performed. However, 
the benefit risk profile remains to be established when comparing to other combination therapies. 
 
Combination with metformin 
 
Combination treatment with metformin is associated with an increased risk of hypoglycaemia. 
 
Acute coronary syndrome 
 
The use of repaglinide might be associated with an increased incidence of acute coronary syndrome 
(e.g. myocardial infarction), see sections 4.8 and 5.1. 
 
Concomitant use 
 
Repaglinide should be used with caution or be avoided in patients receiving medicinal products which 
influence repaglinide metabolism (see section 4.5). If concomitant use is necessary, careful 
monitoring of blood glucose and close clinical monitoring should be performed. 
 
4.5 Interaction with other medicinal products and other forms of interaction 
 
A number of medicinal products are known to influence repaglinide metabolism. Possible interactions 
should therefore be taken into account by the physician: 
 
In vitro data indicate that repaglinide is metabolised predominantly by CYP2C8, but also by CYP3A4. 
Clinical data in healthy volunteers support CYP2C8 as being the most important enzyme involved in 
repaglinide metabolism with CYP3A4 playing a minor role, but the relative contribution of CYP3A4 
can be increased if CYP2C8 is inhibited. Consequently metabolism, and by that clearance of 



15 

repaglinide, may be altered by substances which influence these cytochrome P-450 enzymes via 
inhibition or induction. Special care should be taken when inhibitors of both CYP2C8 and 3A4 are 
co-administered simultaneously with repaglinide. 
 
Based on in vitro data, repaglinide appears to be a substrate for active hepatic uptake (organic anion 
transporting protein OATP1B1). Substances that inhibit OATP1B1 may likewise have the potential to 
increase plasma concentrations of repaglinide, as has been shown for ciclosporin (see below). 
 
The following substances may enhance and/or prolong the hypoglycaemic effect of repaglinide: 
Gemfibrozil, clarithromycin, itraconazole, ketokonazole, trimethoprim, ciclosporin, deferasirox, 
clopidogrel, other antidiabetic substances, monoamine oxidase inhibitors (MAOI), non selective beta 
blocking substances, angiotensin converting enzyme (ACE)-inhibitors, salicylates, NSAIDs, 
octreotide, alcohol, and anabolic steroids. 
 
Co-administration of gemfibrozil (600 mg twice daily), an inhibitor of CYP2C8, and repaglinide (a 
single dose of 0.25 mg) increased the repaglinide AUC 8.1-fold and Cmax 2.4-fold in healthy 
volunteers. Half-life was prolonged from 1.3 hr to 3.7 hr, resulting in possibly enhanced and 
prolonged blood glucose-lowering effect of repaglinide, and plasma repaglinide concentration at 7 hr 
was increased 28.6-fold by gemfibrozil. The concomitant use of gemfibrozil and repaglinide is 
contraindicated (see section 4.3). 
 
Co-administration of trimethoprim (160 mg twice daily), a moderate CYP2C8 inhibitor, and 
repaglinide (a single dose of 0.25 mg) increased the repaglinide AUC, Cmax and t½ (1.6-fold, 1.4-fold 
and 1.2-fold respectively) with no statistically significant effects on the blood glucose levels. This 
lack of pharmacodynamic effect was observed with a sub-therapeutic dose of repaglinide. Since the 
safety profile of this combination has not been established with dosages higher than 0.25 mg for 
repaglinide and 320 mg for trimethoprim, the concomitant use of trimethoprim with repaglinide 
should be avoided. If concomitant use is necessary, careful monitoring of blood glucose and close 
clinical monitoring should be performed (see section 4.4). 
 
Rifampicin, a potent inducer of CYP3A4, but also CYP2C8, acts both as an inducer and inhibitor of 
the metabolism of repaglinide. Seven days pre-treatment with rifampicin (600 mg), followed by co-
administration of repaglinide (a single dose of 4 mg) at day seven resulted in a 50% lower AUC 
(effect of a combined induction and inhibition). When repaglinide was given 24 hours after the last 
rifampicin dose, an 80% reduction of the repaglinide AUC was observed (effect of induction alone). 
Concomitant use of rifampicin and repaglinide might therefore induce a need for repaglinide dose 
adjustment which should be based on carefully monitored blood glucose concentrations at both 
initiation of rifampicin treatment (acute inhibition), following dosing (mixed inhibition and 
induction), withdrawal (induction alone) and up to approximately two weeks after withdrawal of 
rifampicin where the inductive effect of rifampicin is no longer present. It cannot be excluded that 
other inducers, e.g. phenytoin, carbamazepine, phenobarbital, St John’s wort, may have a similar 
effect. 
 
The effect of ketoconazole, a prototype of potent and competitive inhibitors of CYP3A4, on the 
pharmacokinetics of repaglinide has been studied in healthy subjects. Co-administration of 200 mg 
ketoconazole increased the repaglinide (AUC and Cmax) by 1.2-fold with profiles of blood glucose 
concentrations altered by less than 8% when administered concomitantly (a single dose of 4 mg 
repaglinide). Co-administration of 100 mg itraconazole, an inhibitor of CYP3A4, has also been 
studied in healthy volunteers, and increased the AUC by 1.4-fold. No significant effect on the glucose 
level in healthy volunteers was observed. In an interaction study in healthy volunteers, co-
administration of 250 mg clarithromycin, a potent mechanism-based inhibitor of CYP3A4, slightly 
increased the repaglinide (AUC) by 1.4-fold and Cmax by 1.7-fold and increased the mean incremental 
AUC of serum insulin by 1.5-fold and the maximum concentration by 1.6-fold. The exact mechanism 
of this interaction is not clear. 
 



16 

In a study conducted in healthy volunteers, the concomitant administration of repaglinide (a single 
dose of 0.25 mg) and ciclosporin (repeated dose at 100 mg) increased repaglinide AUC and Cmax about 
2.5-fold and 1.8-fold respectively. Since the interaction has not been established with dosages higher 
than 0.25 mg for repaglinide, the concomitant use of ciclosporin with repaglinide should be avoided. 
If the combination appears necessary, careful clinical and blood glucose monitoring should be 
performed (see section 4.4). 
 
In an interaction study with healthy volunteers, co-administration of deferasirox (30 mg/kg/day, 
4 days), a moderate inhibitor of CYP2C8 and CYP3A4, and repaglinide (single dose, 0.5 mg) resulted 
in an increase in repaglinide systemic exposure (AUC) to 2.3-fold (90% CI [2.03-2.63]) of control, a 
1.6-fold (90% CI [1.42-1.84]) increase in Cmax, and a small, significant decrease in blood glucose 
values. Since the interaction has not been established with dosages higher than 0.5 mg for repaglinide, 
the concomitant use of deferasirox with repaglinide should be avoided. If the combination appears 
necessary, careful clinical and blood glucose monitoring should be performed (see section 4.4). 
 
In an interaction study with healthy volunteers, co-administration of clopidogrel (300 mg loading 
dose), a CYP2C8 inhibitor, increased repaglinide exposure (AUC0–∞) 5.1-fold and continued 
administration (75 mg daily dose) increased repaglinide exposure (AUC0–∞) 3.9-fold. A small, 
significant decrease in blood glucose values was observed. Since the safety profile of the co-treatment 
has not been established in these patients, the concomitant use of clopidogrel and repaglinide should 
be avoided. If concomitant use is necessary, careful monitoring of blood glucose and close clinical 
monitoring should be performed (see section 4.4). 
 
β-blocking medicinal products may mask the symptoms of hypoglycaemia. 
 
Co-administration of cimetidine, nifedipine, oestrogen, or simvastatin with repaglinide, all CYP3A4 
substrates, did not significantly alter the pharmacokinetic parameters of repaglinide. 
 
Repaglinide had no clinically relevant effect on the pharmacokinetic properties of digoxin, 
theophylline or warfarin at steady state, when administered to healthy volunteers. Dosage adjustment 
of these compounds when co-administered with repaglinide is therefore not necessary. 
 
The following substances may reduce the hypoglycaemic effect of repaglinide: 
Oral contraceptives, rifampicin, barbiturates, carbamazepine, thiazides, corticosteroids, danazol, 
thyroid hormones and sympathomimetics. 
 
When these medications are administered to or withdrawn from a patient receiving repaglinide, the 
patient should be observed closely for changes in glycaemic control. 
 
When repaglinide is used together with other medicinal products that are mainly secreted by the bile, 
like repaglinide, any potential interaction should be considered. 
 
Paediatric population 
 
No interaction studies have been performed in children and adolescents. 
 
4.6 Fertility, pregnancy and lactation 
 
Pregnancy 
 
There are no studies of repaglinide in pregnant women. Repaglinide should be avoided during 
pregnancy. 
 
Breast-feeding 
 



17 

There are no studies in breast-feeding women. Repaglinide should not be used in breast-feeding 
women. 
 
Fertility 
 
Data from animal studies investigating effects on embryofetal and offspring development as well as 
excretion in milk is described in section 5.3. 
 
4.7 Effects on ability to drive and use machines 
 
NovoNorm has no direct influence on the ability to drive and use machines but may cause 
hypoglycaemia. 
 
Patients should be advised to take precautions to avoid hypoglycaemia whilst driving. This is 
particularly important in those who have reduced or absent awareness of the warning signs of 
hypoglycaemia or have frequent episodes of hypoglycaemia. The advisability of driving should be 
considered in these circumstances. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
 
The most frequently reported adverse reactions are changes in blood glucose levels, i.e. 
hypoglycaemia. The occurrence of such reactions depends on individual factors, such as dietary 
habits, dosage, exercise and stress. 
 
Tabulated list of adverse reactions 
 
Based on the experience with repaglinide and with other hypoglycaemic medicinal products the 
following adverse reactions have been seen: Frequencies are defined as: common (≥1/100 to <1/10); 
uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000) and not known 
(cannot be estimated from the available data). 
 
Immune system disorders Allergic reactions* Very rare  

Metabolism and nutrition 
disorders 

Hypoglycaemia Common 

Hypoglycaemic coma and 
hypoglycaemic 
unconsciousness 

Not known 

Eye disorders Refraction disorder* Very rare 

Cardiac disorders Cardiovascular disease Rare 

Gastrointestinal disorders Abdominal pain, diarrhoea Common 

Vomiting, constipation Very rare 

Nausea Not known 

Hepatobiliary disorders Abnormal hepatic function, 
increased liver enzymes* 

Very rare 

Skin and subcutaneous tissue 
disorders 

Hypersensitivity* Not known 

* see section Description of selected adverse reactions below 
 
Description of selected adverse reactions 
 



18 

Allergic reactions 
Generalised hypersensitivity reactions (e.g. anaphylactic reaction), or immunological reactions such 
as vasculitis. 
 
Refraction disorders 
Changes in blood glucose levels have been known to result in transient visual disturbances, especially 
at the commencement of treatment. Such disturbances have only been reported in very few cases after 
initiation of repaglinide treatment. No such cases have led to discontinuation of repaglinide treatment 
in clinical trials. 
 
Abnormal hepatic function, increased liver enzymes 
Isolated cases of increased liver enzymes have been reported during treatment with repaglinide. Most 
cases were mild and transient, and very few patients discontinued treatment due to increased liver 
enzymes. In very rare cases, severe hepatic dysfunction has been reported. 
 
Hypersensitivity 
Hypersensitivity reactions of the skin may occur as erythema, itching, rashes and urticaria. There is no 
reason to suspect cross-allergenicity with sulphonylurea due to the difference in chemical structure. 
 
Reporting of suspected adverse reactions 
 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V. 
 
4.9 Overdose 
 
Repaglinide has been given with weekly escalating doses from 4 - 20 mg four times daily in a 6 week 
period. No safety concerns were raised. As hypoglycaemia in this study was avoided through 
increased calorie intake, a relative overdose may result in an exaggerated glucose-lowering effect with 
development of hypoglycaemic symptoms (dizziness, sweating, tremor, headache etc.). Should these 
symptoms occur, adequate action should be taken to correct the low blood glucose (oral 
carbohydrates). More severe hypoglycaemia with seizure, loss of consciousness or coma should be 
treated with intravenous glucose. 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1 Pharmacodynamic properties 
 
Pharmaco-therapeutic group: Drugs used in diabetes, other blood glucose lowering drugs, excl. 
insulins, ATC code: A10BX02 
 
Mechanism of action 
 
Repaglinide is a short-acting oral secretagogue. Repaglinide lowers the blood glucose levels acutely 
by stimulating the release of insulin from the pancreas, an effect dependent upon functioning β-cells 
in the pancreatic islets. 
Repaglinide closes ATP-dependent potassium channels in the β-cell membrane via a target protein 
different from other secretagogues. This depolarises the β-cell and leads to an opening of the calcium 
channels. The resulting increased calcium influx induces insulin secretion from the β-cell. 
 
Pharmacodynamic effects 
 
In type 2 diabetic patients, the insulinotropic response to a meal occurred within 30 minutes after an 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


19 

oral dose of repaglinide. This resulted in a blood glucose-lowering effect throughout the meal period. 
The elevated insulin levels did not persist beyond the time of the meal challenge. Plasma repaglinide 
levels decreased rapidly, and low concentrations were seen in the plasma of type 2 diabetic patients 
4 hours post-administration. 
 
Clinical efficacy and safety 
 
A dose-dependent decrease in blood glucose was demonstrated in type 2 diabetic patients when 
administered in doses from 0.5 to 4 mg repaglinide. 
Clinical study results have shown that repaglinide is optimally dosed in relation to main meals 
(preprandial dosing). 
Doses are usually taken within 15 minutes of the meal, but the time may vary from immediately 
preceding the meal to as long as 30 minutes before the meal. 
 
One epidemiological study suggested an increased risk of acute coronary syndrome in repaglinide 
treated patients as compared to sulfonylurea treated patients (see sections 4.4 and 4.8). 
 
5.2 Pharmacokinetic properties 
 
Absorption 
 
Repaglinide is rapidly absorbed from the gastrointestinal tract, which leads to a rapid increase in the 
plasma concentration of the active substance. The peak plasma level occurs within one hour post 
administration. After reaching a maximum, the plasma level decreases rapidly. 
Repaglinide pharmacokinetics are characterised by a mean absolute bioavailability of 63% (CV 11%). 
 
No clinically relevant differences were seen in the pharmacokinetics of repaglinide, when repaglinide 
was administered 0, 15 or 30 minutes before a meal or in fasting state. 
 
A high interindividual variability (60%) in repaglinide plasma concentrations has been detected in the 
clinical trials. Intraindividual variability is low to moderate (35%) and as repaglinide should be 
titrated against the clinical response, efficacy is not affected by interindividual variability. 
 
Distribution 
 
Repaglinide pharmacokinetics are characterised by low volume of distribution, 30 L (consistent with 
distribution into intracellular fluid) and is highly bound to plasma proteins in humans (greater than 
98%). 
 
Elimination 
 
Repaglinide is eliminated rapidly within 4 - 6 hours from the blood. The plasma elimination half-life 
is approximately one hour. 
 
Repaglinide is almost completely metabolised, and no metabolites with clinically relevant 
hypoglycaemic effect have been identified. 
 
Repaglinide metabolites are excreted primarily via the bile. A small fraction (less than 8%) of the 
administered dose appears in the urine, primarily as metabolites. Less than 1% of repaglinide is 
recovered in faeces. 
 
Special patient groups 
 
Repaglinide exposure is increased in patients with hepatic insufficiency and in the elderly type 2 
diabetic patients. The AUC (SD) after 2 mg single dose exposure (4 mg in patients with hepatic 
insufficiency) was 31.4 ng/ml x hr (28.3) in healthy volunteers, 304.9 ng/ml x hr (228.0) in patients 



20 

with hepatic insufficiency, and 117.9 ng/ml x hr (83.8) in the elderly type 2 diabetic patients. 
After a 5 day treatment of repaglinide (2 mg x 3/day) in patients with a severe impaired renal function 
(creatinine clearance: 20-39 ml/min.), the results showed a significant 2-fold increase of the exposure 
(AUC) and half-life (t1/2) as compared to patients with normal renal function. 
 
Paediatric population 
No data are available. 
 
5.3 Preclinical safety data 
 
Non-clinical data revealed no special hazard for humans based on conventional studies of safety 
pharmacology, repeated dose toxicity, genotoxicity and carcinogenic potential. 
 
Repaglinide was shown not to be teratogenic in animal studies. Embryotoxicity, abnormal limb 
development in rat foetuses and new born pups, was observed in female rats exposed to high doses in 
the last stage of pregnancy and during the lactation period. Repaglinide was detected in the milk of 
animals. 
 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Microcrystalline cellulose (E460) 
Calcium hydrogen phosphate, anhydrous 
Maize starch 
Polacrilin potassium 
Povidone (polyvidone) 
Glycerol 85% 
Magnesium stearate 
Meglumine 
Poloxamer 
Iron oxide, yellow (E172) 
 
6.2 Incompatibilities 
 
Not applicable. 
 
6.3 Shelf life 
 
5 years. 
 
6.4 Special precautions for storage 
 
Store in the original package in order to protect from moisture. 
 
6.5 Nature and contents of container 
 
The blister pack (aluminium/aluminium) contains 30, 90, 120 or 270 tablets, respectively. 
Not all pack sizes may be marketed. 
 
6.6 Special precautions for disposal 
 
No special requirements. 
 
 



21 

7. MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
8. MARKETING AUTHORISATION NUMBERS 
 
EU/1/98/076/011-013, EU/1/98/076/024 
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
Date of first authorisation: 17 August 1998 
Date of last renewal: 23 July 2008 
 
 
10. DATE OF REVISION OF THE TEXT 
 
 
 
Detailed information on this medicinal product is available on the website of the European Medicines 
Agency http://www.ema.europa.eu. 
 

http://www.ema.europa.eu/


22 

1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 2 mg tablets 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Each tablet contains 2 mg of repaglinide. 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Tablet 
 
Repaglinide tablets are peach-coloured, round and convex and engraved with Novo Nordisk logo 
(Apis bull). 
 
 
4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Repaglinide is indicated in adults with type 2 diabetes mellitus whose hyperglycaemia can no longer 
be controlled satisfactorily by diet, weight reduction and exercise. Repaglinide is also indicated in 
combination with metformin in adults with type 2 diabetes mellitus who are not satisfactorily 
controlled on metformin alone. 
 
Treatment should be initiated as an adjunct to diet and exercise to lower the blood glucose in relation 
to meals. 
 
4.2 Posology and method of administration 
 
Posology 
 
Repaglinide is given preprandially and is titrated individually to optimise glycaemic control. In 
addition to the usual self-monitoring by the patient of blood and/or urinary glucose, the patient’s 
blood glucose must be monitored periodically by the physician to determine the minimum effective 
dose for the patient. Glycosylated haemoglobin levels are also of value in monitoring the patient’s 
response to therapy. Periodic monitoring is necessary to detect inadequate lowering of blood glucose 
at the recommended maximum dose level (i.e. primary failure) and to detect loss of adequate blood 
glucose-lowering response after an initial period of effectiveness (i.e. secondary failure). 
 
Short-term administration of repaglinide may be sufficient during periods of transient loss of control 
in type 2 diabetic patients usually controlled well on diet. 
 
Initial dose 
 
The dosage should be determined by the physician, according to the patient’s requirements. 
The recommended starting dose is 0.5 mg. One to two weeks should elapse between titration steps (as 
determined by blood glucose response). 
If patients are transferred from another oral hypoglycaemic medicinal product, the recommended 
starting dose is 1 mg. 
 
Maintenance 



23 

 
The recommended maximum single dose is 4 mg taken with main meals. 
The total maximum daily dose should not exceed 16 mg. 
 
Special populations 
 
Elderly 
No clinical studies have been conducted in patients >75 years of age. 
 
Renal impairment 
Repaglinide is not affected by renal disorders (see section 5.2). 
Eight percent of one dose of repaglinide is excreted through the kidneys and total plasma clearance of 
the product is decreased in patients with renal impairment. As insulin sensitivity is increased in 
diabetic patients with renal impairment, caution is advised when titrating these patients. 
 
Hepatic impairment 
No clinical studies have been conducted in patients with hepatic insufficiency. 
 
Debilitated or malnourished patients 
In debilitated or malnourished patients the initial and maintenance dosage should be conservative and 
careful dose titration is required to avoid hypoglycaemic reactions. 
 
Patients receiving other oral hypoglycaemic medicinal products 
Patients can be transferred directly from other oral hypoglycaemic medicinal products to repaglinide. 
However, no exact dosage relationship exists between repaglinide and the other oral hypoglycaemic 
medicinal products. The recommended maximum starting dose of patients transferred to repaglinide is 
1 mg given before main meals. 
 
Repaglinide can be given in combination with metformin, when the blood glucose is insufficiently 
controlled with metformin alone. In this case, the dosage of metformin should be maintained and 
repaglinide administered concomitantly. The starting dose of repaglinide is 0.5 mg, taken before main 
meals; titration is according to blood glucose response as for monotherapy. 
 
Paediatric population 
The safety and efficacy of repaglinide in children below 18 years have not been established. No data 
are available. 
 
Method of administration 
 
Repaglinide should be taken before main meals (i.e. preprandially). 
 
Doses are usually taken within 15 minutes of the meal but time may vary from immediately preceding 
the meal to as long as 30 minutes before the meal (i.e. preprandially 2, 3, or 4 meals a day). Patients 
who skip a meal (or add an extra meal) should be instructed to skip (or add) a dose for that meal. 
 
In the case of concomitant use with other active substances refer to sections 4.4 and 4.5 to assess the 
dosage. 
 
4.3 Contraindications 
 
• Hypersensitivity to repaglinide or to any of the excipients listed in section 6.1. 
• Diabetes mellitus type 1, C-peptide negative. 
• Diabetic ketoacidosis, with or without coma. 
• Severe hepatic function disorder. 
• Concomitant use of gemfibrozil (see section 4.5). 
 



24 

4.4 Special warnings and precautions for use 
 
General 
 
Repaglinide should only be prescribed if poor blood glucose control and symptoms of diabetes persist 
despite adequate attempts at dieting, exercise and weight reduction. 
 
When a patient stabilised on any oral hypoglycaemic medicinal product is exposed to stress such as 
fever, trauma, infection or surgery, a loss of glycaemic control may occur. At such times, it may be 
necessary to discontinue repaglinide and treat with insulin on a temporary basis. 
 
Hypoglycaemia 
 
Repaglinide, like other insulin secretagogues, is capable of producing hypoglycaemia. 
 
Combination with insulin secretagogues 
 
The blood glucose-lowering effect of oral hypoglycaemic medicinal products decreases in many 
patients over time. This may be due to progression of the severity of the diabetes or to diminished 
responsiveness to the medicinal product. This phenomenon is known as secondary failure, to 
distinguish it from primary failure, where the medicinal product is ineffective in an individual patient 
when first given. Adjustment of dose and adherence to diet and exercise should be assessed before 
classifying a patient as a secondary failure. 
 
Repaglinide acts through a distinct binding site with a short action on the β-cells. Use of repaglinide 
in case of secondary failure to insulin secretagogues has not been investigated in clinical trials. 
Trials investigating the combination with other insulin secretagogues have not been performed. 
 
Combination with Neutral Protamine Hagedorn (NPH) insulin or thiazolidinediones 
 
Trials of combination therapy with NPH insulin or thiazolidinediones have been performed. However, 
the benefit risk profile remains to be established when comparing to other combination therapies. 
 
Combination with metformin 
 
Combination treatment with metformin is associated with an increased risk of hypoglycaemia. 
 
Acute coronary syndrome 
 
The use of repaglinide might be associated with an increased incidence of acute coronary syndrome 
(e.g. myocardial infarction), see sections 4.8 and 5.1. 
 
Concomitant use 
 
Repaglinide should be used with caution or be avoided in patients receiving medicinal products which 
influence repaglinide metabolism (see section 4.5). If concomitant use is necessary, careful 
monitoring of blood glucose and close clinical monitoring should be performed. 
 
4.5 Interaction with other medicinal products and other forms of interaction 
 
A number of medicinal products are known to influence repaglinide metabolism. Possible interactions 
should therefore be taken into account by the physician: 
 
In vitro data indicate that repaglinide is metabolised predominantly by CYP2C8, but also by CYP3A4. 
Clinical data in healthy volunteers support CYP2C8 as being the most important enzyme involved in 
repaglinide metabolism with CYP3A4 playing a minor role, but the relative contribution of CYP3A4 



25 

can be increased if CYP2C8 is inhibited. Consequently metabolism, and by that clearance of 
repaglinide, may be altered by substances which influence these cytochrome P-450 enzymes via 
inhibition or induction. Special care should be taken when inhibitors of both CYP2C8 and 3A4 are 
co-administered simultaneously with repaglinide. 
 
Based on in vitro data, repaglinide appears to be a substrate for active hepatic uptake (organic anion 
transporting protein OATP1B1). Substances that inhibit OATP1B1 may likewise have the potential to 
increase plasma concentrations of repaglinide, as has been shown for ciclosporin (see below). 
 
The following substances may enhance and/or prolong the hypoglycaemic effect of repaglinide: 
Gemfibrozil, clarithromycin, itraconazole, ketokonazole, trimethoprim, ciclosporin, deferasirox, 
clopidogrel, other antidiabetic substances, monoamine oxidase inhibitors (MAOI), non selective beta 
blocking substances, angiotensin converting enzyme (ACE)-inhibitors, salicylates, NSAIDs, 
octreotide, alcohol, and anabolic steroids. 
 
Co-administration of gemfibrozil (600 mg twice daily), an inhibitor of CYP2C8, and repaglinide (a 
single dose of 0.25 mg) increased the repaglinide AUC 8.1-fold and Cmax 2.4-fold in healthy 
volunteers. Half-life was prolonged from 1.3 hr to 3.7 hr, resulting in possibly enhanced and 
prolonged blood glucose-lowering effect of repaglinide, and plasma repaglinide concentration at 7 hr 
was increased 28.6-fold by gemfibrozil. The concomitant use of gemfibrozil and repaglinide is 
contraindicated (see section 4.3). 
 
Co-administration of trimethoprim (160 mg twice daily), a moderate CYP2C8 inhibitor, and 
repaglinide (a single dose of 0.25 mg) increased the repaglinide AUC, Cmax and t½ (1.6-fold, 1.4-fold 
and 1.2-fold respectively) with no statistically significant effects on the blood glucose levels. This 
lack of pharmacodynamic effect was observed with a sub-therapeutic dose of repaglinide. Since the 
safety profile of this combination has not been established with dosages higher than 0.25 mg for 
repaglinide and 320 mg for trimethoprim, the concomitant use of trimethoprim with repaglinide 
should be avoided. If concomitant use is necessary, careful monitoring of blood glucose and close 
clinical monitoring should be performed (see section 4.4). 
 
Rifampicin, a potent inducer of CYP3A4, but also CYP2C8, acts both as an inducer and inhibitor of 
the metabolism of repaglinide. Seven days pre-treatment with rifampicin (600 mg), followed by co-
administration of repaglinide (a single dose of 4 mg) at day seven resulted in a 50% lower AUC 
(effect of a combined induction and inhibition). When repaglinide was given 24 hours after the last 
rifampicin dose, an 80% reduction of the repaglinide AUC was observed (effect of induction alone). 
Concomitant use of rifampicin and repaglinide might therefore induce a need for repaglinide dose 
adjustment which should be based on carefully monitored blood glucose concentrations at both 
initiation of rifampicin treatment (acute inhibition), following dosing (mixed inhibition and 
induction), withdrawal (induction alone) and up to approximately two weeks after withdrawal of 
rifampicin where the inductive effect of rifampicin is no longer present. It cannot be excluded that 
other inducers, e.g. phenytoin, carbamazepine, phenobarbital, St John’s wort, may have a similar 
effect. 
 
The effect of ketoconazole, a prototype of potent and competitive inhibitors of CYP3A4, on the 
pharmacokinetics of repaglinide has been studied in healthy subjects. Co-administration of 200 mg 
ketoconazole increased the repaglinide (AUC and Cmax) by 1.2-fold with profiles of blood glucose 
concentrations altered by less than 8% when administered concomitantly (a single dose of 4 mg 
repaglinide). Co-administration of 100 mg itraconazole, an inhibitor of CYP3A4, has also been 
studied in healthy volunteers, and increased the AUC by 1.4-fold. No significant effect on the glucose 
level in healthy volunteers was observed. In an interaction study in healthy volunteers, co-
administration of 250 mg clarithromycin, a potent mechanism-based inhibitor of CYP3A4, slightly 
increased the repaglinide (AUC) by 1.4-fold and Cmax by 1.7-fold and increased the mean incremental 
AUC of serum insulin by 1.5-fold and the maximum concentration by 1.6-fold. The exact mechanism 
of this interaction is not clear. 
 



26 

In a study conducted in healthy volunteers, the concomitant administration of repaglinide (a single 
dose of 0.25 mg) and ciclosporin (repeated dose at 100 mg) increased repaglinide AUC and Cmax about 
2.5-fold and 1.8-fold respectively. Since the interaction has not been established with dosages higher 
than 0.25 mg for repaglinide, the concomitant use of ciclosporin with repaglinide should be avoided. 
If the combination appears necessary, careful clinical and blood glucose monitoring should be 
performed (see section 4.4). 
 
In an interaction study with healthy volunteers, co-administration of deferasirox (30 mg/kg/day, 
4 days), a moderate inhibitor of CYP2C8 and CYP3A4, and repaglinide (single dose, 0.5 mg) resulted 
in an increase in repaglinide systemic exposure (AUC) to 2.3-fold (90% CI [2.03-2.63]) of control, a 
1.6-fold (90% CI [1.42-1.84]) increase in Cmax, and a small, significant decrease in blood glucose 
values. Since the interaction has not been established with dosages higher than 0.5 mg for repaglinide, 
the concomitant use of deferasirox with repaglinide should be avoided. If the combination appears 
necessary, careful clinical and blood glucose monitoring should be performed (see section 4.4). 
 
In an interaction study with healthy volunteers, co-administration of clopidogrel (300 mg loading 
dose), a CYP2C8 inhibitor, increased repaglinide exposure (AUC0–∞) 5.1-fold and continued 
administration (75 mg daily dose) increased repaglinide exposure (AUC0–∞) 3.9-fold. A small, 
significant decrease in blood glucose values was observed. Since the safety profile of the co-treatment 
has not been established in these patients, the concomitant use of clopidogrel and repaglinide should 
be avoided. If concomitant use is necessary, careful monitoring of blood glucose and close clinical 
monitoring should be performed (see section 4.4). 
 
β-blocking medicinal products may mask the symptoms of hypoglycaemia. 
 
Co-administration of cimetidine, nifedipine, oestrogen, or simvastatin with repaglinide, all CYP3A4 
substrates, did not significantly alter the pharmacokinetic parameters of repaglinide. 
 
Repaglinide had no clinically relevant effect on the pharmacokinetic properties of digoxin, 
theophylline or warfarin at steady state, when administered to healthy volunteers. Dosage adjustment 
of these compounds when co-administered with repaglinide is therefore not necessary. 
 
The following substances may reduce the hypoglycaemic effect of repaglinide: 
Oral contraceptives, rifampicin, barbiturates, carbamazepine, thiazides, corticosteroids, danazol, 
thyroid hormones and sympathomimetics. 
 
When these medications are administered to or withdrawn from a patient receiving repaglinide, the 
patient should be observed closely for changes in glycaemic control. 
 
When repaglinide is used together with other medicinal products that are mainly secreted by the bile, 
like repaglinide, any potential interaction should be considered. 
 
Paediatric population 
 
No interaction studies have been performed in children and adolescents.  
 
4.6 Fertility, pregnancy and lactation 
 
Pregnancy 
 
There are no studies of repaglinide in pregnant women. Repaglinide should be avoided during 
pregnancy. 
 
Breast-feeding 
 



27 

There are no studies in breast-feeding women. Repaglinide should not be used in breast-feeding 
women. 
 
Fertility 
 
Data from animal studies investigating effects on embryofetal and offspring development as well as 
excretion in milk is described in section 5.3. 
 
4.7 Effects on ability to drive and use machines 
 
NovoNorm has no direct influence on the ability to drive and use machines but may cause 
hypoglycaemia.  
 
Patients should be advised to take precautions to avoid hypoglycaemia whilst driving. This is 
particularly important in those who have reduced or absent awareness of the warning signs of 
hypoglycaemia or have frequent episodes of hypoglycaemia. The advisability of driving should be 
considered in these circumstances. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
 
The most frequently reported adverse reactions are changes in blood glucose levels, i.e. 
hypoglycaemia. The occurrence of such reactions depends on individual factors, such as dietary 
habits, dosage, exercise and stress. 
 
Tabulated list of adverse reactions 
 
Based on the experience with repaglinide and with other hypoglycaemic medicinal products the 
following adverse reactions have been seen: Frequencies are defined as: common (≥1/100 to <1/10); 
uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000) and not known 
(cannot be estimated from the available data). 
 
Immune system disorders Allergic reactions* Very rare  

Metabolism and nutrition 
disorders 

Hypoglycaemia Common 

Hypoglycaemic coma and 
hypoglycaemic 
unconsciousness 

Not known 

Eye disorders Refraction disorder* Very rare 

Cardiac disorders Cardiovascular disease Rare 

Gastrointestinal disorders Abdominal pain, diarrhoea Common 

Vomiting, constipation Very rare 

Nausea Not known 

Hepatobiliary disorders Abnormal hepatic function, 
increased liver enzymes* 

Very rare 

Skin and subcutaneous tissue 
disorders 

Hypersensitivity* Not known 

* see section Description of selected adverse reactions below 
 
Description of selected adverse reactions 
 



28 

Allergic reactions 
Generalised hypersensitivity reactions (e.g. anaphylactic reaction), or immunological reactions such 
as vasculitis. 
 
Refraction disorders 
Changes in blood glucose levels have been known to result in transient visual disturbances, especially 
at the commencement of treatment. Such disturbances have only been reported in very few cases after 
initiation of repaglinide treatment. No such cases have led to discontinuation of repaglinide treatment 
in clinical trials. 
 
Abnormal hepatic function, increased liver enzymes 
Isolated cases of increased liver enzymes have been reported during treatment with repaglinide. Most 
cases were mild and transient, and very few patients discontinued treatment due to increased liver 
enzymes. In very rare cases, severe hepatic dysfunction has been reported. 
 
Hypersensitivity 
 
Hypersensitivity reactions of the skin may occur as erythema, itching, rashes and urticaria. There is no 
reason to suspect cross-allergenicity with sulphonylurea due to the difference in chemical structure. 
 
Reporting of suspected adverse reactions 
 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V. 
 
4.9 Overdose 
 
Repaglinide has been given with weekly escalating doses from 4 - 20 mg four times daily in a 6 week 
period. No safety concerns were raised. As hypoglycaemia in this study was avoided through 
increased calorie intake, a relative overdose may result in an exaggerated glucose-lowering effect with 
development of hypoglycaemic symptoms (dizziness, sweating, tremor, headache etc.). Should these 
symptoms occur, adequate action should be taken to correct the low blood glucose (oral 
carbohydrates). More severe hypoglycaemia with seizure, loss of consciousness or coma should be 
treated with intravenous glucose. 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1 Pharmacodynamic properties 
 
Pharmaco-therapeutic group: Drugs used in diabetes, other blood glucose lowering drugs, excl. 
insulins, ATC code: A10BX02 
 
Mechanism of action 
 
Repaglinide is a short-acting oral secretagogue. Repaglinide lowers the blood glucose levels acutely 
by stimulating the release of insulin from the pancreas, an effect dependent upon functioning β-cells 
in the pancreatic islets. 
Repaglinide closes ATP-dependent potassium channels in the β-cell membrane via a target protein 
different from other secretagogues. This depolarises the β-cell and leads to an opening of the calcium 
channels. The resulting increased calcium influx induces insulin secretion from the β-cell. 
 
Pharmacodynamic effects 
 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


29 

In type 2 diabetic patients, the insulinotropic response to a meal occurred within 30 minutes after an 
oral dose of repaglinide. This resulted in a blood glucose-lowering effect throughout the meal period. 
The elevated insulin levels did not persist beyond the time of the meal challenge. Plasma repaglinide 
levels decreased rapidly, and low concentrations were seen in the plasma of type 2 diabetic patients 
4 hours post-administration. 
 
Clinical efficacy and safety 
 
A dose-dependent decrease in blood glucose was demonstrated in type 2 diabetic patients when 
administered in doses from 0.5 to 4 mg repaglinide. 
Clinical study results have shown that repaglinide is optimally dosed in relation to main meals 
(preprandial dosing). 
Doses are usually taken within 15 minutes of the meal, but the time may vary from immediately 
preceding the meal to as long as 30 minutes before the meal. 
 
One epidemiological study suggested an increased risk of acute coronary syndrome in repaglinide 
treated patients as compared to sulfonylurea treated patients (see sections 4.4 and 4.8). 
 
5.2 Pharmacokinetic properties 
 
Absorption 
 
Repaglinide is rapidly absorbed from the gastrointestinal tract, which leads to a rapid increase in the 
plasma concentration of the active substance. The peak plasma level occurs within one hour post 
administration. After reaching a maximum, the plasma level decreases rapidly. 
Repaglinide pharmacokinetics are characterised by a mean absolute bioavailability of 63% (CV 11%). 
 
No clinically relevant differences were seen in the pharmacokinetics of repaglinide, when repaglinide 
was administered 0, 15 or 30 minutes before a meal or in fasting state. 
 
A high interindividual variability (60%) in repaglinide plasma concentrations has been detected in the 
clinical trials. Intraindividual variability is low to moderate (35%) and as repaglinide should be 
titrated against the clinical response, efficacy is not affected by interindividual variability. 
 
Distribution 
 
Repaglinide pharmacokinetics are characterised by low volume of distribution, 30 L (consistent with 
distribution into intracellular fluid) and is highly bound to plasma proteins in humans (greater than 
98%). 
 
Elimination 
 
Repaglinide is eliminated rapidly within 4 - 6 hours from the blood. The plasma elimination half-life 
is approximately one hour. 
 
Repaglinide is almost completely metabolised, and no metabolites with clinically relevant 
hypoglycaemic effect have been identified. 
 
Repaglinide metabolites are excreted primarily via the bile. A small fraction (less than 8%) of the 
administered dose appears in the urine, primarily as metabolites. Less than 1% of repaglinide is 
recovered in faeces. 
 
Special patient groups 
 
Repaglinide exposure is increased in patients with hepatic insufficiency and in the elderly type 2 
diabetic patients. The AUC (SD) after 2 mg single dose exposure (4 mg in patients with hepatic 



30 

insufficiency) was 31.4 ng/ml x hr (28.3) in healthy volunteers, 304.9 ng/ml x hr (228.0) in patients 
with hepatic insufficiency, and 117.9 ng/ml x hr (83.8) in the elderly type 2 diabetic patients. 
After a 5 day treatment of repaglinide (2 mg x 3/day) in patients with a severe impaired renal function 
(creatinine clearance: 20-39 ml/min.), the results showed a significant 2-fold increase of the exposure 
(AUC) and half-life (t1/2) as compared to patients with normal renal function. 
 
Paediatric population 
No data are available. 
 
5.3 Preclinical safety data 
 
Non-clinical data revealed no special hazard for humans based on conventional studies of safety 
pharmacology, repeated dose toxicity, genotoxicity and carcinogenic potential. 
 
Repaglinide was shown not to be teratogenic in animal studies. Embryotoxicity, abnormal limb 
development in rat foetuses and new born pups, was observed in female rats exposed to high doses in 
the last stage of pregnancy and during the lactation period. Repaglinide was detected in the milk of 
animals. 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Microcrystalline cellulose (E460) 
Calcium hydrogen phosphate, anhydrous 
Maize starch 
Polacrilin potassium 
Povidone (polyvidone) 
Glycerol 85% 
Magnesium stearate 
Meglumine 
Poloxamer 
Iron oxide, red (E172) 
 
6.2 Incompatibilities 
 
Not applicable. 
 
6.3 Shelf life 
 
5 years. 
 
6.4 Special precautions for storage 
 
Store in the original package in order to protect from moisture. 
 
6.5 Nature and contents of container 
 
The blister pack (aluminium/aluminium) contains 30, 90, 120 or 270 tablets, respectively. 
Not all pack sizes may be marketed. 
 
6.6 Special precautions for disposal 
 
No special requirements. 
 
 



31 

7. MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
8. MARKETING AUTHORISATION NUMBERS 
 
EU/1/98/076/018-020, EU/1/98/076/022 
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
Date of first authorisation: 17 August 1998 
Date of last renewal: 23 July 2008 
 
 
10. DATE OF REVISION OF THE TEXT 
 
 
 
Detailed information on this medicinal product is available on the website of the European Medicines 
Agency http://www.ema.europa.eu. 
 

http://www.ema.europa.eu/


32 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX II 
 
A. MANUFACTURER RESPONSIBLE FOR BATCH RELEASE 
 
B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY 

AND USE 
 
C. OTHER CONDITIONS AND REQUIREMENTS OF THE 

MARKETING AUTHORISATION 
 
D. CONDITIONS OR RESTRICTIONS WITH REGARDS TO 

SAFE AND EFFECTIVE USE OF THE MEDICINAL 
PRODUCT 

 
 



33 

A. MANUFACTURER RESPONSIBLE FOR BATCH RELEASE 
 
Name and address of the manufacturer responsible for batch release 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 
 
Medicinal product subject to medical prescription. 
 
 
C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 

AUTHORISATION 
 
• Periodic Safety Update Reports 
 
The requirements for submission of periodic safety update reports for this medicinal product are set 
out in the list of Union reference dates (EURD list) provided for under Article 107c(7) of Directive 
2001/83/EC and any subsequent updates published on the European medicines web-portal. 
 
 
D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 

EFFECTIVE USE OF THE MEDICINAL PRODUCT 
 
• Risk Management Plan (RMP) 
 
Not applicable 
 
• Obligation to conduct post-authorisation measures 
 
The MAH shall complete, within the stated timeframe, the following measures: 
 
Description Due date 
In case a Risk Management Plan is submitted to any regulatory authority the MAH 
must inform the Rapporteur. 

N/A 

 
 
 
 
 



34 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX III 
 

LABELLING AND PACKAGE LEAFLET 
 
 



35 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

A. LABELLING 
 
 



36 

 
PARTICULARS TO APPEAR ON THE OUTER PACKAGING 
 
OUTER CARTON 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 0.5 mg tablets 
Repaglinide 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE 
 
Each tablet contains 0.5 mg of repaglinide 
 
 
3. LIST OF EXCIPIENTS 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
30 tablets 
90 tablets 
120 tablets 
270 tablets 
 
 
5. METHOD AND ROUTE OF ADMINISTRATION 
 
Read the package leaflet before use 
 
Oral use 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children 
 
 
7. OTHER SPECIAL WARNINGS, IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 
 
Store in the original package in order to protect from moisture 
 
 



37 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 
OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
12. MARKETING AUTHORISATION NUMBERS 
 
EU/1/98/076/004   30 tablets 
EU/1/98/076/005   90 tablets 
EU/1/98/076/006   120 tablets 
EU/1/98/076/023   270 tablets 
 
 
13. BATCH NUMBER 
 
Batch 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
Medicinal product subject to medical prescription 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
novonorm 0.5 mg 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER – HUMAN READABLE DATA 
 
PC: 
SN: 
NN: 



38 

 
MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS 
 
BLISTER FOIL 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 0.5 mg tablets 
Repaglinide 
 
 
2. NAME OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Batch 
 
 
5. OTHER 
 
 



39 

 
PARTICULARS TO APPEAR ON THE OUTER PACKAGING 
 
OUTER CARTON 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 1 mg tablets 
Repaglinide 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE 
 
Each tablet contains 1 mg of repaglinide 
 
 
3. LIST OF EXCIPIENTS 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
30 tablets 
90 tablets 
120 tablets 
270 tablets 
 
 
5. METHOD AND ROUTE OF ADMINISTRATION 
 
Read the package leaflet before use 
 
Oral use 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children 
 
 
7. OTHER SPECIAL WARNINGS, IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 
 
Store in the original package in order to protect from moisture 
 
 



40 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 
OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
12. MARKETING AUTHORISATION NUMBERS 
 
EU/1/98/076/011   30 tablets 
EU/1/98/076/012   90 tablets 
EU/1/98/076/013   120 tablets 
EU/1/98/076/024   270 tablets 
 
 
13. BATCH NUMBER 
 
Batch 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
Medicinal product subject to medical prescription 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
novonorm 1 mg 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER – HUMAN READABLE DATA 
 
PC: 
SN: 
NN: 



41 

 
MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS 
 
BLISTER FOIL 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 1 mg tablets 
Repaglinide 
 
 
2. NAME OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Batch 
 
 
5. OTHER 
 
 



42 

 
PARTICULARS TO APPEAR ON THE OUTER PACKAGING 
 
OUTER CARTON 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 2 mg tablets 
Repaglinide 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE 
 
Each tablet contains 2 mg of repaglinide 
 
 
3. LIST OF EXCIPIENTS 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
30 tablets 
90 tablets 
120 tablets 
270 tablets 
 
 
5. METHOD AND ROUTE OF ADMINISTRATION 
 
Read the package leaflet before use 
 
Oral use 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children 
 
 
7. OTHER SPECIAL WARNINGS, IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 
 
Store in the original package in order to protect from moisture 
 
 



43 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 
OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
12. MARKETING AUTHORISATION NUMBERS 
 
EU/1/98/076/018   30 tablets 
EU/1/98/076/019   90 tablets 
EU/1/98/076/020   120 tablets 
EU/1/98/076/022   270 tablets 
 
 
13. BATCH NUMBER 
 
Batch 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
Medicinal product subject to medical prescription 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
novonorm 2 mg 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER – HUMAN READABLE DATA 
 
PC: 
SN: 
NN: 



44 

 
MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS 
 
BLISTER FOIL 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
NovoNorm 2 mg tablets 
Repaglinide 
 
 
2. NAME OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Batch 
 
 
5. OTHER 
 
 



45 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

B. PACKAGE LEAFLET 
 
 



46 

Package leaflet: Information for the user 
NovoNorm 0.5 mg tablets 
NovoNorm 1 mg tablets 
NovoNorm 2 mg tablets 

 
Repaglinide 

 
Read all of this leaflet carefully before you start taking this medicine because it contains 
important information for you.  
– Keep this leaflet. You may need to read it again. 
– If you have any further questions, ask your doctor or pharmacist. 
– This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, 

even if their signs of illness are the same as yours. 
– If you get any side effects, talk to your doctor or pharmacist. This includes any possible side 

effects not listed in this leaflet. See section 4. 
 
What is in this leaflet 
 
1. What NovoNorm is and what it is used for 
2. What you need to know before you take NovoNorm 
3. How to take NovoNorm 
4. Possible side effects 
5. How to store NovoNorm 
6. Contents of the pack and other information 
 
 
1. What NovoNorm is and what it is used for 
 
NovoNorm is an oral antidiabetic medicine containing repaglinide which helps your pancreas 
produce more insulin and thereby lower your blood sugar (glucose). 
 
Type 2 diabetes is a disease in which your pancreas does not make enough insulin to control the 
sugar in your blood or where your body does not respond normally to the insulin it produces. 
 
NovoNorm is used to control type 2 diabetes in adults as an add-on to diet and exercise: treatment is 
usually started if diet, exercise and weight reduction alone have not been able to control (or lower) 
your blood sugar. NovoNorm can also be given with metformin, another medicine for diabetes. 
 
NovoNorm has been shown to lower the blood sugar, which helps to prevent complications from your 
diabetes. 
 
 
2. What you need to know before you take NovoNorm 
 
Do not take NovoNorm 
 
• If you are allergic to repaglinide or any of the other ingredients in this medicine (listed in 

section 6). 
• If you have type 1 diabetes. 
• If the acid level in your blood is raised (diabetic ketoacidosis). 
• If you have a severe liver disease. 
• If you take gemfibrozil (a medicine used to lower increased fat levels in the blood). 
 
Warnings and precautions 
Talk to your doctor before taking NovoNorm: 
 



47 

• If you have liver problems. NovoNorm is not recommended in patients with moderate liver 
disease. NovoNorm should not be taken if you have a severe liver disease (see Do not take 
NovoNorm). 

• If you have kidney problems. NovoNorm should be taken with caution. 
• If you are about to have major surgery or you have recently suffered a severe illness or 

infection. At such times diabetic control may be lost. 
• If you are under 18 or over 75 years of age. NovoNorm is not recommended. It has not been 

studied in these age groups. 
 
Talk to your doctor if any of the above applies to you. NovoNorm may not be suitable for you. Your 
doctor will advise you. 
 
Children and adolescents 
 
Do not take this medicine if you are under 18 years of age. 
 
If you get a hypo (low blood sugar) 
 
You may get a hypo (short for hypoglycaemia) if your blood sugar gets too low. This may happen: 
• If you take too much NovoNorm 
• If you exercise more than usual 
• If you take other medicines or suffer from liver or kidney problems (see other sections of 2. 

What you need to know before you take NovoNorm). 
 
The warning signs of a hypo may come on suddenly and can include: cold sweat; cool pale skin; 
headache; rapid heart beat; feeling sick; feeling very hungry; temporary changes in vision; 
drowsiness; unusual tiredness and weakness; nervousness or tremor; feeling anxious; feeling 
confused; difficulty in concentrating. 
If your blood sugar is low or you feel a hypo coming on: eat glucose tablets or a high sugar snack 
or drink, then rest. 
When symptoms of hypoglycaemia have disappeared or when blood sugar levels are stabilised 
continue NovoNorm treatment. 
Tell people you have diabetes and that if you pass out (become unconscious) due to a hypo, they 
must turn you on your side and get medical help straight away. They must not give you any food or 
drink. It could choke you. 
• If severe hypoglycaemia is not treated, it can cause brain damage (temporary or permanent) 

and even death. 
• If you have a hypo that makes you pass out, or a lot of hypos, talk to your doctor. The amount 

of NovoNorm, food or exercise may need to be adjusted. 
 
If your blood sugar gets too high 
 
Your blood sugar may get too high (hyperglycaemia). This may happen: 
• If you take too little NovoNorm 
• If you have an infection or a fever 
• If you eat more than usual 
• If you exercise less than usual. 
 
The warning signs of too high blood sugar appear gradually. They include: increased urination; 
feeling thirsty; dry skin and dry mouth. Talk to your doctor. The amount of NovoNorm, food or 
exercise may need to be adjusted. 
 
Other medicines and NovoNorm 
 



48 

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other 
medicines. 
You can take NovoNorm with metformin, another medicine for diabetes, if your doctor prescribes it. 
If you take gemfibrozil (used to lower increased fat levels in the blood) you should not take 
NovoNorm. 
 
Your body’s response to NovoNorm may change if you take other medicines, especially these: 
• Monoamine oxidase inhibitors (MAOI) (used to treat depression) 
• Beta blockers (used to treat high blood pressure or heart conditions) 
• ACE-inhibitors (used to treat heart conditions) 
• Salicylates (e.g. aspirin) 
• Octreotide (used to treat cancer) 
• Nonsteroidal anti-inflammatory drugs (NSAID) (a type of painkillers) 
• Steroids (anabolic steroids and corticosteroids – used for anemia or to treat inflammation) 
• Oral contraceptives (birth control pills) 
• Thiazides (diuretics or ‘water pills’) 
• Danazol (used to treat breast cysts and endometriosis) 
• Thyroid products (used to treat low levels of thyroid hormones) 
• Sympathomimetics (used to treat asthma) 
• Clarithromycin, trimethoprim, rifampicin (antibiotic medicines) 
• Itraconazole, ketokonazole (antifungal medicines) 
• Gemfibrozil (used to treat high blood fats) 
• Ciclosporin (used to suppress the immune system) 
• Deferasirox (used to reduce chronic iron overload) 
• Clopidogrel (prevents blood clots) 
• Phenytoin, carbamazepine, phenobarbital (used to treat epilepsy) 
• St. John’s wort (herbal medicine). 
 
NovoNorm with alcohol 
 
Alcohol can change the ability of NovoNorm to reduce the blood sugar. Watch for signs of a hypo. 
 
Pregnancy and breast-feeding 
 
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask 
your doctor for advice before taking this medicine. 
 
You should not take NovoNorm if you are pregnant or you are planning to become pregnant. 
 
You should not take NovoNorm if you are breast-feeding. 
 
Driving and using machines 
 
Your ability to drive or use a machine may be affected if your blood sugar is low or high. Bear in 
mind that you could endanger yourself or others. Please ask your doctor whether you can drive a car if 
you: 
• Have frequent hypos 
• Have few or no warning signs of hypos. 
 
 
3. How to take NovoNorm 
 
Always take this medicine exactly as your doctor has told you. Check with your doctor if you are not 
sure. 
Your doctor will work out your dose. 
 



49 

• The normal starting dose is 0.5 mg before each main meal. Swallow the tablets with a glass of 
water immediately before or up to 30 minutes before each main meal. 

• The dose may be adjusted by your doctor by up to 4 mg to be taken immediately before or up to 
30 minutes before each main meal. The maximum recommended daily dose is 16 mg. 

 
Do not take more NovoNorm than your doctor has recommended.  
 
If you take more NovoNorm than you should 
 
If you take too many tablets, your blood sugar may become too low, leading to a hypo. Please see If 
you get a hypo on what a hypo is and how to treat it. 
 
If you forget to take NovoNorm 
 
If you miss a dose, take the next dose as usual - do not double the dose. 
 
If you stop taking NovoNorm 
 
Be aware that the desired effect is not achieved if you stop taking NovoNorm. Your diabetes may get 
worse. If any change of your treatment is necessary contact your doctor first. 
 
If you have any further questions on the use of this medicine, ask your doctor or pharmacist. 
 
 
4. Possible side effects 
 
Like all medicines, this medicine can cause side effects, although not everybody gets them. 
 
Hypoglycaemia 
The most frequent side effect is hypoglycaemia which may affect up to 1 in 10 patients (see If you get 
a hypo in section 2). Hypoglycaemic reactions are generally mild/moderate but may occasionally 
develop into hypoglycaemic unconsciousness or coma. If this happens, medical assistance is needed 
immediately. 
 
Allergy 
Allergy is very rare (may affect up to 1 in 10,000 patients). Symptoms such as swelling, difficulty in 
breathing, rapid heartbeat, feeling dizzy and sweating could be signs of anaphylactic reaction. Contact 
a doctor immediately. 
 
Other side effects 
Common (may affect up to 1 in 10 patients) 
• Stomach pain 
• Diarrhoea. 
 
Rare (may affect up to 1 in 1,000 patients) 
• Acute coronary syndrome (but it may not be due to the medicine). 
 
Very rare (may affect up to 1 in 10,000 patients) 
• Vomiting 
• Constipation 
• Visual disturbances 
• Severe liver problems, abnormal liver function such as increased liver enzymes in your blood. 
 
Frequency not known 
• Hypersensitivity (such as rash, itchy skin, redening of the skin, swelling of the skin) 
• Feeling sick (nausea). 



50 

 
Reporting of side effects 
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects 
not listed in this leaflet. You can also report side effects directly via the national reporting system 
listed in Appendix V. By reporting side effects you can help provide more information on the safety 
of this medicine. 
 
5. How to store NovoNorm 
 
Keep this medicine out of the sight and reach of children. 
 
Do not use this medicine after the expiry date which is stated on the carton and the blister foil after 
EXP. The expiry date refers to the last date of that month. 
 
Store in the original package in order to protect from moisture. 
 
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to 
throw away medicines you no longer use. These measures will help protect the environment. 
 
 
6. Contents of the pack and other information 
 
What NovoNorm contains 
 
– The active substance is repaglinide. 
– The other ingredients are microcrystalline cellulose (E460), calcium hydrogen phosphate 

anhydrous, maize starch, polacrilin potassium, povidone (polyvidone), glycerol 85%, 
magnesium stearate, meglumine, poloxamer, iron oxide yellow (E172) only in the 1 mg tablets 
and iron oxide red (E172) only in the 2 mg tablets. 

 
What NovoNorm looks like and contents of the pack 
 
NovoNorm tablets are round and convex and engraved with the Novo Nordisk logo (Apis bull). The 
strengths are 0.5 mg, 1 mg and 2 mg. 0.5 mg tablets are white, 1 mg tablets are yellow and 2 mg 
tablets are peach-coloured. Four blister pack sizes are available. Each pack contains 30, 90, 120 or 
270 tablets. 
Not all pack sizes may be marketed. 
 
Marketing authorisation holder and manufacturer 
 
Novo Nordisk A/S 
Novo Allé, DK-2880 Bagsværd, Denmark. 
 
This leaflet was last revised in  
 
Other sources of information 
 
Detailed information on this medicine is available on the European Medicines Agency web site: 
http://www.ema.europa.eu. 
 
 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.ema.europa.eu/

	SUMMARY OF PRODUCT CHARACTERISTICS
	A. MANUFACTURER RESPONSIBLE FOR BATCH RELEASE
	B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE
	C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING AUTHORISATION
	D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND EFFECTIVE USE OF THE MEDICINAL PRODUCT
	A. LABELLING
	B. PACKAGE LEAFLET