Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

insulin glargine (Rx)Brand and Other Names:Lantus, Lantus SoloStar, more...Toujeo, Basaglar

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100 units/mL (Lantus; 10mL vial)
  • 100 units/mL (Lantus SoloSTAR; Basaglar KwikPen; 3 mL disposable prefilled pens)
  • 300 units/mL (Toujeo; 1.5 mL SolosStar disposable prefilled pen)
  • Note: Toujeo designed to release the insulin more gradually; thus, the product has been labeled an ultralong-acting insulin
more...

Type 1 or 2 Diabetes Mellitus

Lantus (long-acting) and Toujeo (ultra long-acting) are recombinant human insulin analogues indicated to improve glycemic control in adults with type 1 or 2 diabetes mellitus

Dosing Considerations

Indicated for once-daily SC administration; exhibits relatively constant glucose-lowering profile over 24 hr

May be administered at any time during the day; should be administered SC once daily at the same time every day

Dose must be individualized based on clinical response; blood glucose monitoring is essential in all patients receiving insulin therapy

Patients adjusting the amount or timing of dosage should do so only under medical supervision with appropriate glucose monitoring

In patients with type 1 diabetes, insulin glargine must be used in regimens with short-acting insulin

Should not be administered IV or via an insulin pump; IV administration of the usual SC dose could result in severe hypoglycemia

As with all insulins, injection sites should be rotated within the same region (abdomen, thigh, or deltoid) from one injection to the next to reduce the risk of lipodystrophy; no clinically relevant difference in insulin glargine absorption after abdominal, deltoid, or thigh SC administration

As with all insulins, the rate of absorption and, consequently, the onset and duration of action may be affected by exercise and other variables (eg, stress, intercurrent illness, changes in coadministered drugs, meal patterns)

Initial dose

  • Type 1 diabetes mellitus: Starting dose should be approximately one third of the total daily insulin requirements; short-acting, premeal insulin should be used to satisfy the remaining two thirds of the daily insulin requirements; insulin glargine should be used in combination with a short-acting or rapid-acting insulin; usual daily maintenance range is 0.5-1 unit/kg/day in divided doses; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.6-1.2 units/kg/day
  • Type 2 diabetes mellitus: Starting dose in patients who are not currently treated with insulin is 10 units (or 0.2 unit/kg) once daily
  • Dosage should be individualized under the supervision of a healthcare provider in accordance with the needs of the patient and adjusted according to blood glucose measuremen

Converting from other insulins

  • If changing from a treatment regimen with an intermediate- or long-acting insulin to a regimen with insulin glargine, the amount and timing of shorter-acting insulins and doses of any oral antidiabetic drugs may need to be adjusted
  • From once-daily NPH insulin to once-daily insulin glargine: Initial dose is the same as the dose of NPH that is being discontinued
  • From twice-daily NPH insulin to once-daily insulin glargine: Initial dose is 80% of the total daily NPH dose that is being discontinued; this dose reduction will lower the likelihood of hypoglycemia
  • Switching from intermediate-to-long acting insulins to Toujeo
    • To minimize the risk of hypoglycemia when changing patients from a once daily long-acting or intermediate-acting insulin product to Toujeo, the starting dose of Toujeo can be the same as the once daily long-acting dose
    • For patients controlled on Lantus (insulin glargine, 100 units/mL) expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control
  • Switching from intermediate-to-long-acting insulins to Lantus
    • If changing from a treatment regimen with an intermediate- or long-acting insulin to Lantus, a change in the dose of the basal insulin may be required and the amount and timing of the shorter-acting insulins and doses of any oral antidiabetic drugs may be needed to be adjusted
    • If changing patients from once daily Toujeo to once daily Lantus, the recommended initial Lantus dose is 80% of the Toujeo dose that is being discontinued; this dose reduction will lower the likelihood of hypoglycemia

Limitation of Use

Not recommended for treating diabetic ketoacidosis

Dosage Forms & Strengths

injectable solution

  • 100 units/mL (Lantus; 10mL vial)
  • 100 units/mL (Lantus SoloSTAR; Basalglar KwikPen; 3 mL disposable prefilled pens)
more...

Type 1 Diabetes Mellitus

Lantus is a long-acting human insulin analogue indicated to improve glycemic control in children with type 1 diabetes mellitus; Toujeo is not approved for use in children

<6 years: Safety and efficacy not established

≥6 years: Approximately one third of the total daily insulin requirements SC; rapid-acting or short-acting, premeal insulin should be used to satisfy the remaining two thirds of the daily insulin requirements; usual daily maintenance range in adolescents is ≤1.2 units/kg/day during growth spurts

Dosing considerations

  • Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect
  • If changing from a treatment regimen with an intermediate- or a long-acting insulin to a regimen with insulin glargine, the amount and timing of shorter-acting insulins and doses of any oral antidiabetic drugs may need to be adjusted
  • If changing from once-daily NPH insulin to once-daily insulin glargine: Initial dose is the same as the dose of NPH that is being discontinued
  • If changing from twice-daily NPH insulin to once-daily insulin glargine: Initial dose is 80% of the total daily NPH dose that is being discontinued; this dose reduction will lower the likelihood of hypoglycemia
Next

Interactions

Interaction Checker

insulin glargine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            Frequency Not Defined

            Headache

            Influenza-like symptoms

            Dyspepsia

            Diarrhea

            Back pain

            Pharyngitis

            Lipodystrophy

            Lipohypertrophy

            Pallor

            Palpitation

            Tachycardia

            Local allergic reaction

            Hypokalemia

            Peripheral edema

            Previous
            Next

            Warnings

            Contraindications

            Documented hypersensitivity

            During episodes of hypoglycemia

            Cautions

            Toujeo and Lantus are not interchangeable

            Not recommended for treating diabetic ketoacidosis; use IV short-acting insulin instead

            Do not administer IV or via an insulin pump

            Do not dilute or mix with other insulin or solution

            Never share insulin pens between patients, even if the needle is changed

            Decreased insulin requirements: Diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment

            Increased insulin requirements include fever, hyperthyroidism, trauma, infection, surgery

            Hyper-or hypoglycemia may occur with changes in insulin regimen; carry out under close medical supervision

            Increase frequency of glucose monitoring with changes to insulin dosage, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with renal or hepatic impairment and hypoglycemia unawareness

            Accidental mix-ups between insulin products can occur; instruct patients to check insulin labels before injection

            Rapid changes in serum glucose may induce symptoms of hypoglycemia

            Hypoglycemia is the most common cause of adverse reactions (eg, headache, tachycardia)

            May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or conditions that may decrease potassium

            Frequent glucose monitoring and insulin dose reduction may be required with renal or hepatic impairment; not recommended during periods of rapidly declining renal or hepatic function because of risk for prolonged hypoglycemia

            Use cautioin during pregnancy

            Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin; fluid retention may lead to or exacerbate heart failure; monitor for signs and symptoms of heart failure, treat accordingly, and consider discontinuing thiazolidinediones

            Cancer risk data inconclusive

            • The FDA reviewed 4 published observational studies, 3 of which suggested an increased risk of cancer associated with insulin glargine
            • It was determined that the evidence presented in these studies is inconclusive due to methodologic limitations
            • The duration of patient follow-up in all 4 studies was shorter than that which is generally considered necessary to evaluate cancer risk from drug exposure
            • Also, the 4 studies provided limited information on patients' use of insulin products; some studies did not take into account whether the patients used any antidiabetic drugs before the study time period or whether there were any changes in how patients used these drugs during the study period
            • Furthermore, risk factors for cancer (eg, smoking, family history of cancer, obesity) may not have been adequately controlled for in these studies
            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Considered safe for use while breast feeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Regulates glucose metabolism

            Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis and enhances protein synthesis; targets include skeletal muscle, liver, and adipose tissue

            Absorption

            Bioavailability: Delayed absorption from SC site

            Onset of action: 3-4 hr

            Duration: 24 hr (range: 10.8 hr to >24 hr)

            Peak plasma time: Forms microprecipitate in fatty tissue from which a small amount of insulin is gradually released; no pronounced peaks; released at constant rate over >24 h

            Metabolism

            Adipose tissue/muscle

            Partly metabolized at the carboxyl terminus of the B chain in the subcutaneous depot to form 2 active metabolites with in vitro activity similar to that of insulin

            Metabolites (active): M1 (21A-Gly-insulin) and M2 (21A-Gly-des-30BThr-insulin)

            Elimination

            Excretion: Urine

            Previous
            Next

            Administration

            Instructions

            Inject SC once daily into the abdominal area, thigh, or deltoid at the same time each day

            Rotate injection sites within the same region from 1 injection to the next to reduce the risk of lipodystrophy

            Individualize and titrate dose based on the individual’s metabolic needs, blood glucose monitoring results, and glycemic control goal

            The dosage ranges from 1 to 80 units per each injection

            To minimize the risk of hypoglycemia titrate the dose no more frequently than every 3-4 day

            Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (ie, macronutrient content or timing of food intake), changes in renal or hepatic function, or during acute illness to minimize the risk of hypoglycemia or hyperglycemia

            To minimize the risk of hypoglycemia, do not administer IV, IM, or via insulin pump

            To minimize the risk of hypoglycemia, do not dilute or mix with any other insulin products or solutions

            Storage

            Unopened vial or pen (not in-use)

            • Refrigerated (36-46°F [2-8°C]): Until expiration date
            • Unrefrigerated and kept from direct heat and light (ie, temperature does not exceed 86°F [30°C]): Up to 28 days
            • Do not freeze

            Opened vial or pen (in-use)

            • Vial: 28 days at room temperature or refrigerated
            • Pen: 28 days; store only at room temperature (do not refrigerate)
            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.