Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 100 units/mL (Humalog; 10mL vial)
- 100 units/mL (Admelog; 10mL vial)
- 100 units/mL (Lyumjev; 10mL vial)
injectable pen
- 100 units/mL (Humalog KwikPen; Humalog Junior KwikPen 3mL pen or cartridge)
- 100 units/mL (Admelog SoloStar; 3 mL)
- 100 units/mL (Lyumjev KwikPen; Lyumjev Junior KwikPen; Lyumjev Tempo Pen; 3 mL)
- 200 units/mL (Humalog KwikPen; 3mL pen)
- 200 units/mL (Lyumjev KwikPen; 3mL pen)
- KwikPen dose increment: 1 unit; maximum dose/injection is 60 units
- Junior KwikPen dose increment: 0.5 unit; maximum dose/injection is 30 units
Type 1 or 2 Diabetes Mellitus
Rapid-acting human insulin analogue indicated to improve glycemic control in patients with type 1 or 2 diabetes mellitus
Type 1 diabetes mellitus
- 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 0.8-1.2 units/kg/day
- Intermediate- or long-acting insulin: Approximately one-third of the total daily insulin requirements SC
- Rapid-acting or short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements
Type 2 diabetes mellitus
- Intermediate- or long-acting insulin: 10 units/day SC (or 0.1-0.2 unit/kg/day) at bedtime generally recommended
- Short-acting insulin: If necessary, start up to 4 units, 0.1 unit/kg SC within 15 min before each meal, or 10% basal dose; if A1C <8%, consider decreasing basal insulin dose by same amount
- Increase by 1-2 units or 10-15% qWeek or q2Weeks once self-monitoring of blood glucose (SMBG) is achieved (ADA guidelines 2018)
Dosage Modifications
Dose adjustment and increased frequency of glucose monitoring
- See Warnings
- Coadministration of drugs that increase the risk of hypoglycemia, and drugs that may increase or decrease blood glucose lowering effects
- Renal and hepatic impairment: May increase risk for hypoglycemia
Dosing Considerations
Do not mix SC injection with insulin preparations other than NPH insulin
Do not mix IV or continuous SC infusions with any other insulins
Do NOT transfer Humalog U-200 from the KwikPen to a syringe for administration; the markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia
Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed
Do NOT mix Humalog U-200 with any other insulins
Do NOT administer Humalog U-200 using a continuous subcutaneous infusion pump (i.e., insulin pump); insulin pump is to be used only for Humalog U-100
Do NOT administer Humalog U-200 intravenously
Dosage Forms & Strengths
injectable solution
- 100 units/mL (Humalog; 10mL vial)
- 100 units/mL (Admelog; 10mL vial)
injectable pen
- 100 units/mL (Humalog KwikPen; Humalog Junior KwikPen 3mL pen or cartridge)
- 100 units/mL (Admelog SoloStar; 3 mL)
- 100 units/mL (Lyumjev KwikPen; Lyumjev Junior KwikPen; Lyumjev Tempo Pen; 3 mL)
- 200 units/mL (Humalog KwikPen; 3mL pen)
- KwikPen dose increment: 1 unit; maximum dose/injection is 60 units
- Junior KwikPen dose increment: 0.5 unit; maximum dose/injection is 30 units
Type 1 Diabetes Mellitus
Admelog, Humalog only
Rapid-acting human insulin analogue indicated to improve glycemic control in patients with diabetes mellitus
<3 years: Safety and efficacy not established
≥3 years: 0.4-1 units/kg/day SC of total insulin with higher amounts required during puberty; otherwise, use adult dosing (0.5-1 unit/kg/day) (ADA guidelines 2018)
See also Administration
Type 2 Diabetes Mellitus
Safety and efficacy not established
Dosing Considerations
Approved for use in children aged ≥3 yr for SC daily injections and for SC continuous infusion by external insulin pump
Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed
Humalog U-200 with not for mixing with any other insulins
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- pramlintide
insulin lispro, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.
Serious - Use Alternative (2)
- ethanol
ethanol, insulin lispro. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.
- macimorelin
insulin lispro, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may transiently elevate growth hormone (GH) concentrations may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.
Monitor Closely (130)
- acarbose
acarbose, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- albiglutide
albiglutide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- alogliptin
alogliptin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- aripiprazole
aripiprazole, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- asenapine
asenapine, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- aspirin
aspirin increases effects of insulin lispro by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Insulin dose adjustment and increased frequency of glucose monitoring may be required.
- atazanavir
atazanavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- azilsartan
azilsartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- benazepril
benazepril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.
- bexagliflozin
bexagliflozin increases effects of insulin lispro by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin to avoid hypoglycemia when coadministered with bexagliflozin.
- bitter melon
bitter melon increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypoglycemia.
- canagliflozin
insulin lispro, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.
canagliflozin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents. - candesartan
candesartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- captopril
captopril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood glucose. Monitor blood glucose.
- chlorpropamide
chlorpropamide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- cinnamon
cinnamon increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Potential for hypoglycemia.
- ciprofibrate
ciprofibrate increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.
- ciprofloxacin
ciprofloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.
- clozapine
clozapine, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- dapagliflozin
insulin lispro, dapagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with dapagliflozin.
dapagliflozin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents. - darunavir
darunavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- deflazacort
insulin lispro and deflazacort both decrease serum potassium. Use Caution/Monitor.
- dexfenfluramine
dexfenfluramine increases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Dexfenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.
- dichlorphenamide
dichlorphenamide and insulin lispro both decrease serum potassium. Use Caution/Monitor.
- disopyramide
disopyramide increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- dulaglutide
dulaglutide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- empagliflozin
empagliflozin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with SGLT2 inhibitors.
- enalapril
enalapril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- eprosartan
eprosartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- ertugliflozin
ertugliflozin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with ertugliflozin.
- ethinylestradiol
ethinylestradiol decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Oral contraceptives may decrease hypoglycemic effects of antidiabetics by impairing glucose tolerance. Monitor for glycemic control in diabetic patients.
- exenatide injectable solution
exenatide injectable solution, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- exenatide injectable suspension
exenatide injectable suspension, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- fenfluramine
fenfluramine increases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.
- fenofibrate
fenofibrate increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.
- fenofibrate micronized
fenofibrate micronized increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.
- fenofibric acid
fenofibric acid increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.
- fleroxacin
fleroxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.
- fluoxetine
fluoxetine increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and fluoxetine may require insulin dosage adjustment and increased glucose monitoring.
- fosamprenavir
fosamprenavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- fosinopril
fosinopril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- gemfibrozil
gemfibrozil increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.
- gemifloxacin
gemifloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.
- glimepiride
glimepiride, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- glipizide
glipizide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- glucagon
glucagon decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- glucagon intranasal
glucagon intranasal decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- glyburide
glyburide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- iloperidone
iloperidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- imidapril
imidapril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- indinavir
indinavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- irbesartan
irbesartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- isocarboxazid
isocarboxazid increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- ketotifen, ophthalmic
ketotifen, ophthalmic, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Combination may result in thrombocytopenia (rare). Monitor CBC.
- lanreotide
lanreotide increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and somatostatin analogs may require insulin dosage adjustment and increased glucose monitoring.
- levofloxacin
levofloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.
- linagliptin
linagliptin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- linezolid
linezolid increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- liraglutide
liraglutide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- lisinopril
lisinopril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- lithium
lithium, insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.
- lonapegsomatropin
lonapegsomatropin decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Closely monitor blood glucose when treated with antidiabetic agents. Lonapegsomatropin may decrease insulin sensitivity, particularly at higher doses. Patients with diabetes mellitus may require adjustment of their doses of insulin and/or other antihyperglycemic agents.
lonapegsomatropin decreases effects of insulin lispro by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone (GH) analogs may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating growth hormone. - lopinavir
lopinavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- losartan
losartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- lurasidone
lurasidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- magnesium salicylate
magnesium salicylate increases effects of insulin lispro by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Insulin dose adjustment and increased frequency of glucose monitoring may be required.
- marijuana
marijuana decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor.
- mecasermin
mecasermin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Additive hypoglycemic effects.
- metformin
metformin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- metoclopramide intranasal
metoclopramide intranasal increases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Increased GI motility by metoclopramide may increase delivery of food to the intestines and increase blood glucose. Monitor blood glucose and adjust insulin dosage regimen as needed.
- metreleptin
insulin lispro, metreleptin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of metreleptin with insulin and/or insulin secretagogues (eg, sulfonylureas, meglitinide derivatives) may increase risk for hypoglycemia; may require lower dose of insulin or insulin secretagogue.
- miglitol
miglitol, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- moexipril
moexipril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- moxifloxacin
moxifloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.
- nadolol
nadolol, insulin lispro. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.
- nateglinide
nateglinide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- nelfinavir
nelfinavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- niacin
niacin decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.
- octreotide
octreotide increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and somatostatin analogs may require insulin dosage adjustment and increased glucose monitoring.
- ofloxacin
ofloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.
- olanzapine
olanzapine, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- olmesartan
olmesartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- opuntia ficus indica
opuntia ficus indica increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- paliperidone
paliperidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- pasireotide
pasireotide increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and somatostatin analogs may require insulin dosage adjustment and increased glucose monitoring.
- pentamidine
pentamidine, insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- perindopril
perindopril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- phenelzine
phenelzine increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- pindolol
pindolol, insulin lispro. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.
- pioglitazone
insulin lispro increases toxicity of pioglitazone by unknown mechanism. Use Caution/Monitor. Insulin may increase the fluid retention associated with thiazolidinediones (peroxisome proliferator-activated receptor [PPAR]-gamma agonists).
pioglitazone, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents. - procarbazine
procarbazine increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- propranolol
propranolol, insulin lispro. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.
- quetiapine
quetiapine, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- quinapril
quinapril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- ramipril
ramipril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- rasagiline
rasagiline increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- risperidone
risperidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- ritonavir
ritonavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- rosiglitazone
insulin lispro increases toxicity of rosiglitazone by unknown mechanism. Use Caution/Monitor. Insulin may increase the fluid retention associated with thiazolidinediones (peroxisome proliferator-activated receptor [PPAR]-gamma agonists).
rosiglitazone, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents. - sacubitril/valsartan
sacubitril/valsartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- salsalate
salsalate increases effects of insulin lispro by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Insulin dose adjustment and increased frequency of glucose monitoring may be required.
- saquinavir
saquinavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- saxagliptin
saxagliptin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- selegiline
selegiline increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- selegiline transdermal
selegiline transdermal increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- semaglutide
semaglutide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with GLP-1 agonists may increase hypoglycemia risk. Lowering the insulin dose may reduce hypoglycemia risk.
- shark cartilage
shark cartilage increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Theoretical interaction.
- sitagliptin
sitagliptin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
insulin lispro and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- somapacitan
somapacitan decreases effects of insulin lispro by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone (GH) analogs may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating growth hormone.
- somatrogon
somatrogon decreases effects of insulin lispro by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone (GH) analogs may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating growth hormone.
- somatropin
somatropin decreases effects of insulin lispro by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone (GH) analogs may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating growth hormone.
- sotagliflozin
sotagliflozin increases effects of insulin lispro by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Hypoglycemia risk increased. Lower dose of insulin may be required.
- sulfadiazine
sulfadiazine increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.
- sulfamethoxypyridazine
sulfamethoxypyridazine increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- sulfisoxazole
sulfisoxazole increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.
- telmisartan
telmisartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- testosterone intranasal
testosterone intranasal increases effects of insulin lispro by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Androgens may decrease blood glucose and, therefore, may necessitate a decrease in the dose of antidiabetic medication.
- timolol
timolol, insulin lispro. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.
- tipranavir
tipranavir decreases effects of insulin lispro by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .
- tolazamide
tolazamide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- tolbutamide
tolbutamide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.
- trandolapril
trandolapril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- tranylcypromine
tranylcypromine increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.
- valsartan
valsartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
- xipamide
xipamide decreases levels of insulin lispro by increasing renal clearance. Use Caution/Monitor.
- ziprasidone
ziprasidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
Minor (80)
- agrimony
agrimony increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- American ginseng
American ginseng increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- amitriptyline
amitriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- amoxapine
amoxapine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- anamu
anamu increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.
- aspirin rectal
aspirin rectal increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- balsalazide
balsalazide increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- bendroflumethiazide
bendroflumethiazide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- bexarotene
bexarotene increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- budesonide
budesonide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- chlorthalidone
chlorthalidone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- chromium
chromium increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- clomipramine
clomipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- clonidine
clonidine decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.
clonidine, insulin lispro. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production. - coenzyme Q10
coenzyme Q10 increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Monitor insulin requirements.
- cornsilk
cornsilk increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).
- cortisone
cortisone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- cyclopenthiazide
cyclopenthiazide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- damiana
damiana decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.
- danazol
danazol increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- deflazacort
deflazacort decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- desipramine
desipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- devil's claw
devil's claw increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- dexamethasone
dexamethasone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- diflunisal
diflunisal increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- doxepin
doxepin increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- elderberry
elderberry increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (in vitro research).
- eucalyptus
eucalyptus increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.
- fludrocortisone
fludrocortisone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- fluoxymesterone
fluoxymesterone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- fo-ti
fo-ti increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- forskolin
forskolin increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Colenol, a compound found in Coleus root, may stimulate insulin release.
- gotu kola
gotu kola increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).
- guanfacine
guanfacine decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.
guanfacine, insulin lispro. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production. - gymnema
gymnema increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- horse chestnut seed
horse chestnut seed increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- hydrochlorothiazide
hydrochlorothiazide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- hydrocortisone
hydrocortisone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- imipramine
imipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- indapamide
indapamide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- isoniazid
isoniazid decreases effects of insulin lispro by unspecified interaction mechanism. Minor/Significance Unknown.
- juniper
juniper increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).
- lofepramine
lofepramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- lycopus
lycopus increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).
- maitake
maitake increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (animal research).
- maprotiline
maprotiline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- mesalamine
mesalamine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- mesterolone
mesterolone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- methylprednisolone
methylprednisolone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- methyltestosterone
methyltestosterone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- metolazone
metolazone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.
- nettle
nettle increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).
- nortriptyline
nortriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- ofloxacin
ofloxacin, insulin lispro. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential dysglycemia.
- oxandrolone
oxandrolone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- oxymetholone
oxymetholone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- panax ginseng
panax ginseng increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- pegvisomant
pegvisomant increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- potassium acid phosphate
potassium acid phosphate increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.
- potassium chloride
potassium chloride increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.
- potassium citrate
potassium citrate increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.
- prednisolone
prednisolone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- prednisone
prednisone decreases effects of insulin lispro by pharmacodynamic antagonism. Minor/Significance Unknown.
- protriptyline
protriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- sage
sage increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- salicylates (non-asa)
salicylates (non-asa) increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- Siberian ginseng
Siberian ginseng increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- sulfasalazine
sulfasalazine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- testosterone
testosterone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- testosterone buccal system
testosterone buccal system increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- testosterone topical
testosterone topical increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- tongkat ali
tongkat ali increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypoglycemia.
- trazodone
trazodone increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- trimipramine
trimipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- vanadium
vanadium increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- willow bark
willow bark increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
Adverse Effects
>10%
Admelog
- Severe hypoglycemia, after 52 weeks (13.5%)
- Nasopharyngitis, in combination with insulin glargine (13.1%)
Humalog (Type 1 Diabetes)
- Flu syndrome (34.6%)
- Pharyngitis (33.3%)
- Rhinitis (29.6%)
- Headache (24.7%)
- Pain (19.8%)
- Increased cough (17.3%)
- Infection (13.6%)
Humalog (Type 2 Diabetes)
- Headache (11.6%)
- Pain (10.8%)
- Infection (10.1%)
Admelog
- Upper respiratory tract infection, in combination with insulin glargine (6%)
- Severe hypoglycemia, after 26 weeks (2.4%)
Humalog, continuous SC insulin infusion
- Infusion site reactions (2.6%)
Humalog (Type 1 Diabetes)
- Accidental injury (8.6%)
- Diarrhea (8.6%)
- Myalgia (7.4%)
- Abdominal pain (7.4%)
- Asthenia (7.4%)
- Bronchitis (7.4%)
- Urinary tract infection (6.2%)
- Dysmenorrhea (6.2%)
- Surgical procedure (6.2%)
- Fever (6.2%)
- Nausea (6.2%)
Humalog (Type 2 Diabetes)
- Rhinitis (8.1%)
- Surgical procedure (7.4%)
- Pharyngitis (6.6%)
Frequency Not Defined
Hypoglycemia
Pallor
Palpitation
Redness
Hunger
Nausea
Tachycardia
Lipodystrophy
Lipohypertrophy
Local allergic reaction
Hypokalemia
Postmarketing Reports
Hypoglycemia from medication errors
Localized cutaneous amyloidosis
Warnings
Contraindications
During episodes of hypoglycemia
Hypersensitivity to drug or excipients
Cautions
Never share a pen between patients even if the needle is changed
Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia; adjust dosage cautiously and closely monitor blood glucose
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
Do not transfer Humalog U-200 from the KwikPen to a syringe for administration; the markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia
Insulin pump or insulin infusion set malfunction or insulin degradation can rapidly lead to hyperglycemia and ketoacidosis; promptly identify and correct the cause of hyperglycemia or ketosis is necessary; interim insulin lispro injections may be required; patients using continuous SC insulin infusion pump therapy must be trained to administer insulin by injection and have alternate insulin therapy available in case of pump failure
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
Patients receiving therapy may experience redness, swelling, or itching at site of injection; these minor reactions usually resolve in a few days to a few weeks, but in some occasions may require discontinuation of therapy
Severe, life-threatening, generalized allergy including anaphylaxis may occur; if hypersensitivity reactions occur, discontinue treatment; treat accordingly and monitor until resolution of signs and symptoms
Hyperglycemia or hypoglycemia with changes in insulin regimen
- Hypoglycemia is the most common adverse reaction; severe hypoglycemia can cause seizures, may be life-threatening, or cause death
- Decreased insulin requirements may require dose adjustment (eg, diarrhea, nausea, vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment)
- Increased insulin requirements may require dose adjustment (eg, fever, hyperthyroidism, trauma, infection, surgery)
- Self-monitoring of blood glucose is essential in preventing and managing of hypoglycemia; closely monitor high-risk patients and patients who have reduced symptomatic awareness of hypoglycemia
- Risk of hypoglycemia after an injection correlates to the insulin’s duration of action and highest when the glucose lowering effect of the insulin is maximal; glucose lowering effect time course of insulin lispro may vary in different individuals or at different times in the same individual and depends on many conditions, (eg, area of injection, injection site blood supply, temperature
- Other factors which may increase the risk of hypoglycemia include changes in meal pattern (eg, macronutrient content or timing of meals), changes in level of physical activity, or changes to concomitant medications
- Patients with renal or hepatic impairment may be at higher risk of hypoglycemia
- Changes in insulin, insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia
- Changes should be made cautiously and only under close medical supervision and frequency of blood glucose monitoring should be increased
- Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis reported to result in hyperglycemia; a sudden change in the injection site (to unaffected area) has been reported to result in hypoglycemia
- Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring
- Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change injection site to unaffected areas and closely monitor for hypoglycemia
- For patients with type 2 diabetes, dosage adjustments in concomitant oral antidiabetic treatment may be needed
- Medication errors may cause hypoglycemia; accidental mix-ups between insulin products reported; to avoid medication errors between this drug and other insulins, instruct patients to always check insulin label before each injection; do not transfer Humalog U-200 from the Humalog KwikPen to a syringe; the markings on insulin syringe will not measure dose correctly and can result in overdosage and severe hypoglycemia
Drug interactions overview
- Coadministration with antidiabetic agents, salicylates, sulfonamide antibiotics, monoamine oxidase inhibitors, fluoxetine, pramlintide, disopyramide, fibrates, propoxyphene, pentoxifylline, ACE inhibitors, angiotensin II receptor blocking agents, and somatostatin analogs (eg, octreotide) may increase the risk of hypoglycemia (see Dosage Modifications)
- Coadministered with corticosteroids, isoniazid, niacin, estrogens, oral contraceptives, phenothiazines, danazol, diuretics, sympathomimetic agents (eg, epinephrine, albuterol, terbutaline), somatropin, atypical antipsychotics, glucagon, protease inhibitors, and thyroid hormones may decrease glucose lowering effects of insulin lispro (see Dosage Modifications)
- Glucose lowering effect of insulin lispro may be increased or decreased with coadministered with beta blockers, clonidine, lithium salts, and alcohol; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia
- Signs and symptoms of hypoglycemia may be blunted when beta blockers, clonidine, guanethidine, and reserpine are coadministered with insulin lispro
Pregnancy & Lactation
Pregnancy
Published studies with insulin lispro used during pregnancy have not reported an association between insulin lispro and induction of major birth defects, miscarriage, or adverse maternal or fetal outcomes; there are risks to mother and fetus associated with poorly controlled diabetes in pregnancy
Diabetes or gestational diabetes patients’ insulin requirements may decrease during the first trimester, generally increase during the second and third trimesters, and rapidly decline after delivery
Female patients should be advised to tell their physicians if they intend to become, or if they become pregnant while taking insulin lispro
Published studies with human insulins suggest optimizing overall glycemic control (eg, postprandial control, before conception, during pregnancy) improves fetal outcome
Limited available data with Admelog in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes
Poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications; poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity
Animal data
- In a combined fertility and embryo-fetal development study, female rats were given SC insulin lispro injections of 5 and 20 units/kg/day (0.8 and 3 times the human SC dose of 1 unit/kg/day, based on units/body surface area, respectively) from 2 weeks prior to cohabitation through gestation day 19; fetal growth retardation was produced at the 20 units/kg/day-dose as indicated by decreased fetal weight and an increased incidence of fetal runts/litter
Lactation
Available data from published literature suggests that exogenous human insulin products, including insulin lispro, are transferred into human milk
There are no adverse reactions reported in breastfed infants in the literature; there are no data on effects of exogenous human insulin products, including insulin lispro, on milk production
Consider developmental and health benefits of breastfeeding along with mother’s clinical need for insulin, any potential adverse effects on breastfed child from therapy or from underlying maternal condition
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.Pharmacology
Mechanism of Action
Protein hormone; stimulates glucose uptake by peripheral cells
Regulates glucose metabolism; insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis and enhance protein synthesis; targets include skeletal muscle, liver, and adipose tissue
Absorption
Humalog
- Average time required to attain near normoglycemia for IV administration was 129 minutes
- Mean area under the glucose infusion rate curves: 125 g (Humalog U-200) and 126 g (Humalog U-100)
- Bioavailability: 55-77% following SC; well absorbed
- Onset: 0.5-5 hr (initial); 0.5-2.5 hr Duration of action: ≤5 hr
- Peak plasma time, 0.1 to 0.4 unit/kg dose: 0.5-1.5 hr
- Mean observed area under the serum insulin concentration-time curve from time zero to infinity was 2360 pmol·hr/L (Humalog U-200) and 2390 pmol·hr/L (Humalog U-200)
Admelog
- Mean area under the glucose infusion rate curves, SC use: 1953.5 mg/kg
- Mean maximum glucose infusion rate, SC use: 9.97 mg/min/kg
- Mean observed area under the serum insulin concentration-time curve from time zero to infinity was 12800 pg⋅hr/mL
- Peak insulin lispro concentration: 5070 pg/mL
- Median peak plasma time: 0.83 hr
Distribution
Vd: 1.55 L/kg (0.1 unit/kg-dose); 0.72 L/kg (0.2 unit/kg-dose)
Metabolism
Human metabolism studies have not been conducted Animal studies indicate that the metabolism of insulin lispro is identical to regular human insulin
Elimination
Half-life, SC use: 1 hr
Mean clearance, IV use: 21.0 mL/min/kg (0.1 unit/kg dose); 9.6 mL/min/kg (0.2 unit/kg dose)
Mean half-life: 0.85 hr (0.1 unit/kg); 0.92 hr (0.2 unit/kg)
Administration
IV Preparation
Dilute insulin lispro to concentrations from 0.1 unit/mL to 1 unit/mL using 0.9% NaCl
SC Preparation
Admelog
- Dilute with sterile 0.9% NaCl
- Diluting 1 part Admelog to 1 part 0.9% NaCl will yield a concentration one-half of Admelog (equivalent to U-50)
Humalog U-100
- Dilute with sterile diluent for Humalog
- Diluting 1 part Humalog to 9 parts diluent will yield a concentration one-tenth of Humalog (equivalent to U-10)
- Diluting 1 part Humalog to 1 part diluent will yield a concentration one-half of Humalog (equivalent to U-50)
Continuous SC Infusion (Insulin Pump) Preparation
Do not dilute or mix insulin lispro when administering by continuous subcutaneous infusion
Change insulin lispro in the pump reservoir Change infusion sets and the infusion set insertion site Do not expose insulin lispro in pump reservoir to temperatures >98.6°F (37°C) Use insulin lispro in accordance with the insulin infusion pump systems instructions for use See insulin infusion pump system labeling to determine if insulin lispro can be used with the pump system SC use only Administer dose within 15 minutes before a meal or immediately after a meal Should generally be used in regimens with intermediate or long-acting insulin Administer by SC injection in the abdominal wall, thigh, upper arm, or buttocks Rotate injection site within the same region (abdomen, thigh, upper arm, or buttocks) from one injection to the next to reduce the risk of lipodystrophy Administer insulin IV only under medical supervision with close monitoring of blood glucose and potassium levels to avoid hypoglycemia and hypokalemiaSC Administration
Continuous subcutaneous infusion (insulin pump)
IV Administration
Storage
Admelog
Unopened 10 mL vials and 3 mL SoloStar pen
Opened 10 mL vials
Opened 3 mL SoloStar pen
Diluted Admelog for SC injection and infusion bags
Humalog
Unopened Humalog U-100 10 mL vials, 3 mL cartridge, KwikPen (prefilled), Junior KwikPen (prefilled)
Unopened 3 mL Humalog U-200 KwikPen (prefilled)
Opened 10 mL Humalog U-100 vials
Opened Humalog U-100 3 mL cartridge, KwikPen (prefilled), Junior KwikPen (prefilled)
Opened 3 mL Humalog U-200 KwikPen (prefilled)
Diluted Humalog U-100 for SC Injection
Diluted infusion bags
Lyumjev
Unopened Lyumjev U-100 or 10 mL vials, 3 mL cartridge, KwikPen (prefilled), Junior KwikPen (prefilled)
Unopened 3 mL Lyumjev U-200 KwikPen (prefilled)
Opened 10 mL Lyumjev U-100 vials
Opened Lyumjev U-100 3 mL cartridge, KwikPen (prefilled), Junior KwikPen (prefilled)
Opened 3 mL Lyumjev U-200 KwikPen (prefilled)
Diluted Lyumjev
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Humalog U-100 Insulin subcutaneous - | 100 unit/mL solution |  | |
| Humalog U-100 Insulin subcutaneous - | 100 unit/mL vial |  | |
| Humalog U-100 Insulin subcutaneous - | 100 unit/mL vial |  | |
| Admelog SoloStar U-100 Insulin lispro subcutaneous - | 100 unit/mL insulin pen |  | |
| Admelog SoloStar U-100 Insulin lispro subcutaneous - | 100 unit/mL insulin pen |  | |
| Admelog U-100 Insulin lispro subcutaneous - | 100 unit/mL vial |  | |
| Admelog U-100 Insulin lispro subcutaneous - | 100 unit/mL vial |  | |
| Humalog Junior KwikPen U-100 Insulin subcutaneous - | 100 unit/mL insulin pen |  | |
| Humalog KwikPen Insulin subcutaneous - | 200 unit/mL (3 mL) insulin pen |  | |
| Humalog KwikPen Insulin subcutaneous - | 100 unit/mL insulin pen |  | |
| insulin lispro subcutaneous - | 100 unit/mL insulin pen |  | |
| insulin lispro subcutaneous - | 100 unit/mL vial |  | |
| insulin lispro subcutaneous - | 100 unit/mL insulin pen |  | |
| insulin lispro subcutaneous - | 100 unit/mL insulin pen |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
insulin lispro subcutaneous
INSULIN LISPRO - INJECTION
(IN-su-lin LIS-proe)
COMMON BRAND NAME(S): Humalog
USES: Insulin lispro is used with a proper diet and exercise program to control high blood sugar in people with diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke.Insulin lispro is a man-made product that is similar to human insulin. It replaces the insulin that your body would normally make. Insulin lispro starts working faster and lasts for a shorter time than regular insulin. It works by helping blood sugar (glucose) get into cells so your body can use it for energy. This medication is usually used with a medium- or long-acting insulin product. Insulin lispro may also be used with other oral diabetes medications (such as sulfonylureas like glyburide or glipizide).
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using this medication and each time you get a refill. If you have any questions, ask your doctor, diabetes educator, or pharmacist.Learn all preparation and usage instructions from your health care professional and the product package.Before using, check this product visually for particles or discoloration. If either is present, do not use the insulin. Insulin lispro should be clear and colorless.Before injecting each dose, clean the injection site with rubbing alcohol. Change where you inject each time to lessen the risk of problems or damage under the skin (for example, pits/lumps or thickened skin). Insulin lispro may be injected in the stomach area, the thigh, the buttocks, or the back of the upper arm. Do not inject into skin that is red, swollen, itchy, or damaged. Do not inject cold insulin because this can be painful. The insulin container you are currently using can be kept at room temperature (see also Storage section).Inject this medication under the skin as directed by your doctor, usually within 15 minutes before eating a meal or immediately after a meal. Do not inject into a vein or muscle because very low blood sugar (hypoglycemia) may occur. Because this insulin is fast-acting, not eating right after a dose of insulin may also lead to low blood sugar. Do not inject if you have low blood sugar. Do not rub the area after the injection.Giving insulin lispro into a vein should only be done by a health care professional. Very low blood sugar may result.If you are directed to inject this insulin with an infusion pump, read the instruction manual and directions that come with the infusion pump. If you have any questions, ask your health care professional. Avoid exposing the pump or its tubing to direct sunlight or other heat sources. Do not dilute insulin if you are using an insulin pump.This product may be mixed only with certain other insulin products such as NPH insulin. Always draw the insulin lispro into the syringe first, then follow with the longer-acting insulin. Never inject a mixture of different insulins into a vein. Consult your health care professional about which products may be mixed, the proper method for mixing insulin, and the proper way to inject mixtures of insulin. Do not mix insulins if you are using an insulin pump.If you are directed to add a mixing liquid to insulin lispro before use (dilute), ask your health care professional about the correct way to dilute insulin.Do not change brands or types of insulin without directions on how to do so from your doctor.Do not share your pen device with another person, even if the needle is changed. You may give other people a serious infection, or get a serious infection from them. Learn how to store and discard medical supplies safely.The dosage is based on your medical condition and response to treatment. Measure each dose very carefully because even small changes in the amount of insulin may have a large effect on your blood sugar.Check your blood sugar regularly as directed by your doctor. Keep track of your results and share them with your doctor. This is very important in order to determine the correct insulin dose.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.Tell your doctor if your condition does not improve or if it worsens (your blood sugar is too high or too low).
SIDE EFFECTS: Injection site reactions (such as pain, redness, irritation) and weight gain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: signs of low potassium level in the blood (such as muscle cramps, weakness, irregular heartbeat).This medication can cause low blood sugar (hypoglycemia). This may occur if you do not consume enough calories from food or if you do unusually heavy exercise. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your dosage may need to be increased.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using insulin lispro, tell your doctor or pharmacist if you are allergic to it; or to other insulins (such as insulin lispro-aabc); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Do not use this medication when you have low blood sugar (hypoglycemia).Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, thyroid problems.You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.Limit alcohol while using this medication because it can increase your risk of developing low blood sugar.It may be harder to control your blood sugar when your body is stressed (such as due to fever, infection, injury, or surgery). Consult your doctor because this may require a change in your treatment plan, medications, or blood sugar testing.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Check your blood sugar before and after exercise. You may need a snack beforehand.If traveling across time zones, ask your doctor about how to adjust your insulin schedule. Take extra insulin and supplies with you.Older adults may be more sensitive to the side effects of this drug, especially low blood sugar.Children may be more sensitive to the side effects of this drug, especially low blood sugar.Tell your doctor right away if you are pregnant. Pregnancy may cause or worsen diabetes. Discuss a plan with your doctor for managing your blood sugar while pregnant. Your doctor may change your diabetes treatment during your pregnancy (such as diet and medications including insulin).This medication passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding. Your insulin needs may change while breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Beta-blocker medications (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness, hunger, or sweating, are unaffected by these drugs.Many drugs can affect your blood sugar levels, making it more difficult to control your blood sugar. Before you start, stop, or change any medication, talk with your doctor or pharmacist about how the medication may affect your blood sugar. Check your blood sugar regularly as directed by your doctor. Tell your doctor about the results and of any symptoms of high or low blood sugar. (See also Side Effects section.) Your doctor may need to adjust your diabetes medication, exercise program, or diet.Insulin lispro is very similar to insulin lispro-aabc. Do not use insulin lispro-aabc while using insulin lispro.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: signs of low blood sugar such as sweating, shakiness, loss of consciousness, fast heartbeat.
NOTES: Do not share this medication, needles, or syringes with others.Attend a diabetes education program to learn more about how to manage your diabetes with medications, diet, exercise, and regular medical exams.Learn the symptoms of high and low blood sugar and how to treat low blood sugar. Check your blood sugar regularly as directed and share the results with your doctor.Lab and/or medical tests (such as liver and kidney function tests, fasting blood glucose, hemoglobin A1c, complete blood counts) should be done while you are taking this medication. Keep all medical and lab appointments.Keep extra supplies of insulin, syringes, and needles on hand.
MISSED DOSE: It is very important to follow your insulin regimen exactly. Ask your doctor ahead of time what you should do if you miss a dose of insulin.
STORAGE: Store all unopened insulin products in the refrigerator. Opened insulin lispro vials may be stored in the refrigerator or at room temperature. Opened insulin lispro cartridges and prefilled pens can only be stored at room temperature and should not be refrigerated. Throw away all insulin lispro in use after 28 days, even if there is insulin left. Also throw away all insulin products after the expiration date on the package. Do not freeze and do not use insulin that has been frozen.If using this drug in an insulin pump, do not store this drug in the pump for more than 7 days. Doing so may lead to ineffective treatment and high blood sugar. Do not expose the insulin in your pump to direct sunlight or temperatures above 98.6 degrees F (37 degrees C).Protect insulin from light and heat. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised August 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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