insulin glargine (Rx)

Brand and Other Names:Lantus, Lantus SoloStar, more...Toujeo, Basaglar, Semglee, insulin glargine-yfgn
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100 units/mL
    • Lantus (10mL vial)
    • Semglee (10mL vial)

prefilled pen

  • 100 units/mL
    • Lantus SoloSTAR (3mL)
    • Basaglar KwikPen (3mL)
    • Semglee (3mL)
  • 300 units/mL
    • Toujeo SoloStar (1.5mL)
    • Toujeo Max SoloStar (3mL)

Interchangeable biosimilar

  • Semglee is the first (and only as of July 28, 2021) biosimilar that is interchangeable with the reference product Lantus

Type 1 Diabetes Mellitus

Long-acting basal insulin indicated to improve glycemic control

Initial dose

  • For insulin-naïve patients
    • Start ~1/3 of total daily insulin dose; use remaining 2/3 of daily insulin dose on short-acting, premeal insulin
    • Usual initial dose range: 0.2-0.4 units/kg; optimal glucose lowering effect may take 5 days to fully manifest and the first insulin glargine dose may be insufficient to cover metabolic needs in the first 24 hr of use
    • Titrate insulin glargine per instructions, and adjust coadministered glucose-lowering therapies per standard of care
    • See Dosing Considerations and Administration

Type 2 Diabetes Mellitus

Long-acting basal insulin indicated to improve glycemic control

Initial dose

  • For insulin-naïve patients
    • Start 0.2 units/kg qDay; if necessary, adjust dosage of other antidiabetic drugs when starting insulin glargine to minimize the risk of hypoglycemia
    • See Dosing Considerations and Administration

Dosage Modifications

Hepatic and renal impairment

  • Not studied

Dosing Considerations

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

Titrate Toujeo dose no more frequently than every 3-4 days

Use with caution in patients with visual impairment who may rely on audible clicks to dial their dose

Interchangeable biosimilar to Lantus

  • Semglee (insulin glargine-yfgn) is the first interchangeable biosimilar insulin approved by the FDA (as of July 28, 2021)
  • Semglee is both biosimilar to and interchangeable with Lantus (insulin glargine), the reference product
  • As an interchangeable biosimilar product, Semglee may be substituted for Lantus at the pharmacy-level without the intervention of the prescribing health care provider, subject to state pharmacy laws

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
  • For patients controlled on Lantus or Semglee, expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control
  • 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 or Semglee (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 insulin glargine 100 units/mL
    • If changing from a treatment regimen with an intermediate- or long-acting insulin to Lantus, Semglee, or Basaglar, 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 (300 units/mL) to once daily Lantus or Basaglar (100 units/mL), the recommended initial Lantus, Semglee, or Basaglar 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)
    • Semglee (10mL vial)

prefilled pen

  • 100 units/mL
    • Lantus SoloSTAR (3mL)
    • Basaglar KwikPen (3mL)
    • Semglee (3mL)
  • 300 units/mL
    • Toujeo SoloStar (1.5mL)
    • Toujeo Max SoloStar (3mL)

Interchangeable biosimilar

  • Semglee is the first (and only as of July 28, 2021) biosimilar that is interchangeable with the reference product Lantus

Type 1 Diabetes Mellitus

Long-acting human insulin analog 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: Start ~1/3 of total daily insulin dose; use remaining 2/3 of daily insulin dose on short-acting, premeal insulin; 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

Interchangeable biosimilar to Lantus

  • Semglee (insulin glargine-yfgn) is the first interchangeable biosimilar insulin approved by the FDA (as of July 28, 2021)
  • Semglee is both biosimilar to and interchangeable with Lantus (insulin glargine), the reference product
  • As an interchangeable biosimilar product, Semglee may be substituted for Lantus at the pharmacy-level without the intervention of the prescribing health care provider, subject to state pharmacy laws

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
  • For patients controlled on Lantus or Semglee, expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control
  • 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 or Semglee (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 insulin glargine 100 units/mL
    • If changing from a treatment regimen with an intermediate- or long-acting insulin to Lantus, Semglee, or Basaglar, 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 (300 units/mL) to once daily Lantus or Basaglar (100 units/mL), the recommended initial Lantus, Semglee, or Basaglar dose is 80% of the Toujeo dose that is being discontinued; this dose reduction will lower the likelihood of hypoglycemia
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Interactions

Interaction Checker

and insulin glargine

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            Contraindicated (1)

            • pramlintide

              insulin glargine, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            Serious - Use Alternative (2)

            • ethanol

              ethanol, insulin glargine. 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 glargine, 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 (127)

            • acarbose

              acarbose, insulin glargine. 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 glargine. 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 glargine. 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 glargine. 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 glargine. 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 glargine 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • azilsartan

              azilsartan increases effects of insulin glargine 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 glargine by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • bitter melon

              bitter melon increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypoglycemia.

            • canagliflozin

              insulin glargine, 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 glargine. 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 glargine 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 glargine by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose. Monitor blood glucose.

            • chlorpropamide

              chlorpropamide, insulin glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor. Potential for hypoglycemia.

            • ciprofibrate

              ciprofibrate increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • clozapine

              clozapine, insulin glargine. 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 glargine, 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 glargine. 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • deflazacort

              insulin glargine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • dexfenfluramine

              dexfenfluramine increases effects of insulin glargine by Other (see comment). Use Caution/Monitor. Comment: Dexfenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • dichlorphenamide

              dichlorphenamide and insulin glargine both decrease serum potassium. Use Caution/Monitor.

            • disopyramide

              disopyramide increases effects of insulin glargine 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 glargine. 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 glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • eprosartan

              eprosartan increases effects of insulin glargine 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 glargine. 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 glargine 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 glargine. 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 glargine. 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 glargine 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 glargine by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • fenofibrate micronized

              fenofibrate micronized increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • fenofibric acid

              fenofibric acid increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • fleroxacin

              fleroxacin increases effects of insulin glargine 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 glargine 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • fosinopril

              fosinopril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • gemfibrozil

              gemfibrozil increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • gemifloxacin

              gemifloxacin increases effects of insulin glargine 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 glargine. 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 glargine. 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 glargine 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 glargine 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 glargine. 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 glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • indinavir

              indinavir decreases effects of insulin glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • irbesartan

              irbesartan increases effects of insulin glargine 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 glargine by unknown mechanism. Use Caution/Monitor.

            • ketotifen, ophthalmic

              ketotifen, ophthalmic, insulin glargine. Other (see comment). Use Caution/Monitor. Comment: Combination may result in thrombocytopenia (rare). Monitor CBC.

            • lanreotide

              lanreotide increases effects of insulin glargine 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 glargine 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 glargine. 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 glargine by unknown mechanism. Use Caution/Monitor.

            • liraglutide

              liraglutide, insulin glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • lithium

              lithium, insulin glargine. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

            • lixisenatide

              lixisenatide, insulin glargine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Risk of hypoglycemia increased when coadministered with basal insulins. Basal insulin dose reduction may be required.

            • lopinavir

              lopinavir decreases effects of insulin glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • losartan

              losartan increases effects of insulin glargine 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 glargine. 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 glargine 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 glargine by pharmacodynamic antagonism. Use Caution/Monitor.

            • mecasermin

              mecasermin increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor. Additive hypoglycemic effects.

            • metformin

              metformin, insulin glargine. 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.

            • methyltestosterone

              methyltestosterone increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor. It is important to monitor all patients with type 2 diabetes on antidiabetic agents receiving androgens for changes in glycemic control. Potential for hypoglycemia.

            • metoclopramide intranasal

              metoclopramide intranasal increases effects of insulin glargine 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 glargine, 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 glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • moxifloxacin

              moxifloxacin increases effects of insulin glargine 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 glargine. 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 glargine. 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • niacin

              niacin decreases effects of insulin glargine 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 glargine 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 glargine 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 glargine. 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 glargine 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              paliperidone, insulin glargine. 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 glargine 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 glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • phenelzine

              phenelzine increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.

            • pindolol

              pindolol, insulin glargine. 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 glargine 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 glargine. 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 glargine by unknown mechanism. Use Caution/Monitor.

            • propranolol

              propranolol, insulin glargine. 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.

            • pseudoephedrine

              pseudoephedrine decreases effects of insulin glargine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • quetiapine

              quetiapine, insulin glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • ramipril

              ramipril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • rasagiline

              rasagiline increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.

            • risperidone

              risperidone, insulin glargine. 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • rosiglitazone

              insulin glargine 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 glargine. 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 glargine 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 glargine 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • saxagliptin

              saxagliptin, insulin glargine. 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 glargine by unknown mechanism. Use Caution/Monitor.

            • semaglutide

              semaglutide, insulin glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor. Theoretical interaction.

            • sitagliptin

              sitagliptin, insulin glargine. 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 glargine 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 sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of insulin glargine 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 sulfate/magnesium sulfate/polyethylene glycol

              insulin glargine and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • somapacitan

              somapacitan decreases effects of insulin glargine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone products may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating somapacitan. .

            • somatropin

              somatropin decreases effects of insulin glargine by pharmacodynamic antagonism. Use Caution/Monitor.

            • sulfadiazine

              sulfadiazine increases effects of insulin glargine 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 glargine by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.

            • sulfisoxazole

              sulfisoxazole increases effects of insulin glargine 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 glargine 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 glargine 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 glargine. 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 glargine by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • tolazamide

              tolazamide, insulin glargine. 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 glargine. 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 glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • tranylcypromine

              tranylcypromine increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension decreases effects of insulin glargine 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 glargine 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 glargine by increasing renal clearance. Use Caution/Monitor.

            • ziprasidone

              ziprasidone, insulin glargine. 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 (76)

            • agrimony

              agrimony increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • American ginseng

              American ginseng increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • amitriptyline

              amitriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • amoxapine

              amoxapine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • anamu

              anamu increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • balsalazide

              balsalazide increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • bendroflumethiazide

              bendroflumethiazide decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • bexarotene

              bexarotene increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • budesonide

              budesonide decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • chlorothiazide

              chlorothiazide decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • chlorthalidone

              chlorthalidone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • chromium

              chromium increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • clomipramine

              clomipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • clonidine

              clonidine, insulin glargine. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production.

              clonidine decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.

            • coenzyme Q10

              coenzyme Q10 increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Monitor insulin requirements.

            • cornsilk

              cornsilk increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

            • cortisone

              cortisone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • cyclopenthiazide

              cyclopenthiazide decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • damiana

              damiana decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

            • danazol

              danazol increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • deflazacort

              deflazacort decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • desipramine

              desipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • devil's claw

              devil's claw increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • dexamethasone

              dexamethasone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • diflunisal

              diflunisal increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • doxepin

              doxepin increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • elderberry

              elderberry increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (in vitro research).

            • eucalyptus

              eucalyptus increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.

            • fludrocortisone

              fludrocortisone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • fluoxymesterone

              fluoxymesterone increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • fo-ti

              fo-ti increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • forskolin

              forskolin increases effects of insulin glargine 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 glargine by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).

            • guanfacine

              guanfacine, insulin glargine. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production.

              guanfacine decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.

            • gymnema

              gymnema increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • horse chestnut seed

              horse chestnut seed increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • hydrochlorothiazide

              hydrochlorothiazide decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • hydrocortisone

              hydrocortisone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • imipramine

              imipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • indapamide

              indapamide decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • isoniazid

              isoniazid decreases effects of insulin glargine by unspecified interaction mechanism. Minor/Significance Unknown.

            • juniper

              juniper increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

            • lofepramine

              lofepramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • lycopus

              lycopus increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

            • maitake

              maitake increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (animal research).

            • maprotiline

              maprotiline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • mesalamine

              mesalamine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • mesterolone

              mesterolone increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • methylprednisolone

              methylprednisolone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • metolazone

              metolazone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • nettle

              nettle increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).

            • nortriptyline

              nortriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • ofloxacin

              ofloxacin, insulin glargine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential dysglycemia.

            • oxandrolone

              oxandrolone increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • oxymetholone

              oxymetholone increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • panax ginseng

              panax ginseng increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • pegvisomant

              pegvisomant increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • potassium acid phosphate

              potassium acid phosphate increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

            • potassium chloride

              potassium chloride increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

            • potassium citrate

              potassium citrate increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

            • prednisolone

              prednisolone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • prednisone

              prednisone decreases effects of insulin glargine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • protriptyline

              protriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • sage

              sage increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • Siberian ginseng

              Siberian ginseng increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • sulfasalazine

              sulfasalazine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • testosterone

              testosterone increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • testosterone buccal system

              testosterone buccal system increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • testosterone topical

              testosterone topical increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • tongkat ali

              tongkat ali increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypoglycemia.

            • trazodone

              trazodone increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • trimipramine

              trimipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • vanadium

              vanadium increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • willow bark

              willow bark increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

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            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

            Postmarketing Reports

            Localized cutaneous amyloidosis

            Pediatric patients

            • Rhinitis
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            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

            Never share insulin pens between patients, even if the needle is changed; pen sharing poses a risk for transmission of blood-borne pathogens

            To avoid dosing errors and potential overdose, never use a syringe to remove drug from TOUJEO SoloStar or TOUJEO Max SoloStar prefilled pen into a syringe

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

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

            Increase frequency of glucose monitoring with changes to insulin dosage, coadministered glucose lowering medications, meal pattern, or 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 caution during pregnancy

            Hyperglycemia or hypoglycemia with changes in insulin regimen

            • 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

            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

            Drug interactions overview

            • 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
            • Coadministration with these drugs (eg, antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, propoxyphene, salicylates, somatostatin analogs [eg, octreotide], sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors) may increase the risk of hypoglycemia
            • Coadministration with these drugs (eg, atypical antipsychotics [eg, olanzapine and clozapine], corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens [eg, oral contraceptives], protease inhibitors, somatropin, sympathomimetic agents [eg, albuterol, epinephrine, terbutaline], and thyroid hormones) may decrease the risk of hypoglycemia
            • Concomitant use of alcohol, beta-blockers, clonidine, and lithium salts with insulin glargine may increase or decrease blood glucose lowering effect of insulin glargine
            • Pentamidine may cause hypoglycemia, which may sometimes be followed with hyperglycemia
            • Coadministration with beta-blockers, clonidine, guanethidine, or reserpine may blunt signs and symptoms of hypoglycemia
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            Pregnancy & Lactation

            Pregnancy

            Published data do not report a clear association with insulin glargine products and major birth defects, miscarriage, or adverse maternal or fetal outcomes when insulin glargine products used during pregnancy; however, these studies cannot definitely establish absence of any risk because of methodological limitations including small sample size and some with no comparative group

            There are risks to mother and fetus associated with poorly controlled diabetes in pregnancy; poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, stillbirth and delivery complications

            Animal data

            • In animal reproduction studies, rats and rabbits were exposed to insulin glargine in animal reproduction studies during organogenesis, respectively 50 times and 10 times the human subcutaneous dose of 0.2 units/kg/day; overall, effects of insulin glargine did not generally differ from those observed with regular human insulin

            Lactation

            There are no data on presence of insulin glargine in human milk, effects on breastfed infant, or on milk production

            Use of insulin glargine is compatible with breastfeeding, but women with diabetes who are lactating may require adjustments of their insulin doses; health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug 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.

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            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

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            Administration

            SC Administration

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

            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

            Always check insulin labels before administration

            Visually inspect solution for particulate matter and discoloration prior to administration and only use if the solution is clear and colorless with no visible particles

            Do not administer IV, IM, or via insulin pump

            Do not dilute or mix with any other insulin products or solutions

            Switching between Toujeo SoloStar and Toujeo Max SoloStar

            • When changing between Toujeo SoloStar and Max SoloStar, if previous dose was an odd number, increase or decrease dose by 1 unit
            • Toujeo SoloStar or Max SoloStar disposable prefilled pen requires no conversion Never transfer cartridges of the Toujeo SoloStar or Max SoloStar prefilled pen into a syringe for administration
            • Toujeo SoloStar delivers doses in 1 unit increments (up to 80 units in a single injection)
            • Toujeo Max SoloStar delivers doses in 2 unit increments (up to 160 units in a single injection); recommended for patients requiring ≥20 units/day

            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)
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Lantus U-100 Insulin subcutaneous
            -
            100 unit/mL vial
            Basaglar KwikPen U-100 Insulin subcutaneous
            -
            100 unit/mL (3 mL) insulin pen
            Lantus Solostar U-100 Insulin subcutaneous
            -
            100 unit/mL (3 mL) insulin pen

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            insulin glargine subcutaneous

            INSULIN GLARGINE - INJECTION

            (IN-su-lin GLAR-jeen)

            COMMON BRAND NAME(S): Basaglar, Lantus, Semglee

            USES: Insulin glargine 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 glargine is a man-made product that is similar to human insulin. It replaces the insulin that your body would normally make. It acts longer than regular insulin, providing a low, steady level of insulin. It works by helping blood sugar (glucose) get into cells so your body can use it for energy. Insulin glargine may be used with a shorter-acting insulin product. It may also be used alone or with other diabetes drugs.This monograph is about the following insulin glargine products: insulin glargine, insulin glargine-yfgn.

            HOW TO USE: Read the Patient Information Leaflet provided by 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.Follow all package directions for proper use/injection/storage of the particular type of device/insulin you are using. Your health care professional will teach you how to properly inject this medication. If any of the information is unclear, consult your doctor or pharmacist.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). Wash your hands before measuring and injecting insulin. Before using, check the product visually for particles, thickening, or clumps. If any are present, discard that container. Insulin glargine should be clear and colorless. To avoid damaging the insulin, do not shake the container.The dosage is based on your medical condition and response to treatment. Measure each dose carefully, and use exactly as prescribed by your doctor. Even small changes in the amount of insulin may have a large effect on your blood sugar. If you are using the cartridge form of this insulin and a special injecting device with a digital display, take care to read the display right-side up. If you read the display upside-down, you may inject the wrong amount of insulin. Ask your pharmacist if you are unsure how to properly use this type of injecting device.Before injecting each dose, make sure the injection site is clean and dry. Inject this medication under the skin of the abdomen, upper arms, or thighs, usually once daily or as directed by your doctor. Do not rub the injection site. Do not inject into a vein or muscle. Change where you inject each time to lessen the risk of problems or damage under the skin (for example, pits/lumps or thickened skin). Do not inject into skin that is red, swollen, itchy, or damaged.Use this medication regularly as directed by your doctor in order to get the most benefit from it. You may inject insulin glargine once daily at any time during the day (such as before breakfast or at bedtime) but you should inject at the same time each day. Carefully follow the insulin treatment plan, meal plan, and exercise program your doctor has recommended.Do not mix this product with other insulins or solutions, or use it in an insulin pump.Do not change brands or types of insulin without directions on how to do so from your doctor.Monitor your blood sugar on a regular basis. Keep track of the results, and share them with your doctor. This is very important in order to determine the correct insulin dose.If you are measuring doses from vials, do not reuse needles and syringes. If you are using the cartridges or pens, use a new needle each time. 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.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) or weight gain may occur. If any of these effects persist or worsen, 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 glargine, tell your doctor or pharmacist if you are allergic to it; or to other types of insulins; 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.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 taking this medication because it can increase the 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 before exercising.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.A product that may interact with this drug is: rosiglitazone.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, making it harder to control. 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 and share the results with your doctor. Tell your doctor right away if you have 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.

            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: See also the How to Use section.Store all unopened insulin containers in the refrigerator between 36-46 degrees F (2-8 degrees C). Do not freeze, and do not use insulin that has been frozen. If you are using the vials, store open vials in the refrigerator or at room temperature below 86 degrees F (30 degrees C) away from direct heat and light. Store in the carton to protect from light. Do not refrigerate cartridges or pens that are currently in use. Discard all containers in use after 28 days, even if there is insulin left. Also discard all insulin products after the expiration date on the package. Do not store in the bathroom. Keep all medicines 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 September 2021. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

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            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.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            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.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.