insulin aspart protamine/insulin aspart (Rx)

Brand and Other Names:NovoLog Mix 50/50, NovoLog Mix 70/30, more...NovoLog Mix 70/30 FlexPen
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

insulin aspart protamine/insulin aspart

subcutaneous injection

  • (70units/30units)/mL
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Diabetes Mellitus

Combination rapid-onset (faster than regular insulin) and intermediate-acting insulins in fixed dose

Dose regimen varies among patients depending on metabolic needs; typical daily insulin requirements range between 0.5-1 unit/kg

Administer SC q12hr (ie, before breakfast and evening meal); each dose intended to cover 2 meals or a meal and snack

Inject SC into abdominal wall, thigh, or upper arm

Safety and efficacy not established

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Interactions

Interaction Checker

and insulin aspart protamine/insulin aspart

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Hypoglycemia (47-69%)

            Headache (12-35%)

            Influenza-like symptoms (12-13%)

            1-10%

            Headache (9%)

            Dyspepsia (9%)

            Diarrhea (7-8%)

            Back pain (7%)

            Pharyngitis (6-7%)

            Frequency Not Defined

            Insulin resistance

            Lipodystrophy

            Lipohypertrophy

            Local allergic reaction

            Hypokalemia

            Weight gain

            Peripheral edema

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            Warnings

            Contraindications

            Hypersensitivity

            Hypoglycemia

            Cautions

            Suspension for SC use, do not administer IV

            Administer within 15 minutes of meals (rapid onset and peak ~1 hr)

            Rapid changes in serum glucose may induce symptoms of hypoglycemia

            Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions (eg, long duration of diabetes, diabetic nerve disease, use of beta-blockers or intensified diabetes control)

            Caution in conditions with decreased insulin requirements (eg, diarrhea, nausea, vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment)

            Caution in conditions with increased insulin requirements (eg, fever, hyperthyroidism, trauma, infection, surgery)

            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

            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 and treat accordingly and consider discontinuing thiazolidinediones

            Do not mix with other insulins

            Do not administer via insulin infusion pump

            Never share pen between patients even if needle is changed

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Unknown whether distributed in breast milk; compatible with breast feeding, but lactating women may require dosage adjustment; caution advised

            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 analogs 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

            Pharmacokinetics

            Bioavailability: SC, well absorbed (2-3 times faster than regular insulin)

            Half-Life: 8-9 hr Onset: <15 min

            Peak Plasma Time: 1-1.5 hr  

            Peak Pharmacodynamic Activity: 1-4 hr after dose administration

            Peak Plasma Concentration: 23.4 mU/L (after 0.2 unit/kg dose)

            Protein Bound: 0-9%; similar to regular human insulin

            Metabolism: Liver >50%, kidney 30%, adipose tissue/muscle 20%

            Clearance:  1.2 L/hr/kg

            Vd: 0.15 L/kg

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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

            Adding plans allows you to:

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

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

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