Lantus (insulin glargine)
LANTUS (insulin glargine recombinant) – a acting human insulin analog indicated to improve glycemic control in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. The primary activity of insulin, including insulin glargine, is regulation of 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.
FDA approved uses: Lantus is indicated to improve glycemic control in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Important Limitations of Use: Not recommended for treating diabetic ketoacidosis. Use intravenous, short-acting insulin instead.
Available dosage forms: Solution for injection 100 units/mL (U-100) in:
– 10 mL vials
– 3 mL cartridge system for use in OptiClik (Insulin Delivery Device)
– 3 mL SoloStar disposable insulin device
Usual dosage: The starting dose should be individualized based on the type of diabetes and whether the patient is insulin-naïve. Administer subcutaneously once daily at any time of day, but at the same time every day. Rotate injection sites within an injection area (abdomen, thigh, or deltoid) to reduce the risk of lipodystrophy. Converting from other insulin therapies may require adjustment of timing and dose of LANTUS. Closely monitor glucoses especially upon converting to LANTUS and during the initial weeks thereafter.
Contraindications: Do not use in patients with hypersensitivity to LANTUS or one of its excipients.
Adverse reactions (side effects) of these medications: The most common side effects of Lantus include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritis, and rash. Other adverse reactions seen in clinical trials or post-marketing include: Upper respiratory infections, accidental injury, headache, infections, retinal vascular injury, peripheral edema, hypertension, influenza, sinusitis, cataract, bronchitis, arthralgia, pain in extremity, back pain, cough, urinary tract infection, diarrhea, and depression.
Common drug interactions: The following are examples of drugs that may increase the blood-glucose-lowering effect of insulins including LANTUS and, therefore, increase the susceptibility to hypoglycemia: oral anti-diabetic products, pramlintide, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, pentoxifylline, salicylates, somatostatin analogs, and sulfonamide antibiotics.
The following are examples of drugs that may reduce the blood-glucose-lowering effect of insulins including LANTUS: corticosteroids, niacin, danazol, diuretics, sympathomimetic agents (e.g., epinephrine, albuterol, terbutaline), glucagon, isoniazid, phenothiazine derivatives, somatropin, thyroid hormones, estrogens, progestogens (e.g., in oral contraceptives), protease inhibitors and atypical antipsychotic medications (e.g. olanzapine and clozapine).
Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood glucose-lowering effect of insulin. Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.
The signs of hypoglycemia may be reduced or absent in patients taking sympatholytic drugs such as beta-blockers, clonidine, guanethidine, and reserpine.
Special instructions for patients: Changes to insulin regimens must be made cautiously and only under medical supervision. Lipodystrophy (and the need to rotate injection sites within the same body region), weight gain, allergic reactions, and hypoglycemia may occur. The ability to concentrate and react may be impaired as a result of hypoglycemia. This may present a risk in situations where these abilities are especially important, such as driving or operating other machinery. Accidental mix-ups between LANTUS and other insulins, particularly short-acting insulins, have been reported. To avoid medication errors between LANTUS and other insulins, always check the insulin label before each injection. LANTUS must only be used if the solution is clear and colorless with no particles visible. LANTUS must NOT be diluted or mixed with any other insulin or solution.
Full prescribing information may be found at the manufacturer‘s official website Lantus.com or at the U.S. Food and Drug Administration’s website at Lantus Info at Drugs@FDA
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