Adult: Dosage is individualised and adjusted according to patient's metabolic requirement, blood glucose level, and glycaemic control goal. Generally used in combination with intermediate- or long-acting insulin. Dosage adjustments may be necessary when switching from another insulin, during acute illness, or with changes in physical activity, meal patterns, renal or hepatic function, or concurrent medications. Doses may be given via SC inj or continuous SC insulin infusion (CSII). Additionally, may be given via IV administration when necessary, using appropriate preparation for IV use. Refer to specific product or local treatment guidelines for further information. Child: Treatment recommendations may vary among individual products and countries (refer to specific product or local treatment guidelines).
Renal Impairment
Dosage adjustment may be required.
Hepatic Impairment
Dosage adjustment may be required.
Administration
Should be taken with food. Administer w/in 15 min before or immediately after meals.
Contraindications
Hypersensitivity. Episodes of hypoglycaemia.
Special Precautions
Patient at risk for hypokalaemia (e.g. receiving loop diuretics). Early warning symptoms of hypoglycaemia may be different or less pronounced in patients with long-standing diabetes, intensified insulin therapy, diabetic nerve disease, or in those who switched from animal-source insulin to human insulin. Renal and hepatic impairment. Children. Pregnancy and lactation. Concomitant use with peroxisome proliferator-activated receptor (PPAR)-γ agonists (including thiazolidinediones).
Adverse Reactions
Significant: Hypoglycaemia, hypokalaemia; lipodystrophy and cutaneous amyloidosis at the inj site. Gastrointestinal disorders: Diarrhoea, nausea, abdominal pain. General disorders and administration site conditions: Inj site reaction (e.g. redness, itching, swelling), flu-like symptoms, pain, oedema. Immune system disorders: Antibody development. Nervous system disorders: Headache. Respiratory, thoracic and mediastinal disorders: Cough, nasopharyngitis, rhinitis, pharyngitis. Potentially Fatal: Severe hypoglycaemia, hypersensitivity reactions (including anaphylaxis).
This drug may impair the ability to concentrate and react as a result of hypoglycaemia; if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood glucose (usually before meals and snacks and at bedtime; additional monitoring if needed); electrolytes, HbA1c (at least twice yearly in patients who are meeting treatment goals and have stable glycaemic control; quarterly for those who are not meeting treatment goals or with change in therapy); renal and hepatic function, weight.
Overdosage
Symptoms: Hypoglycaemia associated with listlessness, confusion, sweating, vomiting, headache, palpitations. Management: Administer oral glucose, other sugar or saccharated products for mild hypoglycaemic episodes. In case of moderately severe hypoglycaemia, administer IM or SC glucagon followed by oral carbohydrate once the patient sufficiently recovers; administer IV glucose solution for those who do not respond to glucagon. Sustained intake of carbohydrates and observation may be needed.
Drug Interactions
May decrease efficacy with oral contraceptives, corticosteroids, β2 stimulants (e.g. ritodrine, terbutaline, salbutamol), thyroid hormones, danazol, diuretics, growth hormone. May increase risk of hypoglycaemia with other antidiabetic agents, salicylates (e.g. aspirin), sulfa antibiotics, certain ACE inhibitors (e.g. enalapril, captopril), angiotensin II receptor blockers, β-blockers, certain antidepressants (e.g. MAOIs, SSRIs), somatostatin analogues (e.g. octreotide). May cause dose-related fluid retention which may lead to or exacerbate cardiac failure with PPAR-γ agonists including thiazolidinediones (e.g. pioglitazone). Signs and symptoms of hypoglycaemia may be blunted by β-blockers.
Food Interaction
May increase or decrease efficacy with alcohol.
Action
Description: Insulin lispro is a rapid-acting insulin analogue that regulates the metabolism of glucose by binding to insulin receptors. This action stimulates peripheral glucose uptake by the skeletal muscle and fat and inhibits hepatic glucose production, thus lowering blood glucose levels. It also inhibits proteolysis and lipolysis and enhances the synthesis of protein. Onset: Approx 15 minutes (variable). Duration: SC: 2-5 hours (variable). Pharmacokinetics: Absorption: Rapidly absorbed. Time to peak plasma concentration: Approx 30-70 minutes (SC). Excretion: Via urine.
Chemical Structure
Insulin lispro Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 16132438, Insulin lispro. https://pubchem.ncbi.nlm.nih.gov/compound/Insulin-lispro. Accessed Nov. 24, 2021.
Storage
Unopened vial/cartridge/pen: Store between 2-8°C. Do not freeze. Protect from heat and light. Opened (in-use) vials: Store between 2-8°C or below 30°C for up to 28 days. Opened (in-use) cartridge/pen: Store below 30°C for up to 28 days. Do not freeze or refrigerate. Storage recommendations may vary among individual products. Refer to specific product guidelines.
A10AC04 - insulin lispro ; Belongs to the class of intermediate-acting insulins and analogues. Used in the treatment of diabetes. A10AB04 - insulin lispro ; Belongs to the class of fast-acting insulins and analogues. Used in the treatment of diabetes.
References
Anon. Insulin Lispro. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 04/10/2021.Anon. Insulin Lispro. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 08/10/2021.Humalog 100 units/mL Junior KwikPen Solution for Injection in a Pre-Filled Pen (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Humalog 100 units/mL KwikPen Solution for Injection in a Pre-Filled Pen (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Humalog 100 units/mL Solution for Injection in Cartridge (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Humalog 100 units/mL Solution for Injection in Vial (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Humalog 100 units/mL Tempo Pen Solution for Injection in a Pre-Filled Pen (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Humalog KwikPen 100 units/mL Solution for Injection (Eli Lilly [Philippines], Inc). MIMS Philippines. http://www.mims.com/philippines. Accessed 04/10/2021.Humalog KwikPen Injection 3 mL (100 IU/mL), Solution for Injection in a Pre-Filled Pen (Zuellig Pharma Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 04/10/2021.Humalog Kwikpen, Junior Kwikpen, Tempo Pen Injection Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 24/09/2021.Joint Formulary Committee. Insulin Lispro. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/09/2021.Lyumjev 100 units/mL Junior KwikPen Solution for Injection in Pre-Filled Pen (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Lyumjev 100 units/mL KwikPen Solution for Injection in Pre-Filled Pen (Eli Lilly Nederland B.V.). https://products.mhra.gov.uk. Accessed 24/09/2021.Lyumjev 100 units/mL Solution for Injection in Cartridge (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Lyumjev 100 units/mL Solution for Injection in Vial (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Lyumjev 200 units/mL KwikPen Solution for Injection in Pre-Filled Pen (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 24/09/2021.Lyumjev Kwikpen, Junior Kwikpen, Tempo Pen, Injection Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 24/09/2021.
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