Insulin lispro + Insulin lispro protamine


Concise Prescribing Info
Indications/Uses
Diabetes mellitus.
Dosage/Direction for Use
Adult : SC Dosage is individualised and adjusted according to metabolic needs, blood glucose level and therapeutic goals of the patient (may refer to detailed product guidelines).
Dosage Details
Subcutaneous
Diabetes mellitus
Adult: Dosage is individualised and adjusted according to metabolic needs, blood glucose level and therapeutic goals of the patient (may refer to detailed product guidelines).
Renal Impairment
Dosage reduction may be needed.
Hepatic Impairment
Dosage reduction may be needed.
Contraindications
Hypersensitivity. Hypoglycaemic episodes.
Special Precautions
Patient with chronic diabetes, recurrent hypoglycaemia, diabetic nerve disease, risk for hypokalaemia or with illness or emotional disturbances. Increased work or exercise without eating and changes in meal pattern or level of physical activity. Changes in insulin strength, brand, type and/or administration method may lead to abnormal glycaemic control and predispose to hypo- or hyperglycaemia. Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Hypoglycaemia.
Injury, poisoning and procedural complications: Local allergy at injection site including redness, swelling and itching, lipodystrophy.
Investigations: Weight gain.
Metabolism and nutrition disorders: Oedema.
Skin and subcutaneous tissue disorders: Pruritus, rash.
Potentially Fatal: Severe hypoglycaemia, hypokalaemia. Severe allergic reactions, including anaphylaxis.
Patient Counseling Information
This drug may cause hypoglycaemia which may impair ability to concentrate and react, if affected, do not drive or operate machinery. Rotate injection sites within the same region to reduce risk of lipodystrophy.
MonitoringParameters
Monitor blood glucose, HbA1C twice a year or quarterly, renal and hepatic function, weight, serum K (as necessary), and signs and symptoms of hypoglycaemia.
Overdosage
Symptoms: Hypokalaemia and hypoglycaemia associated with listlessness, confusion, palpitations, headache, sweating, and vomiting. Management: For mild hypoglycaemia, administer oral glucose or other saccharated products. For more severe hypoglycaemia, administer IM or SC glucagon, followed by oral carbohydrate by the time the patient recovers sufficiently; consider IV glucose solution when patient fails to respond to glucagon.
Drug Interactions
Concomitant use with peroxisome proliferator-activated receptor (PPAR)-γ agonists (e.g. pioglitazone, rosiglitazone) may cause dose-related fluid retention which may exacerbate or lead to cardiac failure. May increase risk of hypoglycaemia when given with other antidiabetic agents, antihypertensive agents (e.g. ACE inhibitors, angiotensin II receptor blockers, ß-blockers), certain SSRIs (e.g. fluoxetine) or MAOIs, salicylates, somatostatin analogue (e.g. octreotide), pramlintide, and sulfonamide antibiotics. Decreased therapeutic effect with corticosteroids, danazol, diuretics, oestrogens or oral contraceptives, sympathomimetic agents (e.g. terbutaline, epinephrine), and thyroid hormones. Signs and symptoms of hypoglycaemia may be masked by ß-blockers, clonidine, guanethidine and reserpine.
Food Interaction
Increased risk of hypoglycaemia with alcohol.
Action
Description: Insulin lispro is a rapid-acting human insulin analogue while insulin lispro protamine is an intermediate-acting human insulin analogue. It acts by regulating glucose metabolism. Insulins inhibit hepatic glucose production and stimulate peripheral glucose uptake by skeletal muscle and fat, inhibiting lipolysis and proteolysis, and enhancing protein synthesis.
Synonym: Biphasic insulin lispro.
Onset: 0.25-0.5 hours.
Duration: 14-24 hours.
Pharmacokinetics:
Absorption: Two phases of absorption: Rapid onset of insulin lispro (early phase); prolonged absorption of insulin lispro protamine (late phase). Time to peak plasma concentration: 0.75-13.5 hours (50% insulin lispro protamine/50% insulin lispro); 0.5-4 hours (75% insulin lispro protamine/25% insulin lispro).
Excretion: Via urine.
Storage
Unopened vial/cartridge/pen: Store between 2-8°C. Do not freeze. Protect from direct heat and light. Once opened, cartridge/pre-filled pen may be stored below 30°C. Do not freeze or refrigerate. Opened vial may be stored between 2-8°C or below 30°C.
ATC Classification
A10AD04 - insulin lispro ; Belongs to the class of intermediate-acting combined with fast-acting insulins and analogues. Used in the treatment of diabetes.
References
Anon. Insulin Lispro Protamine and Insulin Lispro. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/06/2019.

Humalog Mix 50/50 (Eli and Lily Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/06/2019.

Humalog Mix 75/25 (Eli and Lily Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/06/2019.

Joint Formulary Committee. Biphasic Insulin Lispro. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.new.medicinescomplete.com. Accessed 06/06/2019.

Disclaimer: This information is independently developed by MIMS based on Insulin lispro + Insulin lispro protamine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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