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ALIMENTARY TRACT AND METABOLISM › DRUGS USED IN DIABETES › INSULINS AND ANALOGUES › Insulins and analogues for injection, long-acting
combinations
A10AE30
Forms & Strengths
- Fixed-dose combination of long-acting insulin and GLP-1 receptor agonist
- Insulin glargine 100 units/mL + lixisenatide 33 mcg/mL (Soliqua 100/33)
- Insulin degludec 100 units/mL + liraglutide 3.6 mg/mL (Xultophy 100/3.6)
- Prefilled pens delivering specific insulin unit increments
Adult Dosing
- Individualized based on baseline anti-diabetic therapy and titration needs
- Insulin glargine/lixisenatide: Starting dose typically 15 units (15 units glargine/5 mcg lixisenatide) SC once daily; max 60 units daily
- Insulin degludec/liraglutide: Starting dose typically 16 units (16 units degludec/0.58 mg liraglutide) SC once daily; max 50 units daily
- Administer subcutaneously once daily within 1 hour prior to the first meal of the day
Pediatric Dosing
- Safety and efficacy not established in pediatric patients (< 18 years of age)
- Use in pediatric patients is not recommended
Indications
- Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus inadequately controlled on basal insulin (< 60 units daily) or lixisenatide/liraglutide
Mechanism of Action
- Combines the glucose-lowering effects of a basal insulin and a GLP-1 receptor agonist
- Insulin analog promotes peripheral glucose uptake and inhibits hepatic glucose production
- GLP-1 receptor agonist increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, and slows gastric emptying
Contraindications
- History of severe hypersensitivity to insulin glargine, insulin degludec, lixisenatide, liraglutide, or any component
- Personal or family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- During episodes of hypoglycemia
Adverse Reactions
- Hypoglycemia
- Nausea, diarrhea, vomiting, and constipation
- Headache
- Nasopharyngitis
- Injection site reactions and lipodystrophy
Drug Interactions
- Concomitant use with insulin secretagogues (e.g., sulfonylureas) increases hypoglycemia risk; dose reduction of secretagogues may be needed
- GLP-1 receptor agonists delay gastric emptying, potentially affecting the absorption of concomitantly administered oral medications
- Drugs that affect glucose metabolism (e.g., corticosteroids, thiazide diuretics) may alter glycemic control
- Masking of hypoglycemic symptoms with beta-blockers
Curated Content: Needs Vetting Before Put to Clinical Use