The Next Generation of Lantus ®

There are a number of different insulin products available.  Toujeo® (Too-Jay-o) is a recent addition to the line of long-acting basal insulin.  Toujeo® is the same type of basal insulin (glargine) as Lantus, but is more concentrated.  In Toujeo®, each milliliter (mL) of liquid carries 300 units of insulin (“U300”), whereas Lantus® only carries 100 units of insulin per milliliter (“U100”).

Toujeo®, as with other long-acting insulin analogs, is indicated to improve glycemic control in adults with diabetes mellitus.  The dosage and administration is similar to that of Lantus®.  It should be administered daily at the same time each day and dosing adjustments should not be made more  frequently than every 3 to 4 days.

Toujeo® will only be available in a new SoloStar pen that will carry 450 units, 50% more than the 300-unit Lantus® pen – a major improvement for the many people who require larger doses of insulin. It is imperative that prescribers differentiate when writing orders on the number of units they are ordering, 100 units/ml for Lantus® and 300 units/ml for Toujeo®.  Nursing should always verify the insulin label before each injection and compare it to the administration record, verifying the concentration and dose.

Toujeo® may cause hypoglycemia (low blood sugar), hypokalemia (low potassium) and fluid retention.  In addition, patients could have adverse reactions due to allergies, injection site reactions, rash, edema and weight gain.  Regardless of the type of antidiabetic therapy, minimizing the risk of hypoglycemia must always be at the forefront of the caregiver’s mind.  Patients should have routine blood glucose monitoring and insulin dosing should be modified based upon those values.

The recommended dose of Toujeo® for Type 2 diabetic patients that are insulin naïve is 0.2 units/kilogram of body weight once daily.    Please note that it may require dosage adjustments of other anti-diabetic drugs to minimize the risk of hypoglycemia.  For those patients already taking insulin, the starting dose of Toujeo® can be the same as the once daily long-acting dose.  If the patient is taking a twice-daily NPH, the recommendation is to dose Toujeo® at 80% of the daily total NPH.  See Figure 1:

Figure 1:  Mealtime insulin should be used to complete the remainder of the daily insulin requirements.

The EDITION clinical trial program, once-daily Toujeo® was compared to that of once-daily Lantus® in open-label, randomized, active-control, parallel, treat-to-target studies of up to 26 weeks of duration with 6 months safety extension.

The results of the study met all criteria by showing that Toujeo® demonstrated similar blood sugar control to that of Lantus® and that it’s safety profile was favorable with a lower incidence of hypoglycemia.   The most common adverse events (excluding hypoglycemia) reported for Toujeo® included nasopharyngitis (12.8% in type 1 patients and 7.1% in type 2 patients) and upper respiratory tract infection (9.5% in type 1 patients and 5.7% in type 2 patients).

Warning and precautions

• Insulin pens, needles or syringes must never be shared between patients and never reuse needles
• Do not dilute or mix Toujeo® with any other insulin or solution
• Discard 28 days after opening
• Dosage reduction may be necessary for patients with renal or hepatic impairment
• Potassium monitoring should be monitored in patients at risk for hypokalemia

A huge proportion of diabetic patients (around 50% globally) on insulin are still failing to achieve adequate blood sugar control.  Toujeo® allows flexibility for your diabetic patients, allowing titration of dosing to reach higher limits while still only giving one injection per 24 hour period.

For more information on managing your diabetic patients, please contact your AlixaRx Clinical Pharmacist.

“Toujeo® (insulin Glargine Injection) 300 Units/mL.” Toujeo® (insulin Glargine Injection) 300 Units/mL. Sanofi-aventis U.S. LLC, 1 May 2015. Web. 9 June 2015.

“Toujeo Launches in the US – The Next Generation Lantus.” DiaTribe. 5 Mar. 2015. Web. 31 May 2015. .

Berkrot, Bill. “FDA Approves Sanofi’s Diabetes Drug Toujeo.” Reuters. Thomson Reuters, 25 Feb. 2015. Web. 31 May 2015.

This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.

>>> From the Front Lines – June 2015 <<<