LANTUS ® - Insulin glargine

LANTUS ® a drug based on insulin glargine.

THERAPEUTIC GROUP: Insulin glargine for injectable use - insulins and analogues.

IndicationsAction mechanismStudies and clinical effectiveness Usage and dosage instructionsWarnings Pregnancy and lactationInteractionsContraindicationsUndesirable effects

Indications LANTUS ® - Insulin glargine

LANTUS ® is a useful medicine for the treatment of diabetes mellitus in cases where insulin therapy is needed.

Mechanism of action LANTUS ® - Insulin glargine

LANTUS ® is a drug based on insulin glargine, an insulin analogue characterized by the longest duration of action that allows the diabetic patient to take the drug only once a day (it represents what is commonly called basal insulin).

The long duration of action, mediately of about 20 hours, is guaranteed by the low solubility of this variant with physiological pH, which allows the drug to form microprecipitates in the subcutaneous tissue useful to guarantee a gradual release of the hormone in the circulation, avoiding second pharmacokinetic studies, the appearance of potentially dangerous blood peaks.

If the fundamental characteristic of this formulation is represented by the pharmacokinetic properties it is appropriate to remember that the mechanism of action remains identical to that of the endogenous hormone, acting, through specific receptors, on insulin-sensitive tissues, increasing uptake and utilization of blood glucose.

In addition to the modulating effect on muscle metabolism (glycogen induction synthesis and protein synthesis) and on adipose tissue (lipolysis inhibition and lithogenesis induction), insulin can also act less on other sensitive insulin tissues such as the mammary gland and on metabolically organs fundamental as the liver, inhibiting processes such as glycogenolysis and gluconeogenesis responsible for most of the endogenous glucose production.

Studies carried out and clinical efficacy

1. GLARGEN INSULIN AND TYPE II DIABETES

Insulin glargine, given its long duration of action and the absence of blood peaks, is very well suited to the treatment of type II diabetes, not adequately compensated with oral hypoglycemic agents. In this study that processes data from different clinical trials, it is evident that the addition of insulin glargine to oral metformin therapy can significantly increase the efficacy and safety of the therapy.

2. GLARGEN INSULIN AND GLYCEMIC CONTROL IN PEDIATRIC AGE

An interesting study carried out on 6-year-old diabetic patients has shown that insulin glargine therapy can already guarantee a significant reduction in glycated hemoglobin values compared to other insulins in a period of about 5 months, compared to a lower need for insulin itself .

3. GLARGE INSULIN IN PREGNANCY

Basal therapy with insulin in gestational diabetes certainly represents one of the most appropriate therapeutic choices. The first studies and clinical trials concern the safety of insulin glargine on the health of the fetus, not highlighting any side effects on fetal development or on the health of the pregnant woman.

Method of use and dosage

LANTUS ® 100 IU / ml of insulin glargine: 5 cartridges of 3 ml, 1 bottle of 10 ml or 5 disposable pens of 3 ml pre-filled:

in contrast to pre-prandial insulins, insulin glargine, thanks to its long duration of action, can be administered only once a day, every day at the same time subcutaneously.

The precise dosage should be established by the physician based on the physio-pathological characteristics of the patient and his clinical picture, also considering that it could be associated with other types of insulin ..

Warnings LANTUS ® - Insulin glargine

Treatment with LANTUS ® should be accompanied by periodic monitoring of glycemic values, useful for evaluating the effectiveness of the therapy and for setting any dosage adjustments to avoid the onset of hypoglycemic crises.

It is therefore important that the patient is instructed on the correct methods of intake and storage and on the potential risks, in order to promptly recognize the first signs of hypoglycemia and the conditions capable of masking them.

To maximize insulin therapy it is necessary for the patient to follow a balanced diet and a healthy lifestyle.

In case of suspension of the therapy, variation of the drug, renal pathologies, infectious diseases, medical supervision is essential to adapt the new therapy in the best way while preserving the patient's state of health and the efficacy of the treatment itself.

Episodes of hypoglycemia often are accompanied by a reduction in the patient's reactive and perceptive capacities, making it dangerous to use machinery and drive vehicles.

PREGNANCY AND BREASTFEEDING

At present there are no particularly significant clinical data useful to clarify the safety profile of insulin glargine on the health of the fetus and the mother, when taken during pregnancy, although different jobs seem to agree on its good tolerability.

It is however important to remember that insulin is the drug of first choice for the treatment of gestational diabetes.

Interactions

Insulin glargine, like other insulin analogues, can interact with oral hypoglycemic agents, octreotide, anti-MAO agents, beta blockers, ACE inhibitors, salicylates, alcohol and anabolic steroids, enhancing its hypoglycemic effect and increasing the risk of hypoglycemia.

Conversely, the concomitant intake of oral contraceptives, thiazides, glucocorticoids, thyroid hormones and sympathomimetics could reduce the therapeutic effect of this medicine, requiring a further adjustment of the dosage.

It should be remembered, however, that sympatholytics can mask some important signs of hypoglycemia, increasing the risk of serious reactions.

Contraindications LANTUS ® - Insulin glargine

LANTUS ® contraindicated in case of hypoglycemia and hypersensitivity to human insulin or its excipients.

Undesirable effects - Side effects

Insulin therapy exposes the patient to potential side effects whether confined to the injection site or systemic.

In fact, subcutaneous administration of insulin could cause transient redness, pain and itching during injection, while cases of lipoatrophy, although quite rare, have been observed in patients who did not systematically rotate the inoculation region.

Continued therapy has in some cases been associated with the emergence of anti-insulin antibodies, although recent formulations have significantly reduced the immunogenic charge of this hormone, and hypersensitivity with: dyspnea, breathing difficulties, edema and in more serious cases blood pressure drop.

Like all hypoglycemic therapies, even the one with LANTUS ® could be accompanied by cases of hypoglycemia which currently remains the most frequent side effect.

Other reactions to the nervous, visual, muscular or hematological system have been decidedly rare.