LANTUS ® - Insulin glargine
LANTUS ® a drug based on insulin glargine.
THERAPEUTIC GROUP: Insulin glargine for injectable use - insulins and analogues.
Indications LANTUS ® - Insulin glargine
LANTUS ® is a medicine useful for the treatment of diabetes mellitus in cases where insulin therapy is required.
Mechanism of action LANTUS ® - Insulin glargine
LANTUS ® is a drug based on insulin glargine, an insulin analogue characterized by the longer duration of action which allows the diabetic patient to take the drug only once a day (in fact it represents what is commonly defined as basal insulin).
The long duration of action, averaging about 20 hours, is guaranteed by the low solubility of this variant at physiological pH, which allows the drug to form microprecipitates in the subcutaneous tissue useful for ensuring a gradual release of the hormone into 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 should be remembered that the mechanism of action remains identical to that of the endogenous hormone, acting, through specific receptors, on insulin sensitive tissues, increasing the uptake and utilization of blood glucose.
In addition to the modulating effect on muscle metabolism (induction of glycogen synthesis and protein synthesis) and on adipose tissue (inhibition of lipolysis and induction of lithogenesis), insulin can also act to a lesser extent on other insulin sensitive tissues such as the mammary gland and on metabolically organs fundamental such as the liver, inhibiting processes such as glycogenolysis and gluconeogenesis responsible for a large part of the endogenous production of glucose.
Studies carried out and clinical efficacy
1. INSULIN GLARGIN AND TYPE II DIABETES
Diabetes Obes Metab. 2011 Apr 11.
An analysis of early insulin glargine added to metformin with or without sulfonylurea: impact on glycemic control and hypoglycemia.
Fonseca V, Gill J, Zhou R, Leahy J.
Insulin glargine, given its long duration of action and the absence of blood peaks, is well suited to the treatment of type II diabetes not adequately compensated with oral hypoglycemic agents. In this study which elaborates the data of different clinical trials, it is highlighted that the addition of insulin glargine to oral metformin therapy can significantly increase the efficacy and safety of the therapy.
2. GLARGIN INSULIN AND GLYCEMIC CONTROL IN PEDIATRIC AGE
Pediatr Diabetes. 2011 Mar 28.
Lower HbA1c after 1 year, in children with type 1 diabetes treated with insulin glargine vs. NPH insulin from diagnosis: a retrospective study.
Salemyr J, Bang P, Ortqvist E.
An interesting study conducted on 6-year-old diabetic patients has shown how therapy with insulin glargine can already guarantee a significant reduction in glycated hemoglobin values compared to other insulins in a period of about 5 months, against a lower need for insulin itself. .
3. INSULIN GLARGIN IN PREGNANCY
Ann Pharmacother. 2011 Jan; 45: 9-16.
Safety of insulin glargine use in pregnancy: a systematic review and meta-analysis.
Pollex E, Moretti ME, Koren G, Feig DS.
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 the fetal development or on the health conditions of the pregnant woman.
Method of use and dosage
LANTUS ® 100 IU / ml insulin glargine: 5 cartridges of 3 ml, 1 bottle of 10 ml or 5 disposable 3 ml pre-filled pens:
unlike pre-meal insulins, insulin glargine, thanks to its long duration of action, can be administered only once a day, every day at the same time by subcutaneous route.
The precise dosage should be established by the doctor 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.
LANTUS ® warnings - Insulin glargine
Treatment with LANTUS ® should be accompanied by periodic monitoring of glycemic values, useful for evaluating the efficacy of the therapy and for setting any dose 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, the patient must follow a balanced diet and a healthy lifestyle.
In the event of discontinuation of therapy, drug changes, kidney diseases, infectious diseases, medical supervision is essential to adapt the new therapy in the best possible way, preserving the patient's health and the effectiveness of the treatment itself.
Episodes of hypoglycemia are often accompanied by a reduction in the patient's reactive and perceptive abilities, making the use of machinery and driving vehicles dangerous.
PREGNANCY AND BREASTFEEDING
At the moment there are no particularly significant clinical data useful to clarify the safety profile of insulin glargine on the health of the fetus and mother, when taken during pregnancy, although different studies seem to agree on its good tolerability.
However, it is important to remember that insulin is the drug of choice for the treatment of gestational diabetes.
Insulin glargine, like other insulin analogues, may interact with oral hypoglycemic agents, octreotide, anti-MAO, beta blocking agents, ACE inhibitors, salicylates, alcohol and anabolic steroids, enhancing its hypoglycemic effect and increasing the risk of hypoglycemia.
On the contrary, the concomitant intake of oral contraceptives, thiazides, glucorticoids, thyroid hormones and sympathomimetics could reduce the therapeutic effect of this medicine, requiring a further adjustment of the dosage.
However, it should be remembered 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 both confined to the injection site and systemic.
In fact, the subcutaneous administration of insulin could cause transient redness, pain and itching at the injection site, while cases of lipoatrophy, albeit 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 appearance of anti-insulin antibodies, although recent formulations have significantly reduced the immunogenic load of this hormone, and with hypersensitivity with: dyspnoea, breathing difficulties, edema and, in the most serious cases, a drop in blood pressure.
Like all hypoglycemic therapies, even that with LANTUS ® could be accompanied by cases of hypoglycemia which at the moment remains the most frequent side effect.
Other reactions affecting the nervous, visual, muscular or haematological systems have been very rare.
LANTUS ® sold only under medical prescription.
LANTUS ® falls within the doping class: Hormones and related substances (prohibited in and out of competition)
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