insulin regular human (Rx, OTC)

Brand and Other Names:Humulin R, Novolin R, more...Humulin R U-500, Myxredlin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • OTC
    • 100units/mL (3mL vial)
    • 100units/mL (10mL vial)
  • Rx
    • 500units/mL (20mL vial); prescribe with U-500 syringes to avoid conversion for U-100 tuberculin syringes
    • 500units/mL (3mL pen)
    • 100units/100mL 0.9% NaCl (Myxredlin)

Type 1 Diabetes Mellitus

Indicated to improve glycemic control in with diabetes mellitus

SC injection

  • Initial: 0.2-0.4 units/kg/day SC divided q8hr or more frequently  
  • Maintenance: 0.5-1 unit/kg/day SC divided q8hr or more frequently; in insulin-resistant patients (eg, due to obesity), substantially higher daily insulin may be required
  • Approximately 50-75% of the total daily insulin requirements are given as intermediate- or long-acting insulin administered in 1-2 injections; rapid- or short-acting insulin should be used before or at mealtimes to satisfy the remainder balance of the total daily insulin requirements
  • Premixed combinations are available that deliver rapid- or short-acting components at the same time as the intermediate- or long-acting component

Insulin pump (continuous SC insulin infusion)

  • Use appropriate rapid-acting insulin formulation consisting of a combination of basal continuous insulin infusion rate with preprogrammed, premeal bolus doses controlled by the patient
  • Conversion from multiple daily SC doses of maintenance insulin: Consider reducing the basal rate to less than equivalent of total daily units of longer acting insulin (eg, NPH); divide total number of units by 24 to get basal rate in units/hr; total units of regular insulin or other rapid-acting insulin formulations should not be included in this calculation

IV infusion

  • Individualize and adjust dosage based on the individual's metabolic needs, blood glucose monitoring results, and glycemic control goal
  • Dosage adjustments may be needed with changes in nutrition, changes in renal or hepatic function or during acute illness

Type 2 Diabetes Mellitus

Type 2 diabetes inadequately controlled by diet, exercise, or oral medication

SC injection

  • Suggested beginning dose of 10 units/day SC (or 0.1-0.2 unit/kg/day) in evening or divided q12hr  
  • Morning
    • Give two thirds of daily insulin requirement
    • Ratio of regular insulin to NPH insulin 1:2
  • Evening
    • Give one third of daily insulin requirement
    • Ratio of regular insulin to NPH insulin 1:1

IV infusion

  • Individualize and adjust dosage based on the individual's metabolic needs, blood glucose monitoring results, and glycemic control goal
  • Dosage adjustments may be needed with changes in nutrition, changes in renal or hepatic function or during acute illness

Severe Hyperglycemia/Diabetic Ketoacidosis (Off-label)

IV regular insulin recommended over SC administration

0.1 unit/kg IV bolus (some argue against bolus), THEN  

0.1 unit/kg/hr IV continuous infusion; if serum glucose does not fall by 50 mg/dL in the first hour, check hydration status; if possible, double the insulin hourly until glucose levels fall at the rate of 50-75 mg/dL/hr; decrease infusion to 0.05-0.1 unit/kg/hour when blood sugar reaches 250 mg/dL

Hyperkalemia (Off-label)

5-10 units IV insulin in 50 mL D50W (25 g) infused over 15-30 min

Dosing Considerations

Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect

Dose adjustments should be based on regular blood glucose testing

Adjust to achieve appropriate glucose control

Planning dose adjustments

  • Look for consistent pattern in blood sugars for >3 days
  • Same time each day: Compare blood glucose levels with previous levels found at that time of day
  • For each time of day: Calculate blood glucose range
  • Calculate median blood glucose
  • Consider eating and activity patterns during day

Making dose adjustments

  • Adjust only 1 insulin dose at a time
  • Correct hypoglycemia first
  • Correct highest blood sugars next
  • If all blood sugars are high (within 2.75 mmol/L [50 mg/dL]): Correct morning fasting blood glucose first
  • Change insulin doses in small increments: Type 1 diabetes (1-2 unit change); type 2 diabetes (2-3 unit change)

Sliding scales

  • Many sliding scales exist to determine exact insulin dose based on frequent blood glucose monitoring
  • Commonly written for q4hr blood glucose test
  • Sliding scale coverage usually begins after blood glucose >11 mmol/L (200 mg/dL)
  • If coverage is needed q4hr for 24 hr, then base insulin dose is adjusted first; sliding scale doses may be adjusted upwards as well

Short Bowel Syndrome (Orphan)

Orphan designation for treatment of short bowel syndrome

Sponsor

  • Nutrinia, Ltd; 15 Abba Hillel Silver Rd, 7th Floor;Ramat-Gan 5252208; Israel

Dosage Forms & Strengths

injectable solution

  • OTC
    • 100units/mL (3mL vial)
    • 100units/mL (10mL vial)
  • Rx
    • 500units/mL (20mL vial); prescribe with U-500 syringes to avoid conversion for U-100 tuberculin syringes
    • 500units/mL (3mL pen)
    • 100units/100mL 0.9% NaCl (Myxredlin)

Type 1 Diabetes Mellitus

Initial: 0.2-0.4 unit/kg/day SC divided q8hr or more frequently  

Maintenance: 0.5-1 unit/kg/day SC divided q8hr or more frequently; in insulin-resistant patients (eg, due to obesity), substantially higher daily insulin may be required

Adolescents: May require up to 1.5 mg/kg/day during puberty

Average total daily insulin requirement for prepubertal children varies from 0.7-1 unit/kg/day but may be much lower

Insulin pump (continuous SC insulin infusion)

  • Use appropriate rapid-acting insulin formulation consisting of a combination of basal continuous insulin infusion rate with preprogrammed, premeal bolus doses controlled by the patient
  • Conversion from multiple daily SC doses of maintenance insulin: Consider reducing the basal rate to less than equivalent of total daily units of longer acting insulin (eg, NPH); divide total number of units by 24 to get basal rate in units/hr; total units of regular insulin or other rapid-acting insulin formulations should not be included in this calculation

IV infusion

  • Individualize and adjust dosage based on the individual's metabolic needs, blood glucose monitoring results, and glycemic control goal
  • Dosage adjustments may be needed with changes in nutrition, changes in renal or hepatic function or during acute illness

Type 2 Diabetes Mellitus

<10 years

  • Safety & efficacy not established

≥10 years

  • Goal is to achieve HbA1C <6.5% as quickly as possible by titrating the medications
  • Therapy may include once daily intermediate-acting insulin or basal insulin in combination with lifestyle changes and metformin
  • Initial treatment with prandial insulin (rapid acting insulin or regular insulin) may be considered in patients failing to achieve glycemic goals with metformin and basal insulin
  • Taper once initial goal is reached; transition to lowest effective dose or metformin monotherapy, if possible
  • IV infusion
    • Individualize and adjust dosage based on the individual's metabolic needs, blood glucose monitoring results, and glycemic control goal
    • Dosage adjustments may be needed with changes in nutrition, changes in renal or hepatic function or during acute illness

Severe Hyperglycemia/Diabetic Ketoacidosis (Off-label)

IV regular insulin recommended over SC administration

Patients with uncomplicated diabetic ketoacidosis and adequate peripheral circulation may be treated with SC rapid acting analogs including insulin aspart or lispro when continuous IV regular insulin not possible

Dextrose (5%) added to normal saline or ½ normal saline should be administered to prevent hypoglycemia after achieving serum glucose levels between 250-300 mg/dL; administer sooner if serum glucose decreases precipitously; may use 10-12.5% dextrose if necessary

Administer 0.05 to 0.1 units/kg/hr until resolution of ketoacidosis (pH>7.3; bicarbonate >15 mEq/L and/or closure of anion gap); may administer lower infusion rates if patient exhibits marked sensitivity to insulin and resolution of acidosis can be achieved

Transition to SC insulin regimen once ketoacidosis resolved; to ensure adequate plasma insulin levels, overlap discontinuation of IV insulin and administration of SC insulin; timing of SC insulin administration prior to IV infusion discontinuation depends on type of insulin used (1-2 hr for regular insulin and 15-30 min for rapid acting insulin)

Hyperkalemia (Off-label)

0.1 unit/kg with 400 mg/kg of glucose administered IV; (insulin to glucose ratio 1 unit of insulin for every 4 g of glucose recommended)

Dosing Considerations

Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect

Approximately 50-75% of the total daily insulin requirements are given as intermediate- or long-acting insulin administered in 1-2 injections

Rapid- or short-acting insulin should be used before or at mealtimes to satisfy the remainder balance of the total daily insulin requirements

Premixed combinations are available that deliver a rapid- or short-acting component at the same time as the intermediate- or long-acting component

Next:

Interactions

Interaction Checker

and insulin regular human

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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             activity indicator 

            Contraindicated (1)

            • pramlintide

              insulin regular human, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            Serious - Use Alternative (2)

            • ethanol

              ethanol, insulin regular human. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

            • macimorelin

              insulin regular human, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may transiently elevate growth hormone (GH) concentrations may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.

            Monitor Closely (126)

            • acarbose

              acarbose, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • albiglutide

              albiglutide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • alogliptin

              alogliptin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • aripiprazole

              aripiprazole, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • aspirin

              aspirin increases effects of insulin regular human by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Insulin dose adjustment and increased frequency of glucose monitoring may be required.

            • atazanavir

              atazanavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • azilsartan

              azilsartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • benazepril

              benazepril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • bexarotene

              bexarotene increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Based on the mechanism of action, bexarotene capsules may increase the action of insulin enhancing agents, resulting in hypoglycemia. Hypoglycemia has not been associated with bexarotene monotherapy.

            • bitter melon

              bitter melon increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypoglycemia.

            • canagliflozin

              insulin regular human, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

              canagliflozin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • candesartan

              candesartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • captopril

              captopril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose. Monitor blood glucose.

            • chlorpropamide

              chlorpropamide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • cinnamon

              cinnamon increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Potential for hypoglycemia.

            • ciprofibrate

              ciprofibrate increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • ciprofloxacin

              ciprofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • clozapine

              clozapine, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • dapagliflozin

              insulin regular human, dapagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with dapagliflozin.

              dapagliflozin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • darunavir

              darunavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • deflazacort

              insulin regular human and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • dexfenfluramine

              dexfenfluramine increases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Dexfenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • dichlorphenamide

              dichlorphenamide and insulin regular human both decrease serum potassium. Use Caution/Monitor.

            • disopyramide

              disopyramide increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.

            • dulaglutide

              dulaglutide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • empagliflozin

              empagliflozin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with SGLT2 inhibitors.

            • enalapril

              enalapril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • eprosartan

              eprosartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • ertugliflozin

              ertugliflozin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with ertugliflozin.

            • ethinylestradiol

              ethinylestradiol decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Oral contraceptives may decrease hypoglycemic effects of antidiabetics by impairing glucose tolerance. Monitor for glycemic control in diabetic patients.

            • exenatide injectable solution

              exenatide injectable solution, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • exenatide injectable suspension

              exenatide injectable suspension, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • fenfluramine

              fenfluramine increases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Fenfluramine enhances glucose uptake in peripheral tissue, increasing risk of hypoglycemia.

            • fenofibrate

              fenofibrate increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • fenofibrate micronized

              fenofibrate micronized increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • fenofibric acid

              fenofibric acid increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • fleroxacin

              fleroxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

            • fluoxetine

              fluoxetine increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and fluoxetine may require insulin dosage adjustment and increased glucose monitoring.

            • fosamprenavir

              fosamprenavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • fosinopril

              fosinopril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • gemfibrozil

              gemfibrozil increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

            • gemifloxacin

              gemifloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

            • glimepiride

              glimepiride, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • glipizide

              glipizide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • glucagon

              glucagon decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.

            • glucagon intranasal

              glucagon intranasal decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.

            • glyburide

              glyburide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • iloperidone

              iloperidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • imidapril

              imidapril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • indinavir

              indinavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • irbesartan

              irbesartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • isocarboxazid

              isocarboxazid increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.

            • ketotifen, ophthalmic

              ketotifen, ophthalmic, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Combination may result in thrombocytopenia (rare). Monitor CBC.

            • lanreotide

              lanreotide increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and somatostatin analogs may require insulin dosage adjustment and increased glucose monitoring.

            • levofloxacin

              levofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

            • linagliptin

              linagliptin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • linezolid

              linezolid increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.

            • liraglutide

              liraglutide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • lisinopril

              lisinopril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • lithium

              lithium, insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

            • lopinavir

              lopinavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • losartan

              losartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • lurasidone

              lurasidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • magnesium salicylate

              magnesium salicylate increases effects of insulin regular human by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Insulin dose adjustment and increased frequency of glucose monitoring may be required.

            • marijuana

              marijuana decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor.

            • mecasermin

              mecasermin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Additive hypoglycemic effects.

            • metformin

              metformin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • methyltestosterone

              methyltestosterone increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. It is important to monitor all patients with type 2 diabetes on antidiabetic agents receiving androgens for changes in glycemic control. Potential for hypoglycemia.

            • metoclopramide intranasal

              metoclopramide intranasal increases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Increased GI motility by metoclopramide may increase delivery of food to the intestines and increase blood glucose. Monitor blood glucose and adjust insulin dosage regimen as needed.

            • metreleptin

              insulin regular human, metreleptin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of metreleptin with insulin and/or insulin secretagogues (eg, sulfonylureas, meglitinide derivatives) may increase risk for hypoglycemia; may require lower dose of insulin or insulin secretagogue.

            • miglitol

              miglitol, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • moexipril

              moexipril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • moxifloxacin

              moxifloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

            • nadolol

              nadolol, insulin regular human. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • nateglinide

              nateglinide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • nelfinavir

              nelfinavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • niacin

              niacin decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant use of insulin and niacin may require insulin dosage adjustment and increased glucose monitoring.

            • octreotide

              octreotide increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and somatostatin analogs may require insulin dosage adjustment and increased glucose monitoring.

            • ofloxacin

              ofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

            • olanzapine

              olanzapine, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • olmesartan

              olmesartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • opuntia ficus indica

              opuntia ficus indica increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              paliperidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • pasireotide

              pasireotide increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and somatostatin analogs may require insulin dosage adjustment and increased glucose monitoring.

            • pentamidine

              pentamidine, insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • perindopril

              perindopril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • phenelzine

              phenelzine increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.

            • pindolol

              pindolol, insulin regular human. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • pioglitazone

              insulin regular human increases toxicity of pioglitazone by unknown mechanism. Use Caution/Monitor. Insulin may increase the fluid retention associated with thiazolidinediones (peroxisome proliferator-activated receptor [PPAR]-gamma agonists).

              pioglitazone, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • propranolol

              propranolol, insulin regular human. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • pseudoephedrine

              pseudoephedrine decreases effects of insulin regular human by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • quetiapine

              quetiapine, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • quinapril

              quinapril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • ramipril

              ramipril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • risperidone

              risperidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • ritonavir

              ritonavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • rosiglitazone

              insulin regular human increases toxicity of rosiglitazone by unknown mechanism. Use Caution/Monitor. Insulin may increase the fluid retention associated with thiazolidinediones (peroxisome proliferator-activated receptor [PPAR]-gamma agonists).

              rosiglitazone, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • sacubitril/valsartan

              sacubitril/valsartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • salsalate

              salsalate increases effects of insulin regular human by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Insulin dose adjustment and increased frequency of glucose monitoring may be required.

            • saquinavir

              saquinavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • saxagliptin

              saxagliptin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • selegiline

              selegiline increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.

            • selegiline transdermal

              selegiline transdermal increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.

            • semaglutide

              semaglutide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin with GLP-1 agonists may increase hypoglycemia risk. Lowering the insulin dose may reduce hypoglycemia risk.

            • shark cartilage

              shark cartilage increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Theoretical interaction.

            • sitagliptin

              sitagliptin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              insulin regular human and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • somapacitan

              somapacitan decreases effects of insulin regular human by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone products may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating somapacitan. .

            • somatropin

              somatropin decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor.

            • sulfadiazine

              sulfadiazine increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

            • sulfamethoxypyridazine

              sulfamethoxypyridazine increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.

            • sulfisoxazole

              sulfisoxazole increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

            • telmisartan

              telmisartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • testosterone intranasal

              testosterone intranasal increases effects of insulin regular human by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Androgens may decrease blood glucose and, therefore, may necessitate a decrease in the dose of antidiabetic medication.

            • timolol

              timolol, insulin regular human. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • tipranavir

              tipranavir decreases effects of insulin regular human by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • tolazamide

              tolazamide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • tolbutamide

              tolbutamide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • trandolapril

              trandolapril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • tranylcypromine

              tranylcypromine increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

            • valsartan

              valsartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

            • xipamide

              xipamide decreases levels of insulin regular human by increasing renal clearance. Use Caution/Monitor.

            • ziprasidone

              ziprasidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            Minor (78)

            • agrimony

              agrimony increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • American ginseng

              American ginseng increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • amitriptyline

              amitriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • amoxapine

              amoxapine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • anamu

              anamu increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.

            • aspirin rectal

              aspirin rectal increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • balsalazide

              balsalazide increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • bendroflumethiazide

              bendroflumethiazide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • budesonide

              budesonide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • chlorothiazide

              chlorothiazide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • chlorthalidone

              chlorthalidone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • chromium

              chromium increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • clomipramine

              clomipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • clonidine

              clonidine decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.

              clonidine, insulin regular human. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production.

            • coenzyme Q10

              coenzyme Q10 increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Monitor insulin requirements.

            • cornsilk

              cornsilk increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

            • cortisone

              cortisone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • cyclopenthiazide

              cyclopenthiazide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • damiana

              damiana decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

            • danazol

              danazol increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • deflazacort

              deflazacort decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • desipramine

              desipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • devil's claw

              devil's claw increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • dexamethasone

              dexamethasone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • diflunisal

              diflunisal increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • doxepin

              doxepin increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • elderberry

              elderberry increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (in vitro research).

            • eucalyptus

              eucalyptus increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.

            • fludrocortisone

              fludrocortisone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • fluoxymesterone

              fluoxymesterone increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • fo-ti

              fo-ti increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • forskolin

              forskolin increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Colenol, a compound found in Coleus root, may stimulate insulin release.

            • gotu kola

              gotu kola increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).

            • guanfacine

              guanfacine decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.

              guanfacine, insulin regular human. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production.

            • gymnema

              gymnema increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • horse chestnut seed

              horse chestnut seed increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • hydrochlorothiazide

              hydrochlorothiazide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • hydrocortisone

              hydrocortisone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • imipramine

              imipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • indapamide

              indapamide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • isoniazid

              isoniazid decreases effects of insulin regular human by unspecified interaction mechanism. Minor/Significance Unknown.

            • juniper

              juniper increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

            • lofepramine

              lofepramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • lycopus

              lycopus increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

            • maitake

              maitake increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (animal research).

            • maprotiline

              maprotiline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • mesalamine

              mesalamine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • mesterolone

              mesterolone increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • methyclothiazide

              methyclothiazide decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • methylprednisolone

              methylprednisolone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • metolazone

              metolazone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

            • nettle

              nettle increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).

            • nortriptyline

              nortriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • ofloxacin

              ofloxacin, insulin regular human. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential dysglycemia.

            • oxandrolone

              oxandrolone increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • oxymetholone

              oxymetholone increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • panax ginseng

              panax ginseng increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • pegvisomant

              pegvisomant increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • potassium acid phosphate

              potassium acid phosphate increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

            • potassium chloride

              potassium chloride increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

            • potassium citrate

              potassium citrate increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

            • prednisolone

              prednisolone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • prednisone

              prednisone decreases effects of insulin regular human by pharmacodynamic antagonism. Minor/Significance Unknown.

            • protriptyline

              protriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • sage

              sage increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • Siberian ginseng

              Siberian ginseng increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • sulfasalazine

              sulfasalazine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

            • testosterone

              testosterone increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • testosterone buccal system

              testosterone buccal system increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • testosterone topical

              testosterone topical increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • tongkat ali

              tongkat ali increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypoglycemia.

            • trazodone

              trazodone increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • trimipramine

              trimipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • vanadium

              vanadium increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • willow bark

              willow bark increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

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            Adverse Effects

            Frequency Not Defined

            Intensification or rapid improvement in glucose control associated with a transitory, reversible ophthalmologic refraction disorder, worsening of diabetic retinopathy, and acute painful peripheral neuropathy

            Hypersensitivity reactions

            Severe, life-threatening, generalized allergy, including anaphylaxis

            Hypoglycemia

            Hypokalemia

            Peripheral edema

            Weight gain

            Immunogenicity

            Postmarketing Reports

            Injection site reactions

            Localized cutaneous amyloidosis

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            Warnings

            Contraindications

            Hypersensitivity to product or excipients

            Hypoglycemia

            Cautions

            Never share pen, needles, or syringes between patients

            Use with caution in patients with decreased insulin requirements: Diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, and hepatic impairment

            Use with caution in patients with increased insulin requirements: Fever, hyperthyroidism, trauma, infection, and surgery

            Severe, life-threatening, generalized allergy, including anaphylaxis, can occur; discontinue therapy if indicated

            Not for mixing with any insulin for intravenous use or with insulins other than NPH insulin for subcutaneous use

            Use caution in pregnancy

            Hyperglycemia or hypoglycemia with changes in insulin regimen

            • Rapid changes in serum glucose may induce symptoms of hypoglycemia; increase monitoring with changes to insulin dosage, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with renal impairment or hepatic impairment or hypoglycemia unawareness
            • Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia; changes should be made cautiously and under close medical supervision and frequency of blood glucose monitoring should be increased; for patients with type 2 diabetes, dosage adjustments of concomitant antidiabetic products may be needed
            • Hypoglycemia is the most common cause of adverse reactions (headache, tachycardia, etc)
            • Severe hypoglycemia can cause seizures, may lead to unconsciousness, may be life threatening or cause death; can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g. driving or operating other machinery)
            • Hypoglycemia can happen suddenly and symptoms may differ in each individual and change over time in the same individual; symptomatic awareness of may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications that block sympathetic nervous system (e.g., beta-blockers), or in patients who experience recurrent hypoglycemia
            • Risk of hypoglycemia after injection is related to duration of action of insulin and, in general, is highest when glucose lowering effect of insulin is maximal; as with all insulin preparations, the glucose lowering effect time course may vary in different individuals or at different times in same individual and depends on many conditions, including area of injection as well as injection site blood supply and temperature
            • Patients and caregivers must be educated to recognize and manage hypoglycemia; self- monitoring of blood glucose plays an essential role in prevention and management of hypoglycemia; in patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, increased frequency of blood glucose monitoring recommended
            • Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis reported to result in hyperglycemia; a sudden change in the injection site (to unaffected area) has been reported to result in hypoglycemia
            • Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring
            • Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change injection site to unaffected areas and closely monitor for hypoglycemia
            • For patients with type 2 diabetes, dosage adjustments in concomitant oral antidiabetic treatment may be needed

            Medication errors associated with U-500

            • Prescribed dose should always be expressed in actual units of insulin and NOT volume
            • Reports of errors resulting in hyperglycemia, hypoglycemia, or death
            • Majority of errors occurred due to errors in dispensing, prescribing, or administration; confusion with corresponding markings on the syringe the patient is using (ie, a U-100 insulin syringe or tuberculin syringe)
            • To avoid medication errors between insulin types, instruct patients to always check insulin label before each injection

            Drug interactions overview

            • May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or when administered to patients with a condition that may decrease potassium; untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death; monitor potassium levels in patients at risk for hypokalemia if indicated
            • Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin; fluid retention may lead to or exacerbate heart failure; monitor for signs and symptoms of heart failure, treat the patient accordingly, and consider discontinuing thiazolidinediones
            • Coadministration with drugs that may decrease the blood glucose lowering effect (eg, atypical antipsychotics): Adjust dose and increase the frequency of monitoring
            • Coadministration with drugs that may decrease or increase the blood glucose lowering effect (eg, alcohol): Adjust dose and increase the frequency of monitoring
            • Increased frequency of glucose monitoring when concomitantly insulin regular human with drugs that may blunt signs and symptoms of hypoglycemia (eg, beta-blockers)
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            Pregnancy & Lactation

            Pregnancy

            Available data from published studies over decades have not established association with human insulin use during pregnancy and major birth defects, miscarriage or adverse maternal or fetal outcomes

            There are risks to mother and fetus associated with poorly controlled diabetes in pregnancy; animal reproduction studies were not performed

            Clinical considerations

            • Poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, stillbirth, and delivery complications; poorly controlled diabetes increases fetal risk for major birth defects, stillbirth, and macrosomia-related morbidity

            Lactation

            Available data from published literature suggests that exogenous human insulin products, are transferred into human milk; there are no adverse reactions reported in breastfed infants in the literature; there are no data on effects of exogenous human insulin products, on milk production

            Consider developmental and health benefits of breastfeeding along with the mother’s clinical need for therapy, and any potential adverse effects on breastfed infant from drug, or from underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Regulates glucose metabolism

            Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis and enhances protein synthesis; targets include skeletal muscle, liver, and adipose tissue

            Absorption

            Bioavailability: 55-77% (SC)

            Onset: 0.5 hr (early effect); 2.5-5 hr (peak effect)

            Duration: 4-12 hr (U-100); up to 24 hr (U-500)

            Peak plasma time: 0.8-2 hr (SC)

            Distribution

            Vd: 0.26-0.36 L/kg

            Metabolism

            Metabolized by liver (>50%), kidney (30%), and adipose tissue/muscle (20%)

            Elimination

            Excretion: Urine

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            Administration

            IV Compatibilities (Vials only)

            Humulin R or Novolin R: 0.9% NaCl

            Novolin R only

            • Dextrose 5%
            • Dextrose 10% with 40 mmol/L potassium chloride

            SC Preparation

            Mix with isophane insulin human suspension

            When mixing, draw insulin regular into the syringe first and inject mixture immediately after mixing

            IV Preparation

            Vial

            • Humulin R: Use at concentrations from 0.1-1 unit/mL in infusion systems containing 0.9% NaCl
            • Novolin R: Dilute to concentrations from 0.05-1 unit/mL insulin in infusion systems using polypropylene infusion bags; stable in infusion fluids such as 0.9% NaCl, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride

            IV Administration

            Administer IV ONLY under medical supervision with close monitoring of blood glucose and potassium levels to reduce the risk of hypoglycemia and hypokalemia

            Do not use of Novolin R in insulin pumps because of the risk of precipitation

            Premix bag

            • Visually inspect before use; should appear clear and colorless; do not use if particulate matter or coloration is seen
            • Do not add supplementary medication or additives
            • Do not use in series connections
            • Do not shake
            • Do not freeze
            • Discard any unused portion

            SC Administration

            Always check insulin label before administration to confirm the correct insulin product before use

            Visually inspect before use; should appear clear and colorless; do not use if particulate matter or coloration is seen

            Inject SC ~30 minutes before meals into the thigh, upper arm, abdomen, or buttocks

            Rotate injection sites within the same region from 1 injection to the next to reduce the risk of lipodystrophy

            Storage

            Humulin R U-100

            • Unopened vials: Refrigerator at 2-8°C (36-46°F) until expiration date or store at room temperature for up to 31 days; do not freeze; protect from heat and sunlight
            • Opened vials: Refrigerate at 2-8°C (36-46°F) or at room temperature of ≤30°C (≤86°F) for up to 31 days

            Humulin R U-500

            • Unopened vials: Refrigerate at 2-8°C (36-46°F) until expiration date; do not freeze; protect from heat and sunlight or may be stored at room temperature <30°C [86°F]) for up to 40 days
            • Opened vials: Refrigerate at 2-8°C (36-46°F) or at room temperature <30°C [86°F]) and discard after 40 days; do not shake vial

            Humulin R KwikPen

            • Unopened pens: Refrigerate at 2-8°C (36-46°F) until expiration date or store at room temperature <30°C [86°F]) for up to 28 days; protect from heat and light; do not freeze or use if pen has been frozen
            • Used pens: Store at room temperature (<30°C [86°F]) and discard pen after 28 days; do not refrigerate; for single-patient use only

            Novolin R vials

            • Unopened vials: Refrigerator at 2-8°C (36-46°F) until expiration date or at room temperature ≤25°C (≤77°F) for up to 42 days; do not freeze; protect from heat and sunlight
            • Opened vials: Store at room temperature ≤25°C (≤77°F) for up to 42 days; refrigeration of in-use vials is not recommended

            Novolin R FlexPen

            • Unopened pens: Refrigerate at 2-8°C (36 -46°F) until product expiration date or at room temperature (<30°C [86°F]) for up to 28 days
            • Used pens: Store at room temperature (<30°C [86°F]) for up to 28 days; do not use if pen has been frozen; keep away from heat and light; for single-patient use only

            Diluted solutions

            • Humulin R U-100: Refrigerate 2-8°C (36 -46°F) for 48 hr and then may be used at room temperature for up to an additional 48 hr
            • Novolin R: Stable for 24 hours at room temperature; after dilution of 100 units of regular human insulin (product not specified) in 100 mL of 0.9% NaCl (PVC bag), diluted solutions are stable under refrigeration between 2-8°C (36-46°F) for up to 336 hours (Rocchio 2013)

            Premix bag

            • Refrigerate at 2-8°C (36-46°F) in the original carton to protect from light until administration; do not use after the expiration date
            • If needed, store at room temperature up to 25°C (77°F) for up to 30 days in the original carton
            • Once stored at room temperature, do not place back in the refrigerator; discard after 30 days if stored at room temperature
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Novolin R Regular U-100 Insulin injection
            -
            100 unit/mL vial
            Afrezza inhalation
            -
            12 unit device
            Afrezza inhalation
            -
            4 unit (90)/ 8 unit (90) device
            Afrezza inhalation
            -
            4 unit/8 unit/ 12 unit (60) device
            Afrezza inhalation
            -
            4 unit device
            Humulin R Regular U-100 Insulin injection
            -
            100 unit/mL vial
            Humulin R Regular U-100 Insulin injection
            -
            100 unit/mL vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            insulin regular human subcutaneous

            INSULIN REGULAR HUMAN - INJECTION

            (IN-su-lin)

            COMMON BRAND NAME(S): Humulin R, Novolin R

            USES: Insulin regular is used with a proper diet and exercise program to control high blood sugar in people with diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke.This man-made insulin product is the same as human insulin. It replaces the insulin that your body would normally make. It is a short-acting insulin. It works by helping blood sugar (glucose) get into cells so your body can use it for energy. This medication is usually used in combination with a medium- or long-acting insulin product. This medication may also be used alone or with other oral diabetes drugs (such as metformin).

            HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start using this medication and each time you get a refill. If you have any questions, ask your doctor, diabetes educator, or pharmacist.Learn all preparation and usage instructions from your health care professional and the product package.Before using, check this product visually for particles or discoloration. If either is present, do not use the insulin. Insulin regular should be clear and colorless.Before injecting each dose, clean the injection site with rubbing alcohol. Change where you inject each time to lessen the risk of problems or damage under the skin (for example, pits/lumps or thickened skin). Insulin regular may be injected in the stomach area, the thigh, the buttocks, or the back of the upper arm. Do not inject into a vein or muscle because very low blood sugar (hypoglycemia) may occur. Do not rub the area after the injection. Do not inject into skin that is red, swollen, itchy, or damaged. Do not inject cold insulin because this can be painful. The insulin container you are currently using can be kept at room temperature.Inject this medication under the skin as directed by your doctor, usually 30 minutes before meals. Because this insulin is fast-acting, not eating right after a dose of this insulin may lead to low blood sugar (hypoglycemia).Giving insulin regular into a vein should only be done by a health care professional. Very low blood sugar may result.Do not use insulin regular in an insulin pump.This product may be mixed only with certain other insulin products such as NPH insulin. Always draw the insulin regular into the syringe first, then follow with the longer-acting insulin. Never inject a mixture of different insulins into a vein. Consult your health care professional about which products may be mixed, the proper method for mixing insulin, and the proper way to inject mixtures of insulin.Do not change brands or types of insulin without directions on how to do so from your doctor.Do not share your pen device with another person, even if the needle is changed. You may give other people a serious infection, or get a serious infection from them. Learn how to store and discard medical supplies safely.The dosage is based on your medical condition and response to treatment. Measure each dose very carefully because even small changes in the amount of insulin may have a large effect on your blood sugar.Check your blood sugar regularly as directed by your doctor. Keep track of your results and share them with your doctor. This is very important in order to determine the correct insulin dose.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.Tell your doctor if your condition does not improve or if it worsens (your blood sugar is too high or too low).

            SIDE EFFECTS: Injection site reactions (such as pain, redness, irritation) or weight gain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: signs of low potassium level in the blood (such as muscle cramps, weakness, irregular heartbeat).This medication can cause low blood sugar (hypoglycemia). This may occur if you do not consume enough calories from food or if you do unusually heavy exercise. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your dosage may need to be increased.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using insulin regular, tell your doctor or pharmacist if you are allergic to it; or to other insulins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Do not use this medication when you have low blood sugar (hypoglycemia).Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, thyroid problems.You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.Limit alcohol while taking this medication because it can increase your risk of developing low blood sugar.It may be harder to control your blood sugar when your body is stressed (such as due to fever, infection, injury, or surgery). Consult your doctor because this may require a change in your treatment plan, medications, or blood sugar testing.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Check your blood sugar before and after exercise. You may need a snack before exercising.If traveling across time zones, ask your doctor about how to adjust your insulin schedule. Take extra insulin and supplies with you.Older adults may be more sensitive to the side effects of this drug, especially low blood sugar.Children may be more sensitive to the side effects of this drug, especially low blood sugar.Tell your doctor right away if you are pregnant. Pregnancy may cause or worsen diabetes. Discuss a plan with your doctor for managing your blood sugar while pregnant. Your doctor may change your diabetes treatment during your pregnancy (such as diet and medications including insulin).This medication passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding. Your insulin needs may change while breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: rosiglitazone.Beta-blocker medications (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness, hunger, or sweating, are unaffected by these drugs.Many drugs can affect your blood sugar levels, making it more difficult to control your blood sugar. Before you start, stop, or change any medication, talk with your doctor or pharmacist about how the medication may affect your blood sugar. Check your blood sugar regularly as directed by your doctor. Tell your doctor about the results and of any symptoms of high or low blood sugar. (See also Side Effects section.) Your doctor may need to adjust your diabetes medication, exercise program, or diet.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: signs of low blood sugar such as sweating, shakiness, loss of consciousness, fast heartbeat.

            NOTES: Do not share this medication, needles, or syringes with others.Attend a diabetes education program to learn more about how to manage your diabetes with medications, diet, exercise, and regular medical exams.Learn the symptoms of high and low blood sugar and how to treat low blood sugar. Check your blood sugar regularly as directed and share the results with your doctor.Lab and/or medical tests (such as liver and kidney function tests, fasting blood glucose, hemoglobin A1c, complete blood counts) should be done while you are taking this medication. Keep all medical and lab appointments.Keep extra supplies of insulin, syringes, and needles on hand.

            MISSED DOSE: It is very important to follow your insulin regimen exactly. Ask your doctor ahead of time what you should do if you miss a dose of insulin.

            STORAGE: Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Protect insulin from light and heat. Do not store in the bathroom. Do not freeze, and do not use insulin that has been frozen. Throw away all insulin products after the expiration date on the package, or after the specified number of days after it has been opened or kept at room temperature, whichever date is earlier. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised July 2020. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.