insulin aspart protamine/insulin aspart (NovoLog Mix 50/50, NovoLog Mix 70/30, NovoLog Mix 70/30 FlexPen)
Classes: Antidiabetics, Insulins
- Dosing and uses of NovoLog Mix 50/50, NovoLog Mix 70/30 (insulin aspart protamine/insulin aspart)
- NovoLog Mix 50/50, NovoLog Mix 70/30 (insulin aspart protamine/insulin aspart) adverse (side) effects
- Warnings
- Pregnancy
- Pharmacology of NovoLog Mix 50/50, NovoLog Mix 70/30 (insulin aspart protamine/insulin aspart)
Dosing and uses of NovoLog Mix 50/50, NovoLog Mix 70/30 (insulin aspart protamine/insulin aspart)
Adult dosage forms and strengths
insulin aspart protamine/insulin aspart
subcutaneous injection
- (70units/30units)/mL
Diabetes Mellitus
Combination rapid-onset (faster than regular insulin) and intermediate-acting insulins in fixed dose
Dose regimen varies among patients depending on metabolic needs; typical daily insulin requirements range between 0.5-1 unit/kg
Administer SC q12hr (ie, before breakfast and evening meal); each dose intended to cover 2 meals or a meal and snack
Inject SC into abdominal wall, thigh, or upper arm
Pediatric dosage forms and strengths
Safety and efficacy not established
NovoLog Mix 50/50, NovoLog Mix 70/30 (insulin aspart protamine/insulin aspart) adverse (side) effects
>10%
Hypoglycemia (47-69%)
Headache (12-35%)
Influenza-like symptoms (12-13%)
1-10%
Headache (9%)
Dyspepsia (9%)
Diarrhea (7-8%)
Back pain (7%)
Pharyngitis (6-7%)
Frequency not defined
Insulin resistance
Lipodystrophy
Lipohypertrophy
Local allergic reaction
Hypokalemia
Weight gain
Peripheral edema
Warnings
Contraindications
Hypersensitivity
Hypoglycemia
Cautions
Suspension for SC use, do not administer IV
Administer within 15 minutes of meals (rapid onset and peak ~1 hr)
Rapid changes in serum glucose may induce symptoms of hypoglycemia
Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions (eg, long duration of diabetes, diabetic nerve disease, use of beta-blockers or intensified diabetes control)
Caution in conditions with decreased insulin requirements (eg, diarrhea, nausea, vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment)
Caution in conditions with increased insulin requirements (eg, fever, hyperthyroidism, trauma, infection, surgery)
May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or conditions that may decrease potassium
Frequent glucose monitoring and insulin dose reduction may be required with renal or hepatic impairment; not recommended during periods of rapidly declining renal or hepatic function because of risk for prolonged hypoglycemia
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 and treat accordingly and consider discontinuing thiazolidinediones
Do not mix with other insulins
Do not administer via insulin infusion pump
Never share pen between patients even if needle is changed
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether distributed in breast milk; compatible with breast feeding, but lactating women may require dosage adjustment; caution advised
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.
Pharmacology of NovoLog Mix 50/50, NovoLog Mix 70/30 (insulin aspart protamine/insulin aspart)
Mechanism of action
Regulates glucose metabolism
Insulin and its analogs 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
Pharmacokinetics
Bioavailability: SC, well absorbed (2-3 times faster than regular insulin)
Half-Life: 8-9 hr Onset: <15 min
Peak Plasma Time: 1-1.5 hr
Peak Pharmacodynamic Activity: 1-4 hr after dose administration
Peak Plasma Concentration: 23.4 mU/L (after 0.2 unit/kg dose)
Protein Bound: 0-9%; similar to regular human insulin
Metabolism: Liver >50%, kidney 30%, adipose tissue/muscle 20%
Clearance: 1.2 L/hr/kg
Vd: 0.15 L/kg