Insulin Glargine Lixisenatide Brand Name– SOLIQUA
What is Insulin Glargine Lixisenatide
Insulin glargine lixisenatide is a subcutaneous injection containing a combination of basal insulin (insulin glargine) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA) (lixisenatide).
The combination is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (DM).
The combination of allows for administration once-daily at the same time each day given within the hour before the first meal of the day.
Insulin glargine gives a flat and stable effect on blood glucose throughout the day; lixisenatide stimulates insulin secretion and lowers inappropriately high glucagon secretion in a glucose-dependent manner.
The combination has also been added to metformin therapy in patients naive to basal insulin and GLP-1 RAs; during clinical trials, the A1C was reduced an average of 0.5% more vs. the use of insulin glargine alone.
In the treatment of type 2 DM, metformin is first-line. Additional therapy with a GLP-1 RA that has proven cardiovascular (CV) benefit should be considered in patients with indicators of high-risk or established CV disease, independent of baseline A1C or individualized A1C target.
There is no evidence of CV benefit with lixisenatide; however, in clinical trials, lixisenatide did not increase the risk of CV adverse events.
GLP-1 RAs improve CV outcomes, as well as secondary outcomes such as heart failure (HF) and progression of renal disease, in patients with established CV disease or chronic kidney disease (CKD); this makes them an alternative treatment option in patients with indicators of high-risk or established heart failure HF or CKD who cannot tolerate a sodium-glucose cotransporter 2 inhibitor (SGLT2i).
Patients who need to minimize weight gain or lose weight should be started on a GLP-1 RA with proven efficacy for weight loss or an SGLT2i.
Insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents.
Consider switching to a fixed-ratio combination, like insulin glargine; lixisenatide in patients already receiving a GLP-1 RA who are starting on insulin.
In patients who are starting on insulin therapy and are taking a thiazolidinedione or insulin secretagogue, discontinue or reduce the dose of the oral medication.
Indications
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus in combination with diet and exercise
Side Effects
- abdominal pain
- anaphylactoid reactions
- angioedema
- antibody formation
- bronchospasm
- cataracts
- constipation
- cutaneous amyloidosis
- diarrhea
- dyspepsia
- erythema
- flatulence
- gastritis
- gastroesophageal reflux
- headache
- hematoma
- hyperinsulinemia
- hypertension
- hypoglycemia
- hypokalemia
- hypotension
- infection
- injection site reaction
- insulin resistance
- insulin shock
- laryngeal edema
- lipodystrophy
- nausea
- pancreatitis
- peripheral edema
- peripheral neuropathy
- pharyngitis
- pruritus
- renal failure (unspecified)
- retinopathy
- Somogyi effect
- urticaria
- vomiting
- weight gain
Monitoring Parameters
- blood glucose
- glycosylated hemoglobin A1c (HbA1c)
Contraindications
- alcoholism
- breast-feeding
- burns
- children
- cholelithiasis
- coma
- continuous subcutaneous insulin infusion (CSII) administration
- diabetic ketoacidosis
- diarrhea
- fever
- gastroparesis
- geriatric
- hepatic disease
- history of angioedema
- hyperosmolar hyperglycemic state (HHS)
- hypoglycemia
- hypokalemia
- infants
- infection
- intramuscular administration
- intravenous administration
- pancreatitis
- pregnancy
- renal failure
- renal impairment
- surgery
- thyroid disease
- tobacco smoking
- trauma
- type 1 diabetes mellitus
- visual impairment
- vomiting
Interactions
- Acebutolol
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