Insulin lispro

Insulin lispro, sold under the brand name Humalog among others, is a type of manufactured insulin used to treat type I and type II diabetes.[2] Typically it is taken around the time of eating.[2] It is used by injection under the skin or within an insulin pump.[2][3] Onset of effects typically occurs within 30 minutes and lasts about 5 hours.[2] Often a longer acting insulin like NPH is also needed.[2]

Insulin lispro
Clinical data
Trade namesHumalog, Admelog[1]
AHFS/Drugs.comMonograph
MedlinePlusa697021
License data
Pregnancy
category
  • US: C (Risk not ruled out)
    Routes of
    administration    		Subcutaneous
    ATC code
    Legal status
    Legal status
    Identifiers
    CAS Number
    PubChem CID
    DrugBank
    ChemSpider
    • none
    UNII
    KEGG
    CompTox Dashboard (EPA)
    Chemical and physical data
    FormulaC257H389N65O77S6
    Molar mass5813.63 g/mol g·mol−1
     NY (what is this?)  (verify)

    Common side effects include low blood sugar.[2] Other serious side effects may include low blood potassium.[2] Use in pregnancy and breastfeeding is generally safe.[4] It works the same as human insulin by increasing the amount of glucose that tissues take in and decreasing the amount of glucose made by the liver.[2]

    Insulin lispro was first approved for use in the United States in 1996.[2] In the United Kingdom it costs the NHS about £1.89 per 100 units as of 2019.[3] In the United States the wholesale cost of this amount is about US$30.00.[5] In 2016 it was the 100th most prescribed medication in the United States with more than 7 million prescriptions.[6]

    Medical uses

    Insulin lispro is used to treat people with Type 1 diabetes or Type 2 diabetes.[2] People doing well on regular insulin should not generally be changed to insulin lispro.[2]

    Side effects

    Common side effects include skin irritation at the site of injection, hypoglycemia, hypokalemia, and lipodystrophy.[7] Other serious side effects include anaphylaxis, and hypersensitivity reactions.[7]

    Contraindications

    Do not administer insulin lispro during episodes of hypoglycemia, or if a person has a hypersensitivity to insulin lispro or any of its excipients.[7]

    Mechanism of action

    Through recombinant DNA technology, the final lysine and proline residues on the C-terminal end of the B-chain are reversed. This modification does not alter receptor binding, but blocks the formation of insulin dimers and hexamers. This allows larger amounts of active monomeric insulin to be immediately available for postprandial injections.[8]

    Cost

    In the United States, in 2015, the cost was between $10.06 and $29.36 per 100 units.[9] In April of 2019, Eli Lilly and Company announced they would produce a version selling for $137.35 per vial, about half the current cost. The chief executive said that this was a contribution "to fix the problem of high out-of-pocket costs for Americans living with chronic conditions", but Patients for Affordable Drugs Now said this was just a public relations move, as "other countries pay $20 for a vial of insulin.”[10]

    The cost in the UK was between £1.66 (about $2.50) and £1.96 (about $3.00) per 100 units, in 2017.[11]

    References
    1. "Press Announcements - FDA approves Admelog, the first short-acting". FDA. Retrieved 12 December 2017.
    2. "Insulin Lispro Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019.
    3. British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 698. ISBN 9780857113382.
    4. "Insulin lispro Pregnancy and Breastfeeding Warnings". Drugs.com. Retrieved 3 March 2019.
    5. "NADAC as of 2019-02-27". Centers for Medicare and Medicaid Services. Retrieved 3 March 2019.
    6. "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
    7. Product Information: HUMALOG(R) pen injection, insulin lispro (rDNA origin) pen injection. Eli Lilly and Company, Indianapolis, IN, 2007
    8. Walton, Bill; Johnston, Elizabeth; Noble, Sara L. (1998-01-15). "Insulin Lispro: A Fast-Acting Insulin Analog". American Family Physician. 57 (2): 279–86, 289–92. PMID 9456992. Retrieved 2007-06-08.
    9. Langreth, Robert (June 29, 2016). "Decoding Big Pharma's Secret Drug Pricing Practices". Bloomberg. Retrieved 15 July 2016.
    10. "Drug company announces new version of insulin at half the price". The Hill. 3 April 2019. Retrieved 15 April 2019.
    11. "Humalog | MIMS online". www.mims.co.uk. Retrieved 2017-01-12.
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