Lantus (lantus)

	Lantus (lantus) LANTUS (Lantus) Synonym : glargin Insulin, Insulin glargine Description pharmaceutical form : Transparent colourless liquid. Description : Insulin for long periods. Insulin glargin is similar to human insulin derived recombinant DNA type bacteria Escherichia coli (strain K12). The drugs act : Gipoglikemicheskoe. Pharmacokinetics : A comparative study of concentrations of insulin and glargina insulina- izofana in the serum of healthy individuals and patients with diabetes mellitus after S / to the introduction of drugs found in slow and much longer absorption, and lack of peak concentration of insulin glargina compared with insulin - izofanom. With a single one-day p / Lantusa to introduce sustainable glargina average concentrations of insulin in the blood is achieved through the 2-4 day after the first dose. When in / in a half times glargina insulin and human insulin were comparable. In humans, in subcutaneous adipose tissue insulin glargin partially split with carboxylic end (C-end) B-chain (beta chain) with the formation 21A-Gly- insulin and 21 A-Gly-des-30 V-Thr- insulin. In the presence of plasma insulin glargin unchanged, and products of fission. Farmakodinamika : Insulin glargin is similar to human insulin, which had a low solubility in neutral. In the drug Lantus completely soluble, which is an acid solution to the injection (rN4). With the introduction of subcutaneous fat fibre solution because of its acidity reacts with the formation of neutralizing mikropretsipitatov, which has released small amounts of insulin glargina, providing a predictable, smooth (not peaks) profile "concentration time curve, and b? Higher length action. Connectivity insulinovymi receptor : binding parameters with specific receptors glargina insulin and human insulin very close, and it can oposredovat biological effects similar to endogenous insulin. The most important action of insulin, and therefore insulin glargina is regulation of glucose metabolism. Insulin and its analogues reduce blood glucose content, encouraging consumption of glucose peripheral tissues (especially the loss of adipose tissue and musculature), as well as education ingibiruya glucose in the liver (glyukoneogenez). Insulin inhibits lipolysis and proteolysis in adipotsitah while increasing protein synthesis. Most duration of insulin glargina directly attributable to a lower rate of absorption that allows one product every day. After S / to the beginning of the introduction is, on average, by 1 hour The average duration of 24 hours and a maximum 29-hour Indication : Diabetes mellitus, requiring treatment with insulin, in adults, adolescents and children over 6 years. Contraindications : Increased susceptibility to insulin glarginu or any of the substance. Children up to age 6 years (clinical data for the application is not currently). With caution should be used in pregnant women. Application of pregnancy and breast-feeding : In animal studies had not received direct or indirect data embriotoksicheskom or fetotoksicheskom glargina effects of insulin. So far, no statistical data on the use of the drug during pregnancy. While the application Lantusa 100 pregnant women with diabetes. The course and outcome of pregnancy in these patients did not differ from those of pregnant women with diabetes receiving insulin other drugs. Appointment Lantusa in pregnant must be carried out with caution. For patients with previous or gestational diabetes is important throughout the pregnancy maintain adequate regulation of metabolic processes. The need for insulin can be affected in the first trimester of pregnancy and grow during the II and III terms. Immediately after birth the need for insulin rapidly declining (increasing the risk of hypoglycemia). In these circumstances it is essential to carefully monitor the content of glucose in the blood. A nursing women may need correction mode dispensing insulin and diet. Side Effects : Gipoglikemiya most frequently insulinoterapii undesirable consequence might be, if insulin dose is too high compared with the need for it. Asthma severe hypoglycemia, particularly recurring may lead to the defeat of the nervous system. Episodes long and expressed hypoglycemia may endanger patients' lives. Psychiatric abuses against the backdrop of hypoglycemia ( "twilight" of his loss of consciousness or, convulsant syndrome) is usually preceded by symptoms adrenergicheskoy kontrregulyatsii (activating simpato- adrenalovoy system in response to hypoglycemia) : a feeling of hunger, irritability, "" cold sweat, tachycardia (faster than developing hypoglycaemia and she greater, the greater the expressed symptoms adrenergicheskoy kontrregulyatsii). Undesirable phenomena of the eye. Meaningful changes in the regulation of blood glucose can cause temporary visual impairment due to changes turgora tissues and in the refractive index aphykia eyes. Long-term normalization of blood glucose reduces the risk of progression of diabetic retinopathy. Insulinoterapiya, with the sharp fluctuations of glucose in the blood, can lead to temporary deterioration during diabetic retinopathy. In patients with Proliferative retinopathy, especially not receiving treatment fotokoagulyatsiey, episodes of severe hypoglycemia can lead to the development of transient vision loss. Lipodistrofiya. As with any other drugs treating insulin, the site of injection may develop lipodistrofiya and local delay removal / insulin intake. In clinical studies in insulinoterapii with Lantusa lipodistrofiya there from 1-2% of patients, whereas lipoatrofiya was generally tight. Permanent change of injection in the areas of the body, recommended for S / to the introduction of insulin can reduce symptoms of this reaction or prevent its development. Local reaction to the introduction and allergic reactions. In clinical studies in insulinoterapii with Lantusa reaction in place of 3-4% were observed in patients. These reactions were Blush, pain, itch, urticaria, swelling or inflammation. Most minor reactions in a insulinov usually resolved in the period of time from a few days to several weeks. Allergic reactions immediate type hypersensitivity to insulin occur rarely. Such responses to insulin (including insulin glargin) or auxiliary substances may occur development generalized skin reactions angionevroticheskogo swelling, bronchospasm, arterial hypotension or shock, and may thus constitute a threat to life. Other reactions. The use of insulin may cause education antibodies to it. In clinical studies of patients receiving treatment insulinom- izofanom and insulin glarginom, education antibodies, cross-reacting with human insulin observed with the same frequency. In rare cases, the presence of antibodies to insulin may cause the correction to remove the feeding trend towards hypo - or giperglikemii. Rarely insulin may cause delay removal of sodium and education circles, especially if stronger insulinoterapiya has improved previously under-regulation of metabolic processes. Networking : A number of LS affect glucose metabolism, which may require corrective doses of insulin glargina. For drugs that can enhance hypoglycemic effect of insulin and improve predisposition to the development of hypoglycemia include oral gipoglikemicheskie means, ACE inhibitors, dizopiramid, fibraty, fluoxetin, MAO inhibitors, pentoksifillin, propoksifen, musk and sulfanilamidnye anti funds. By drugs, which can reduce hypoglycemic effect of insulin, include corticosteroids, danazol, diazoksid, Diuretics, Glucagon, isoniazid, estrogen, gestageny, derivatives fenotiazina, somatotropin, simpatomimetiki such as epinephrine (adrenaline), salbutamol, terbutaline and thyroid hormones, inhibitors protease, some neuroleptic (eg Olanazapine or Clozapine). Beta adrenoblokatory, clonidine, lithium salts or alcohol may increase as well relax hypoglycemic effect of insulin. Pentamidine can cause hypoglycemia, which is sometimes replaced giperglikemiey. In addition, under the influence of drugs simpatoliticheskogo act as a beta adrenoblokatory, clonidine, and guanfatsin Reserpine signs adrenergicheskoy kontrregulyatsii may decrease or missing. Overdosing : Symptoms : severe hypoglycemia and sometimes long, life-threatening symptoms. Treatment : moderate hypoglycemia episodes usually kupiruyutsya by receiving inside EASILY carbohydrates. It may be necessary to change feeding patterns drug, diet or physical activity. More severe hypoglycemia episodes, causing coma, convulsions or neurological disorders, requiring / m or S / glyukagona to introduce and / in a concentrated solution of dextrose. It may take a long reception of carbohydrates and surveillance specialist, as hypoglycemia can recur after apparent clinical improvement. Dosing and Administration : P / to, in the subcutaneous fat fibre, abdomen, shoulder or hip, always at the same time, one time a day. Injection sites must alternate with each new injection in the areas recommended for S / introduction to the drug. In / in a normal dose, for S / to the introduction, development can cause severe hypoglycemia. Dose Lantusa and time of day for a chosen individually. In patients with type 2 diabetes Lantus can be used as monotherapies or in combination with other gipoglikemicheskimi LS. Migrating from the treatment of other drugs in gipoglikemicheskimi Lantus. When treatment is insulin, or an average duration of the long-acting treatment for Lantusom may require correction daily basal insulin dose, as well as a need to change protivodiabeticheskoy concomitant therapy (dose and treatment of more applicable insulinov short or their equivalent or oral doses of medicines gipoglikemicheskih ). When transferring patients with a double in a day of insulina- izofana on a single Lantusa to reduce the risk of hypoglycemia in the night and early morning hours should be reduced initial basal insulin dose by 20-30% in the first weeks of treatment. During the period, reducing dose can be increased doses of insulin short, and further treatment dosing should be adjusted individually. Lantus should not be mixed with other drugs or insulin to play. When mixing or breeding may change the profile of its time, in addition, mixing with other insulin can cause deposition of sediment. As with the application of other human insulin analogue, in patients receiving high doses of drugs, the prevalence of antibody to human insulin, when the Lantus may see some improvement in response to the introduction of insulin. In the process of Lantus in the first week after it requires careful monitoring of blood glucose. If improved regulation of metabolism and the resulting increase sensitivity to insulin may be needed further correction dosing regime. Correction doses may also be required, for example, a variation in body mass index patient, his lifestyle, time of day for a drug or when there are other circumstances to improve predisposition to the development of hypo - or giperglikemii. The drug should not be brought into / in. Duration Lantusa due to its entry into the subcutaneous adipose tissue. Precautions : Directions for compatibility. Lantus should not be confused with any other LAN. Ensure that the syringes did not contain traces of other LS. Special instructions : Lantus is not a drug of choice for the treatment of diabetic ketoacidosis. In such cases it is recommended to / for the introduction of short-acting insulin. Due to the limited experience of Lantusa it was not possible to assess its efficacy and safety in treating patients with liver function violation of patients with medium or heavy or severe renal insufficiency. In patients with kidney function violation need for insulin may decrease due to the weakening of its elimination. For older patients progressive deterioration in kidney function could lead to a permanent reduction in the need for insulin. In patients with severe liver failure need for insulin may be downgraded because of reduced ability to glyukoneogenezu and biotransformation of insulin. In the case of poor control over the level of glucose in the blood, and if there is a trend towards hypo - or giperglikemii, before correction dosing should verify compliance with the prescribed treatment is, the introduction of products and technology literate of the S / for injection, taking into account all factors relevant to the issue. Hypoglycemia. Time Development hypoglycemia depends on the profile of insulinov used, and can thus evolve in changing patterns of treatment. Owing to the increase of time in the body of long-acting insulin when using Lantusa reduces development hypoglycemia night, while in the morning, the likelihood is likely to increase. Patients who have episodes of hypoglycemia may be of particular clinical importance, such as patients with coronary artery stenosis expressed or brain vessels (cardial risk of hypoglycemia and brain complications), and patients with Proliferative retinopathy, especially if they do not receive treatment fotokoagulyatsiey (risk transient loss of vision due to hypoglycemia) should observe special precautions, as well as to intensify monitoring of blood glucose. Patients need to know the circumstances under which simptomy- predictor of hypoglycemia can be changed, becoming less pronounced or not certain at-risk groups. These groups include : - Patients who have markedly improved the regulation of blood glucose; - patients with hypoglycemia develops slowly; - Patients older; - Patients with neuropathy; - Patients with a long period of diabetes; - patients suffering from mental disorders; - patients receiving concomitant treatment of other drugs (see "Synergy"). Such situations can lead to the development of severe hypoglycemia (with a possible loss of consciousness) before the patient is aware that he is developing hypoglycemia. If there are normal or reduced rates glikozilirovannogo hemoglobin, to be mindful of the development of recurrent episodes of hypoglycemia unrecognized (especially at night). Compliance schemes dosing patients, diet and nutrition, the proper use of insulin and control of the appearance of the symptoms of hypoglycemia contributed significantly reduce the risk of hypoglycemia. Factors that increase predisposition to hypoglycemia require particularly careful monitoring, as be the need to correct dose of insulin. These factors include : - Changing the place of insulin; - Increased sensitivity to insulin (for example, eliminating stress factors); - inappropriately, increased or prolonged physical activity; - interkurrentnye disease, causing vomiting, diarrhea; - diet and nutrition; Skipped-eating; - consumption of alcohol; some uncompensated endocrine disorders (such as hypothyroidism, or a lack adenogipofiza adrenal cortex); treatment-related several other LS. Interkurrentnye disease. In interkurrentnyh diseases require more intensive monitoring of blood glucose. �� , �� . �� . �� 1 �� , �� , �� , �� , �� .�. �� . �� : 2 ��. �� - 4 ��. �� �� : �� . � �� , �� 2-8 �C (�� ). �� 25 �C � �� (�� )
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