Understanding Soliqua 100/33™and Xultophy 100/3.6™: Once-Daily Injectables

Learning about: Soliqua 100/33™ and Xultophy 100/3.6™: the new once-daily injectable GLP-1 receptor agonist/basal insulin combination pens

Insulin injection pen

Soliqua 100/33 and Xultophy 100/3.6 are two new injectable combination products approved by the U.S. Food and Drug Administration (FDA) in November of 2016. They are used for the treatment of type 2 diabetes (T2DM) in adults who are not well-controlled on metformin or oral medications and either a basal (long-acting) insulin or a glucagon-like peptide 1 receptor agonist (GLP-1 RA). Each pen is a combination of a basal insulin and a GLP-1 RA . Soliqua 100/33 is a combination of insulin glargine (Lantus) 100U/ml and lixisenatide (Adlyxin) 33mcg/ml. Xultophy 100/3.6 is a combination of insulin degludec (Tresiba) 100U/ml and liraglutide (Victoza) 3.6mg/ml.

The combination of these two medications lower blood sugar levels more when compared to using either alone. The basal insulin will help lower your fasting and pre-meal blood sugars (the amount of sugar in your blood before you eat), while the GLP-1 agonist will help lower your blood sugars after meals.  Liraglutide will help with fasting blood sugars as well, while lixisenitide only targets after meals. Basal insulin provides a steady amount of background insulin that lasts up to 24 hours or longer to try to mimic a normal functioning pancreas. Insulin is very effective for controlling blood sugar levels.  If you have very high blood sugar levels your provider may start you on this type of insulin.  You will feel better when you replace the insulin your body is no longer making.  It may cause weight gain and low blood sugar reactions (hypoglycemia). GLP-1 RAs tell your body to release insulin from your pancreas, prevents your liver from releasing stored glucose (sugar), can slow down how fast your stomach empties, can make you feel full and cause weight loss.  GLP-1 RAs only work when your blood sugars are high so the risk of a low blood sugar reaction is low.  When basal insulin and GLP-1 RAs  are combined there is more likely to be weight loss or no weight gain compared to insulin alone with no additional risks of low blood sugars.

GLP-1 agonists can cause nausea or other gastrointestinal side effects that usually goes away over time. The combination products are started at a lower dose and increased slowly to help minimize this side effect.  It is dosed based on the insulin dose and your fasting blood sugar levels.  Your provider will give you directions on which dose to start and how to increase your dose on your own

Previously, patients using both a basal insulin and GLP-1 RA would have need two separate injections daily. This also means patients had to pay two copay’s for each prescription. With these new combinations, you only inject once a day and will have one less copay.

Both pens need to be stored in the refrigerator with the pen caps on in the boxes that they came in until the expiration date on the label. Do not store these pens in the freezer. These pens need to be thrown away if they become frozen. After first use, Soliqua 100/33 should be kept at room temperature.  Throw away the Soliqua 100/33 pen 14 days after first use. After first use, a Xultophy 100/3.6pen should be stored at room temperature for up to 21 days. Keep both pens away from direct heat and light.

It is important to use these medications along with lifestyle changes, including diet and exercise. Talk to your healthcare provider to see if you are a good candidate for Soliqua 100/33or Xultophy 100/3.6. It is usually combined with metformin.

 

This Article is Brought to you By Our Guest Staff Writers:
Vincent Loksa, Pharm.D.Candidate 2017 MCPHS University
David Sze, Pharm.D. MCPHS Fellow
Jennifer Goldman, RPh, PharmD, CDE, BC-ADM‎‎ Clinical Pharmacist, Well Life‎‎

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