insulin nph [SC]

Adult Dosing

Diabetes Mellitus

Novolin N, Humulin N

Dosing individualized to patient's needs, generally used in combination with short or rapid acting insulins
30%-50% of total insulin requirements may be provided by intermediate-acting insulin
Give SC in divided doses; Onset approx 2-4 hours, peak 4-10 hours, and duration 10-16 hours

Pediatric Dosing

Diabetes Mellitus

Novolin N, Humulin N

Dosing individualized to patient's needs, generally used in combination with short or rapid acting insulins
30%-50% of total insulin requirements may be provided by intermediate-acting insulin
Give SC in divided doses; Onset approx 2-4 hours, peak 4-10 hours, and duration 10-16 hours

[Outline]

Adult Dosing
Pediatric Dosing

Indications ⬆ ⬇

Type I & II Diabetes mellitus

Contraindications ⬆ ⬇

Hypersensitivity to any of the ingredients of the product
Episodes of hypoglycemia
It is not intended for intravenous or intramuscular administration

Black Box Warnings ⬆ ⬇

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment

Renal impairment: Dose reduction recommended, dose adjustments not defined

Hepatic Dose Adjustment

Hepatic impairment: Dose reduction recommended, dose adjustments not defined

Warnings/Precautions ⬆ ⬇

Hypoglycemia is the most common adverse effect of insulin. Change in insulin strength, timing of dosing, or frequency may require a change in the dosage. Concomitant oral treatment may need to be changed.
Check blood sugar frequently and watch for signs of hypoglycemia. Any change should be made cautiously and only under medical supervision
Unexplained hyperglycemia or ketosis can occur. Prompt identification and correction of the cause is necessary. Provide interim therapy with subcutaneous insulin injections
Dose adjustment is required if there is any change in physical activity or usual meal plan, and also during illness, emotional disturbances, or other stress
Change in dose should be made cautiously under medical supervision. Changes in insulin strength, timing of dosing, manufacturer, type (eg, regular, NPH, or insulin analogs), species (animal, human), or method of manufacture (rDNA versus animal-source insulin) may require a change in dosage
If lipoatrophy or lipohypertrophy occurs following subcutaneous insulin administration, change the injection technique
Insulin NPH can cause severe life-threatening, generalized allergy, including anaphylaxis
Concomitant use of thiazolidinediones can cause dose-related fluid retention, which may lead to or exacerbate heart failure. Monitor for signs and symptoms of heart failure and treat accordingly or consider discontinuation or dose reduction

Cautions: Use cautiously in patients with

Renal Impairment
Hepatic Impairment
Edema
Infection, stress, or illness
Hypokalemia

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:B

Breastfeeding: No specific data available on the use of insulin lispro during breastfeeding. No adverse reactions have been reported due to insulin in breastmilk, infect insulin in breastmilk may decrease the risk of type 1 diabetes in breastfed infants. In general mothers with diabetes using insulin may nurse their infants, based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 11 Jan 2011). As per manufacturer data as insulin is excreted in human milk, caution should be exercised when administering to a nursing woman.

Adverse Reactions ⬆ ⬇

CNS: Headache, depression
CV: Palpitation
METABOLIC: Hypoglycemia, hypokalemia
EENT: Vision disorder
GU: Urinary tract infection
MUSC: Arthralgia, pain in extremity, back pain
MISC: Hypersensitivity and allergic reactions, peripheral edema, infection
LOCAL: Lipodystrophy, injection site reaction

Clinical Pharmacology ⬆ ⬇

Intermediate-acting insulin with a slower onset of action and a longer duration of activity; stimulates peripheral glucose uptake and inhibits hepatic glucose. Also inhibits lipolysis and proteolysis, and enhances protein synthesis
Metabolism/ Excretion: Partly metabolized at the site of injection and partly by liver, kidney, fat, muscle
Half life: Unknown

Brands and Availability ⬆ ⬇

US Trade Name(s)

Humulin N
Novolin N

US Availability

Humulin N

OTC INJ (100 units/mL): 10 mL vials
OTC INJ (100 units/mL): 3 mL cartridges
Humulin N pen (100 units/mL): 3mL prefilled disposable injection device

Novolin N

OTC INJ (100 units/mL): 10 mL vials
OTC INJ (100 units/mL): 3 mL cartridges
Novolin N InnoLet (100 units/mL): 3mL prefilled disposable injection device
Novolin N flexpen (100 units/mL): 3mL prefilled disposable injection device

Canadian Trade Name(s)

Humulin N
Novolin ge NPH

Canadian Availability

Humulin N

INJ (100 units/mL): 10 mL vials
INJ (100 units/mL): 3 mL cartridges (for Humulin N pen)
Humulin N pen (100 units/mL): 3mL prefilled disposable injection device

Novolin ge NPH

INJ (100 units/mL): 10 mL vials
INJ (100 units/mL): 3 mL penfill cartridges
Novolin ge FlexPen (100 units/mL): 3mL prefilled disposable injection device
Novolin ge InnoLet (100 units/mL): 3mL prefilled disposable injection device

UK Trade Name(s)

Humulin I
Insulatard
Insuman Basal

UK Availability

Humulin I

INJ (100 units/mL): 10 mL vials
INJ (100 units/mL): 3 mL cartridges (for AutoPen Classic or HumaPen)
Humulin I-Pen (100 units/mL): 3mL prefilled disposable injection device

Insulatard

INJ (100 units/mL): 10 mL vials
INJ (100 units/mL): 3 mL penfill cartridges (for Novopen)
Insulatard InnoLet (100 units/mL): 3mL prefilled disposable injection device

Insuman Basal

INJ (100 units/mL): 5 mL vials
INJ (100 units/mL): 3 mL cartridges (for OptiPen Pro 1)
Insuman Basal OptiSet (100 units/mL): 3mL prefilled disposable injection device

Australian Trade Name(s)

Humulin NPH
Protophane

Australian Availability

Humulin NPH

INJ (100 units/mL): 10 mL vials
INJ (100 units/mL): 3 mL cartridges (for Humapen)

Protophane

INJ (100 units/mL): 10 mL vials
INJ (100 units/mL): 3 mL penfill cartridges
Protophane InnoLet (100 units/mL): 3mL prefilled disposable injection device
Protophane NovoLet (100 units/mL): 3mL prefilled disposable injection device