Hospital Pharmacy - May 2017 - 374

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research-article2017

HPXXXX10.1177/0018578717715383Hospital PharmacyBaker

Formulary Drug Reviews
Hospital Pharmacy
2017, Vol. 52(5) 374-380
© The Author(s) 2017
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https://doi.org/10.1177/0018578717715383
DOI: 10.1177/0018578717715383
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Insulin Degludec/Liraglutide
Danial E. Baker1

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that
are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees.
Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing
in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each
month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the
needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For
more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. The
May 2017 monograph topics are brodalumab, etelcalcetide, guselkumab, ribociclib, and sirukumab. The MUE is on ribociclib.
Generic Name: Insulin Degludec/Liraglutide
Proprietary Name: Xultophy (Novo Nordisk)
Approval Rating: 4S
Therapeutic Class: Antidiabetics, Insulins, Glucagon-like
Peptide 1 (GLP-1) Receptor Agonists
Similar Drugs: Insulin Glargine/Lixisenatide (Soliqua)
Sound- or Look-Alike Names: None

Indications
Insulin degludec/liraglutide is US Food and Drug
Administration (FDA) approved as an adjunct to diet and
exercise to improve glycemic control in adults with type 2
diabetes mellitus inadequately controlled on basal insulin
(less than 50 units daily) or liraglutide (less than or equal to
1.8 mg daily).1 Both insulin degludec and liraglutide are
approved to improve glycemic control in patients with diabetes mellitus and are widely used, either alone or in combination with each other or other antidiabetic drugs. Insulin
glargine/lixisenatide is similarly approved as an adjunct to
diet and exercise to improve glycemic control in adults with
type 2 diabetes mellitus inadequately controlled on basal
insulin (less than 60 units daily) or lixisenatide.1,2
Insulin degludec/liraglutide and insulin glargine/lixisenatide combination products have similar limitations for use:
** Consider other antidiabetic therapies in patients with
a history of pancreatitis.
** Not recommended for use in combination with any
other product containing the same or another glucagon-like peptide 1 (GLP-1) receptor agonist.
** Not for treatment of type 1 diabetes mellitus or diabetic ketoacidosis.
** Has not been studied in combination with prandial
insulin.1,2
In addition, insulin glargine/lixisenatide is not recommended for use in patients with gastroparesis.2

Clinical Pharmacology
Insulin degludec is a long-acting basal insulin analog that
lowers blood glucose by stimulating peripheral glucose
uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Liraglutide is a GLP-1 receptor agonist that increases glucose-dependent insulin release,
decreases glucagon secretion, and slows gastric emptying.1

Pharmacokinetics
The pharmacokinetics of insulin degludec and liraglutide
were not affected in a clinically relevant manner when
administered as the combination product; a small decrease in
the peak concentration of liraglutide was observed.1,3
In patients with type 2 diabetes reaching the maximum
daily dose (insulin degludec 50 units/liraglutide 1.8 mg), the
estimated mean steady-state exposure (area under the curve
[AUC0-24 h]) was 113 h*nmol/L and 1227 h*ng/mL for insulin
degludec and liraglutide, respectively. The corresponding
maximum concentrations were 5196 pmol/L and 55 ng/mL,
respectively. Steady-state concentrations of these agents are
reached after 2 to 3 days of daily administration. Both products are extensively bound to plasma proteins (more than
99% and more than 98%, respectively). Degradation of insulin degludec is similar to that of human insulin; all metabolites formed are inactive. Liraglutide is endogenously
metabolized in a similar manner to large proteins without a
specific organ as a major route of elimination. The half-life is
approximately 25 hours for insulin degludec and 13 hours for
liraglutide.1
1

Washington State University, USA

Corresponding Author:
Danial E. Baker, Director, Drug Information Center, and Professor of
Pharmacotherapy, College of Pharmacy, Washington State University,
PO Box 1495, Spokane, WA 99210-1495, USA.
Email: danial.baker@wsu.edu


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Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
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