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No adjustments in dose are required for elderly patients;
however, hypoglycemia may be difficult to recognize in this
population. Initial therapy for an elderly patient should be conservative to minimize the risk of hypoglycemic reactions.1
Dosage adjustments may be required in patients with
renal impairment. Liraglutide should be used with caution
in patients with impaired renal function because of the risk
of acute kidney injury or worsening of chronic renal
failure.1
Liraglutide slows gastric emptying. It has not been evaluated in patients with preexisting gastroparesis.1
The warnings and precautions in insulin degludec/liraglutide product labeling are similar to those of insulin glargine/
lixisenatide.1,2 One exception is regarding the risk of thyroid
C-cell tumors in the insulin degludec/liraglutide product
labeling.

Adverse Reactions
Adverse reactions commonly associated with insulin
degludec/liraglutide therapy include nasopharyngitis (9.6%),
headache (9.1%), nausea (7.8%), diarrhea (7.5%), increased
lipase (6.7%), and upper respiratory tract infection (5.7%).
Severe symptomatic hypoglycemia occurred in 0% to 0.5%
of patients in clinical trials. Other adverse reactions included
GI adverse reactions (eg, vomiting, constipation, dyspepsia,
gastritis, abdominal pain, flatulence, gastroesophageal reflux
disease, abdominal distension, decreased appetite), cholelithiasis, cholecystitis, lipodystrophy at the injection site,
injection-site reactions, peripheral edema, and weight gain.1
Similar adverse reactions have been reported with insulin
glargine/lixisenatide.2

Drug Interactions
Concomitant use of medications that can affect glucose
metabolism requires careful monitoring for impact on glycemic control; appropriate dosage adjustments should be made,
if necessary.1
The liraglutide component of insulin degludec/liraglutide
may delay gastric emptying and therefore may reduce the
rate of absorption of orally administered medications.1
The drug interactions addressed in insulin degludec/liraglutide product labeling are similar to those with insulin
glargine/lixisenatide.1,2

Recommended Monitoring
The frequency of blood glucose monitoring should be
increased after any change in dose or after the addition of
other antidiabetic drugs or drugs known to alter blood glucose levels.1
Potassium levels should be monitored in patients at risk
for hypokalemia.1

The monitoring recommendations regarding blood glucose and potassium for insulin degludec/liraglutide are similar to those for insulin glargine/lixisenatide.1,2

Dosing
Prior to administration of the first dose of insulin degludec/
liraglutide, previous liraglutide and basal insulin therapy
must be discontinued. The starting dose of insulin degludec/
liraglutide is determined by the patient's previous basal insulin or liraglutide dose. If the patient was previously receiving
less than 30 units of basal insulin or was receiving liraglutide, the starting dosage of the combination product is 16
units (insulin degludec 16 units/liraglutide 0.58 mg) given
subcutaneously once daily.1
Dosage titration should occur at 3- to 4-day intervals in
increments of 2 units, based on the patient's metabolic needs,
blood glucose monitoring results, and glycemic control goal.
Dosage adjustments may be needed to minimize the risk of
hypoglycemia or hyperglycemia in cases of change in
patient's physical activity, meal patterns, or renal or hepatic
function; during acute illness; or when used with other
medications.1
If a dose of insulin degludec/liraglutide is missed, the
patient should resume the prescribed once-daily regimen
with the next scheduled dose. If more than 3 days have
elapsed since the last dose, therapy should be reinitiated at
the starting dose.1
The insulin degludec/liraglutide combination should be
injected subcutaneously once daily. The maximum daily dosage is 50 units (insulin degludec 50 units/liraglutide 1.8 mg).
The pens are designed to deliver insulin degludec doses of 10
to 50 units with each injection. If the patient requires a persistent daily dosage of insulin degludec below 16 units or
above 50 units, alternative products should be prescribed; the
ability of the pen to deliver 10 units of insulin degludec is
intended for temporary dosing during down-titration, not for
continuous therapy.1
Insulin degludec/liraglutide is for subcutaneous administration in the thigh, upper arm, or abdomen. Rotate injection
sites within the same region from one injection to the next to
reduce the risk of lipodystrophy. Insulin degludec/liraglutide
should not be administered intravenously, intramuscularly,
or by an infusion pump; nor should it be diluted or mixed
with any other insulin products or solutions.1
Both insulin degludec/liraglutide and insulin glargine/lixisenatide are for administration subcutaneously once daily.1,2

Product Availability
Insulin degludec/liraglutide was approved by the FDA on
November 21, 2016.14 It is available as a 3-mL single-patientuse pen injector. Each pen contains insulin degludec 100 units/
mL and liraglutide 3.6 mg/mL. The product is distributed in



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
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
Hospital Pharmacy - May 2017 - 383
Hospital Pharmacy - May 2017 - 384
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