LYUMJEV
(+3 other brands)
Drug Facts
Composition & Profile
Identifiers & Packaging
16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied LYUMJEV (insulin lispro-aabc) injection is a clear and colorless solution available as shown in Table 12 . Table 12. How Supplied a 3 mL cartridge is for use in Eli Lilly and Company's HumaPen ® Luxura ® HD insulin delivery device. Patients need to check their device manual to determine if the LYUMJEV cartridge is compatible for use in other devices. b Tempo Pen contains a component that allows for data connectivity when used with a compatible transmitter. LYUMJEV NDC Number Concentration Total Units in Presentation Dose Increment Package Size U-100 multiple-dose 10 mL vial 0002-7728-01 100 units/mL 1,000 units n/a 1 vial U-100 single-patient-use 3 mL cartridge a 0002-7726-05 100 units/mL 300 units n/a 5 cartridges U-100 single-patient-use 3 mL KwikPen 0002-8207-05 100 units/mL 300 units 1 unit 5 pens U-100 single-patient-use 3 mL Junior KwikPen 0002-8351-05 100 units/mL 300 units 0.5 unit 5 pens U-100 single-patient-use 3 mL Tempo Pen b 0002-8235-05 100 units/mL 300 units 1 unit 5 pens U-200 single-patient-use 3 mL KwikPen 0002-8228-27 200 units/mL 600 units 1 unit 2 pens 16.2 Storage and Handling Dispense in the original sealed carton with the enclosed Instructions for Use. Refrigerate unopened LYUMJEV vials, pens, and cartridges between 36°F to 46°F (2°C to 8°C) until time of use and keep in the original carton to protect from light. Do not freeze or use LYUMJEV if it has been frozen. Do not expose to direct heat. Discard opened or unopened LYUMJEV vials, pens, and cartridges stored at room temperature below 86°F (30°C) after 28 days. The storage conditions for vials, pens, and cartridges are summarized in Table 13 . Table 13. Storage Conditions for Vials, Pens, and Cartridges a In-use (opened) vials, whether or not refrigerated, must be used within 28 days. b When stored at room temperature, LYUMJEV can only be used for a total of 28 days including both not in-use (unopened) and in-use (opened) storage time. LYUMJEV Presentation Not In-use (Unopened) In-use (Opened) Room Temperature (below 86°F [30°C]) Refrigerated (36°F to 46°F [2°C to 8°C]) Room Temperature (below 86°F [30°C]) Refrigerated (36°F to 46°F [2°C to 8°C]) 10 mL vial a,b 28 days Until expiration date 28 days 28 days 3 mL cartridge b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV KwikPen (U-100 and U-200) b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV Junior KwikPen b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV Tempo Pen b 28 days Until expiration date 28 days Do not refrigerate Storage of LYUMJEV in Insulin Pump Change the LYUMJEV U-100 in the pump reservoir at least every 9 days, or according to the pump user manual, whichever is shorter, or after exposure to temperatures that exceed 98.6°F (37°C). Storage of LYUMJEV in Intravenous Infusion Fluids Diluted LYUMJEV may be stored for up to 4 days when refrigerated at 36°F to 46°F (2°C to 8°C) until time of use. The same solution may be stored up to 12 hours at room temperature at 68°F to 77°F (20°C to 25°C) [see Dosage and Administration ( 2.2 )].; 16.1 How Supplied LYUMJEV (insulin lispro-aabc) injection is a clear and colorless solution available as shown in Table 12 . Table 12. How Supplied a 3 mL cartridge is for use in Eli Lilly and Company's HumaPen ® Luxura ® HD insulin delivery device. Patients need to check their device manual to determine if the LYUMJEV cartridge is compatible for use in other devices. b Tempo Pen contains a component that allows for data connectivity when used with a compatible transmitter. LYUMJEV NDC Number Concentration Total Units in Presentation Dose Increment Package Size U-100 multiple-dose 10 mL vial 0002-7728-01 100 units/mL 1,000 units n/a 1 vial U-100 single-patient-use 3 mL cartridge a 0002-7726-05 100 units/mL 300 units n/a 5 cartridges U-100 single-patient-use 3 mL KwikPen 0002-8207-05 100 units/mL 300 units 1 unit 5 pens U-100 single-patient-use 3 mL Junior KwikPen 0002-8351-05 100 units/mL 300 units 0.5 unit 5 pens U-100 single-patient-use 3 mL Tempo Pen b 0002-8235-05 100 units/mL 300 units 1 unit 5 pens U-200 single-patient-use 3 mL KwikPen 0002-8228-27 200 units/mL 600 units 1 unit 2 pens; PACKAGE LABEL – LYUMJEV U100 Vial Carton NDC 0002-7728-01 LYUMJEV TM (insulin lispro-aabc) injection 100 units per mL (U-100) for subcutaneous or intravenous use 10 mL multiple-dose vial Rx only www.lyumjev.com Lilly PACKAGE LABEL – LYUMJEV U100 Vial Carton; PACKAGE LABEL – LYUMJEV U100 Cartridges 5 Count Carton NDC 0002-7726-05 5 x 3 mL Cartridges LYUMJEV TM (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) For subcutaneous use Rx only For use in Eli Lilly and Company's HumaPen ® LUXURA ® HD and other compatible insulin delivery devices. www.lyumjev.com Lilly PACKAGE LABEL – LYUMJEV U100 Cartridges 5 Count Carton; PACKAGE LABEL – LYUMJEV U100 KwikPen 5 Count Carton Dispense in this sealed carton. NDC 0002-8207-05 LYUMJEV TM KwikPen ® (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) For subcutaneous use 5 x 3 mL prefilled pens Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly PACKAGE LABEL – LYUMJEV U100 KwikPen 5 Count Carton; PACKAGE LABEL – LYUMJEV U100 Junior KwikPen 5 Count Carton Dispense in this sealed carton. NDC 0002-8351-05 LYUMJEV TM Junior KwikPen ® (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) This pen can deliver 0.5 (1/2) to 30 units in one injection. 5 x 3 mL prefilled pens For subcutaneous use Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly PACKAGE LABEL – LYUMJEV U100 Junior KwikPen 5 Count Carton; PACKAGE LABEL – LYUMJEV U100 Tempo Pen 5 Count Carton Dispense in this sealed carton. NDC 0002-8235-05 LYUMJEV TM Tempo Pen TM (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) For subcutaneous use 5 x 3 mL prefilled pens Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly PACKAGE LABEL – LYUMJEV U100 Tempo Pen 5 Count Carton; PACKAGE LABEL – LYUMJEV U200 KwikPen 5 Count Carton Dispense in this sealed carton. NDC 0002-8228-27 LYUMJEV TM KwikPen ® (insulin lispro-aabc) injection For Single Patient Use Only 200 units per mL (U-200) For subcutaneous use 2 x 3 mL prefilled pens Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly DO NOT TRANSFER TO A SYRINGE SEVERE OVERDOSE CAN RESULT PACKAGE LABEL – LYUMJEV U200 KwikPen 5 Count Carton
- 16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied LYUMJEV (insulin lispro-aabc) injection is a clear and colorless solution available as shown in Table 12 . Table 12. How Supplied a 3 mL cartridge is for use in Eli Lilly and Company's HumaPen ® Luxura ® HD insulin delivery device. Patients need to check their device manual to determine if the LYUMJEV cartridge is compatible for use in other devices. b Tempo Pen contains a component that allows for data connectivity when used with a compatible transmitter. LYUMJEV NDC Number Concentration Total Units in Presentation Dose Increment Package Size U-100 multiple-dose 10 mL vial 0002-7728-01 100 units/mL 1,000 units n/a 1 vial U-100 single-patient-use 3 mL cartridge a 0002-7726-05 100 units/mL 300 units n/a 5 cartridges U-100 single-patient-use 3 mL KwikPen 0002-8207-05 100 units/mL 300 units 1 unit 5 pens U-100 single-patient-use 3 mL Junior KwikPen 0002-8351-05 100 units/mL 300 units 0.5 unit 5 pens U-100 single-patient-use 3 mL Tempo Pen b 0002-8235-05 100 units/mL 300 units 1 unit 5 pens U-200 single-patient-use 3 mL KwikPen 0002-8228-27 200 units/mL 600 units 1 unit 2 pens 16.2 Storage and Handling Dispense in the original sealed carton with the enclosed Instructions for Use. Refrigerate unopened LYUMJEV vials, pens, and cartridges between 36°F to 46°F (2°C to 8°C) until time of use and keep in the original carton to protect from light. Do not freeze or use LYUMJEV if it has been frozen. Do not expose to direct heat. Discard opened or unopened LYUMJEV vials, pens, and cartridges stored at room temperature below 86°F (30°C) after 28 days. The storage conditions for vials, pens, and cartridges are summarized in Table 13 . Table 13. Storage Conditions for Vials, Pens, and Cartridges a In-use (opened) vials, whether or not refrigerated, must be used within 28 days. b When stored at room temperature, LYUMJEV can only be used for a total of 28 days including both not in-use (unopened) and in-use (opened) storage time. LYUMJEV Presentation Not In-use (Unopened) In-use (Opened) Room Temperature (below 86°F [30°C]) Refrigerated (36°F to 46°F [2°C to 8°C]) Room Temperature (below 86°F [30°C]) Refrigerated (36°F to 46°F [2°C to 8°C]) 10 mL vial a,b 28 days Until expiration date 28 days 28 days 3 mL cartridge b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV KwikPen (U-100 and U-200) b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV Junior KwikPen b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV Tempo Pen b 28 days Until expiration date 28 days Do not refrigerate Storage of LYUMJEV in Insulin Pump Change the LYUMJEV U-100 in the pump reservoir at least every 9 days, or according to the pump user manual, whichever is shorter, or after exposure to temperatures that exceed 98.6°F (37°C). Storage of LYUMJEV in Intravenous Infusion Fluids Diluted LYUMJEV may be stored for up to 4 days when refrigerated at 36°F to 46°F (2°C to 8°C) until time of use. The same solution may be stored up to 12 hours at room temperature at 68°F to 77°F (20°C to 25°C) [see Dosage and Administration ( 2.2 )].
- 16.1 How Supplied LYUMJEV (insulin lispro-aabc) injection is a clear and colorless solution available as shown in Table 12 . Table 12. How Supplied a 3 mL cartridge is for use in Eli Lilly and Company's HumaPen ® Luxura ® HD insulin delivery device. Patients need to check their device manual to determine if the LYUMJEV cartridge is compatible for use in other devices. b Tempo Pen contains a component that allows for data connectivity when used with a compatible transmitter. LYUMJEV NDC Number Concentration Total Units in Presentation Dose Increment Package Size U-100 multiple-dose 10 mL vial 0002-7728-01 100 units/mL 1,000 units n/a 1 vial U-100 single-patient-use 3 mL cartridge a 0002-7726-05 100 units/mL 300 units n/a 5 cartridges U-100 single-patient-use 3 mL KwikPen 0002-8207-05 100 units/mL 300 units 1 unit 5 pens U-100 single-patient-use 3 mL Junior KwikPen 0002-8351-05 100 units/mL 300 units 0.5 unit 5 pens U-100 single-patient-use 3 mL Tempo Pen b 0002-8235-05 100 units/mL 300 units 1 unit 5 pens U-200 single-patient-use 3 mL KwikPen 0002-8228-27 200 units/mL 600 units 1 unit 2 pens
- PACKAGE LABEL – LYUMJEV U100 Vial Carton NDC 0002-7728-01 LYUMJEV TM (insulin lispro-aabc) injection 100 units per mL (U-100) for subcutaneous or intravenous use 10 mL multiple-dose vial Rx only www.lyumjev.com Lilly PACKAGE LABEL – LYUMJEV U100 Vial Carton
- PACKAGE LABEL – LYUMJEV U100 Cartridges 5 Count Carton NDC 0002-7726-05 5 x 3 mL Cartridges LYUMJEV TM (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) For subcutaneous use Rx only For use in Eli Lilly and Company's HumaPen ® LUXURA ® HD and other compatible insulin delivery devices. www.lyumjev.com Lilly PACKAGE LABEL – LYUMJEV U100 Cartridges 5 Count Carton
- PACKAGE LABEL – LYUMJEV U100 KwikPen 5 Count Carton Dispense in this sealed carton. NDC 0002-8207-05 LYUMJEV TM KwikPen ® (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) For subcutaneous use 5 x 3 mL prefilled pens Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly PACKAGE LABEL – LYUMJEV U100 KwikPen 5 Count Carton
- PACKAGE LABEL – LYUMJEV U100 Junior KwikPen 5 Count Carton Dispense in this sealed carton. NDC 0002-8351-05 LYUMJEV TM Junior KwikPen ® (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) This pen can deliver 0.5 (1/2) to 30 units in one injection. 5 x 3 mL prefilled pens For subcutaneous use Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly PACKAGE LABEL – LYUMJEV U100 Junior KwikPen 5 Count Carton
- PACKAGE LABEL – LYUMJEV U100 Tempo Pen 5 Count Carton Dispense in this sealed carton. NDC 0002-8235-05 LYUMJEV TM Tempo Pen TM (insulin lispro-aabc) injection For Single Patient Use Only 100 units per mL (U-100) For subcutaneous use 5 x 3 mL prefilled pens Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly PACKAGE LABEL – LYUMJEV U100 Tempo Pen 5 Count Carton
- PACKAGE LABEL – LYUMJEV U200 KwikPen 5 Count Carton Dispense in this sealed carton. NDC 0002-8228-27 LYUMJEV TM KwikPen ® (insulin lispro-aabc) injection For Single Patient Use Only 200 units per mL (U-200) For subcutaneous use 2 x 3 mL prefilled pens Rx only Needles not included This device is recommended for use with Becton, Dickinson and Company's insulin pen needles. Lilly DO NOT TRANSFER TO A SYRINGE SEVERE OVERDOSE CAN RESULT PACKAGE LABEL – LYUMJEV U200 KwikPen 5 Count Carton
Overview
Insulin lispro-aabc is a rapid-acting human insulin analog used to lower blood glucose. Insulin lispro-aabc is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli . Insulin lispro-aabc differs from human insulin in that the amino acid proline at position B28 is replaced by lysine and the lysine in position B29 is replaced by proline. Chemically, it is Lys(B28), Pro(B29) human insulin analog and has the empirical formula C 257 H 383 N 65 O 77 S 6 and a molecular weight of 5808 daltons, both identical to that of human insulin. Insulin lispro-aabc has the following primary structure: LYUMJEV (insulin lispro-aabc) injection is a sterile, aqueous, clear, and colorless solution for subcutaneous or intravenous administration. Each mL of LYUMJEV U-100 contains 100 units of insulin lispro-aabc and the inactive ingredients: glycerol (12.1 mg), magnesium chloride hexahydrate (1.02 mg), metacresol (3.15 mg), sodium citrate dihydrate (4.41 mg), treprostinil sodium (1.06 mcg), zinc oxide (content adjusted to provide 39 mcg zinc ion), and Water for Injection, USP. Each mL of LYUMJEV U-200 contains 200 units of insulin lispro-aabc and the inactive ingredients: glycerol (12.1 mg), magnesium chloride hexahydrate (1.02 mg), metacresol (3.15 mg), sodium citrate dihydrate (4.41 mg), treprostinil sodium (1.06 mcg), zinc oxide (content adjusted to provide 52 mcg zinc ion), and Water for Injection, USP. Hydrochloric acid and/or sodium hydroxide may be added to adjust the pH. LYUMJEV has a pH of 7.0 to 7.8. Primary Structure
Indications & Usage
LYUMJEV ® is indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. LYUMJEV ® is a rapid-acting human insulin analog indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. ( 1 )
Dosage & Administration
See Full Prescribing Information for important administration instructions. ( 2.1 , 2.2 ) Subcutaneous Injection ( 2.2 ): Administer LYUMJEV U-100 or U-200 at the start of a meal or within 20 minutes after starting a meal subcutaneously into the abdomen, upper arm, thigh, or buttocks. Rotate injection sites within the same region to reduce risk of lipodystrophy and localized cutaneous amyloidosis. Should generally be used in regimens with an intermediate or long-acting insulin. Continuous subcutaneous infusion (Insulin Pump) ( 2.2 ): Refer to the insulin infusion pump user manual to see if LYUMJEV can be used. Use in accordance with the insulin pump instructions for use. Administer LYUMJEV U-100 by continuous subcutaneous infusion using an insulin pump in a region recommended in the instructions from the pump manufacturer. Rotate infusion sites within the same region to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. Do not administer LYUMJEV U-200 by continuous subcutaneous infusion. Intravenous Infusion ( 2.2 ): Administer LYUMJEV U-100 intravenously only under medical supervision. DO NOT administer LYUMJEV U-200 by intravenous infusion. Dilute LYUMJEV U-100 to a concentration of 1 unit/mL. Individualize and adjust the dosage of LYUMJEV based on the patient's metabolic needs, glucose monitoring results, and glycemic control goal. ( 2.3 ) Dose adjustments may be needed when switching from another insulin, with changes in physical activity, changes in concomitant medications, changes in meal patterns (i.e., amount and type of food, timing of food intake), changes in renal or hepatic function, or during acute illness. ( 2.3 ) 2.1 Important Administration Instructions Always check insulin labels before administration [see Warnings and Precautions ( 5.4 )] . Inspect LYUMJEV visually before use. It should appear clear and colorless. Do not use LYUMJEV if particulate matter and discoloration is seen. Use LYUMJEV prefilled pens with caution in patients with visual impairment that may rely on audible clicks to dial their dose. Do not perform dose conversion when using any LYUMJEV U-100 or U-200 prefilled pens. The dose window of LYUMJEV prefilled pens shows the number of units of LYUMJEV to be delivered and no conversion is needed . Do not transfer LYUMJEV U-200 from the prefilled pen to a syringe for administration [see Warnings and Precautions ( 5.4 )] . Do not mix LYUMJEV with any other insulin products. Do not administer LYUMJEV U-200 using continuous subcutaneous infusion insulin pump. Do not administer LYUMJEV U-200 intravenously. 2.2 Route of Administration Instructions Subcutaneous Injection for LYUMJEV U-100 or U-200 Administer LYUMJEV at the start of a meal or within 20 minutes after starting a meal subcutaneously into the abdomen, upper arm, thigh, or buttocks. Rotate injection sites within the same region from one injection to the next to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. Do not inject into areas of lipodystrophy or localized cutaneous amyloidosis [see Adverse Reactions ( 6.1 , 6.2 )]. LYUMJEV given by subcutaneous injection should generally be used in regimens with intermediate or long-acting insulin. The LYUMJEV U-100 KwikPen, LYUMJEV U-100 Tempo Pen, and LYUMJEV U-200 KwikPen each dial in 1 unit increments and deliver a maximum dose of 60 units per injection. The LYUMJEV U-100 Junior KwikPen dials in 0.5 unit increments and delivers a maximum dose of 30 units per injection. Continuous Subcutaneous Insulin Infusion (Insulin Pump) for LYUMJEV U-100 Only Do not administer LYUMJEV U-200 using an insulin pump. Refer to the continuous subcutaneous insulin infusion pump user manual to see if LYUMJEV can be used with the insulin pump. Use LYUMJEV in accordance with the insulin pump system's instructions for use. Administer LYUMJEV U-100 by continuous subcutaneous infusion in a region recommended in the instructions from the pump manufacturer. Rotate infusion sites within the same region to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. Do not infuse into areas of lipodystrophy or localized cutaneous amyloidosis [see Warnings and Precautions ( 5.2 ) and Adverse Reactions ( 6.1 )] . Train patients using continuous subcutaneous insulin infusion (CSII) therapy to administer insulin by injection and have alternate insulin therapy available in case of insulin pump failure [see Warnings and Precautions ( 5.8 )] . Change LYUMJEV U-100 in the pump reservoir at least every 9 days or according to the pump user manual, whichever is shorter. Change the infusion sets and the infusion set insertion site according to the manufacturer's user manual. Do not dilute or mix LYUMJEV U-100 when administering by CSII. Do not expose LYUMJEV in the pump reservoir to temperatures greater than 98.6°F (37°C). Intravenous Administration for LYUMJEV U-100 Only Do not administer LYUMJEV U-200 intravenously. Administer LYUMJEV U-100 intravenously only under medical supervision with close monitoring of glucose and potassium levels to avoid hypoglycemia and hypokalemia [see Warnings and Precautions ( 5.3 , 5.5 )] . Dilute LYUMJEV U-100 to a concentration of 1 unit/mL using 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP infusion solutions. Dilutions to concentrations below 1 unit/mL are not recommended. Diluted LYUMJEV may be stored for up to 4 days when refrigerated or up to 12 hours at room temperature [see HOW SUPPLIED/STORAGE AND HANDLING ( 16.2 )]. 2.3 General Dosage Instructions Individualize and adjust the dosage of LYUMJEV based on the patient's metabolic needs, glucose monitoring results, and glycemic control goal. If converting from another mealtime insulin to LYUMJEV, the change can be done on a unit-to-unit basis. Dosage adjustments may be needed when switching from another insulin, with changes in physical activity, changes in concomitant medications, changes in meal patterns (i.e., macronutrient content or timing of food intake), changes in renal or hepatic function or during acute illness to minimize the risk of hypoglycemia or hyperglycemia [see Warnings and Precautions ( 5.2 , 5.3 ), Drug Interactions ( 7 ) and Use in Specific Populations ( 8.6 , 8.7 )] . During changes to a patient's insulin regimen, increase the frequency of glucose monitoring [see Warnings and Precautions ( 5.2 )] . Instruct patients who forget a mealtime dose to monitor their glucose level to decide if an insulin dose is needed, and to resume their usual dosing schedule at the next meal.
Warnings & Precautions
Never share a LYUMJEV prefilled pen or cartridge between patients, even if the needle is changed. ( 5.1 ) Hyperglycemia or hypoglycemia with changes in insulin regimen: Make changes to a patient's insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) under close medical supervision with increased frequency of glucose monitoring. ( 5.2 ) Hypoglycemia: May be life-threatening. Increase frequency of glucose monitoring with changes to: insulin dosage, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with renal impairment or hepatic impairment or hypoglycemia unawareness. ( 5.3 ) Hypoglycemia due to medication errors: Accidental mix-ups between insulin products can occur. Instruct patients to check insulin labels before injection. Do not transfer LYUMJEV U-200 from the LYUMJEV KwikPen to a syringe as overdosage and severe hypoglycemia can result. ( 5.4 ) Hypokalemia: May be life-threatening. Monitor potassium levels in patients at risk for hypokalemia and treat if indicated. ( 5.5 ) Hypersensitivity reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue LYUMJEV, monitor, and treat if indicated. ( 5.6 ) Fluid retention and heart failure with concomitant use of thiazolidinediones (TZDs): Observe for signs and symptoms of heart failure; consider dosage reduction or discontinuation of TZD if heart failure occurs. ( 5.7 ) Hyperglycemia and ketoacidosis due to insulin pump device malfunction: Monitor glucose and administer LYUMJEV by subcutaneous injection if pump malfunction occurs. ( 5.8 ) 5.1 Never Share a LYUMJEV Prefilled Pen, Cartridge, or Syringe Between Patients LYUMJEV prefilled pens or cartridges should never be shared between patients, even if the needle is changed. Patients using LYUMJEV vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens. 5.2 Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen Changes in an insulin regimen (e.g., insulin, insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia [see Warnings and Precautions ( 5.3 )] or hyperglycemia. Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia [see Adverse Reactions ( 6.1 )] . Make any changes to a patient's insulin regimen under close medical supervision with increased frequency of blood glucose monitoring. Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to unaffected areas and closely monitor for hypoglycemia. For patients with type 2 diabetes, dosage adjustments of concomitant anti-diabetic products may be needed. 5.3 Hypoglycemia Hypoglycemia is the most common adverse reaction associated with insulins, including LYUMJEV [see Adverse Reactions ( 6.1 )] . Severe hypoglycemia can cause seizures, may lead to unconsciousness, may be life-threatening, or cause death. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving or operating other machinery). LYUMJEV, or any insulin, should not be used during episodes of hypoglycemia [see Contraindications ( 4 )] . Hypoglycemia can happen suddenly and symptoms may differ in each individual and change over time in the same individual. Symptomatic awareness of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications that block the sympathetic nervous system (e.g., beta-blockers) [see Drug Interactions ( 7 )] , or in patients who experience recurrent hypoglycemia. Risk Factors for Hypoglycemia The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal. The timing of hypoglycemia usually reflects the time-action profile of the administered insulin formulation. As with all insulins, the glucose lowering effect time course of LYUMJEV may vary in different individuals or at different times in the same individual and depends on many conditions, including the area of injection as well as the injection site blood supply and temperature [see Clinical Pharmacology ( 12.2 )] . Other factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content or timing of meals), changes in level of physical activity, or changes to co-administered medication [see Drug Interactions ( 7 )] . Patients with renal or hepatic impairment may be at higher risk of hypoglycemia [see Use in Specific Populations ( 8.6 , 8.7 )] . Risk Mitigation Strategies for Hypoglycemia Patients and caregivers must be educated to recognize and manage hypoglycemia. Self-monitoring of glucose plays an essential role in the prevention and management of hypoglycemia. In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, increased frequency of glucose monitoring is recommended. 5.4 Hypoglycemia Due to Medication Errors Accidental mix-ups between insulin products have been reported. To avoid medication errors between LYUMJEV and other insulins, instruct patients to always check the insulin label before each injection. Do not transfer LYUMJEV U-200 from the LYUMJEV KwikPen to a syringe. The markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia [see Dosage and Administration ( 2.1 ) and Warnings and Precautions ( 5.3 )] . 5.5 Hypokalemia All insulins, including LYUMJEV, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Monitor potassium levels in patients at risk for hypokalemia if indicated (e.g., patients using potassium-lowering medications, patients taking medications sensitive to serum potassium concentrations). 5.6 Hypersensitivity Reactions Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulins, including LYUMJEV [see Adverse Reactions ( 6.1 )] . If hypersensitivity reactions occur, discontinue LYUMJEV; treat per standard of care and monitor until symptoms and signs resolve. LYUMJEV is contraindicated in patients who have had hypersensitivity reactions to insulin lispro-aabc or any of its excipients [see Contraindications ( 4 )] . 5.7 Fluid Retention and Heart Failure with Concomitant Use of PPAR-Gamma Agonists Thiazolidinediones (TZDs), which are peroxisome proliferator-activated receptor (PPAR)-gamma agonists, can cause dose-related fluid retention, particularly when used in combination with insulin. Fluid retention may lead to or exacerbate heart failure. Patients treated with insulin, including LYUMJEV, and a PPAR-gamma agonist should be observed for signs and symptoms of heart failure. If heart failure develops, it should be managed according to current standards of care, and discontinuation or dose reduction of the PPAR-gamma agonist must be considered. 5.8 Hyperglycemia and Ketoacidosis Due to Insulin Pump Device Malfunction Pump or infusion set malfunctions can lead to a rapid onset of hyperglycemia and ketoacidosis. Prompt identification and correction of the cause of hyperglycemia or ketosis is necessary. Interim therapy with subcutaneous injection of LYUMJEV may be required. Patients using continuous subcutaneous insulin infusion pump therapy must be trained to administer insulin by injection and have alternate insulin therapy available in case of pump failure [see Dosage and Administration ( 2.2 ), How Supplied/Storage and Handling ( 16.2 ), and Patient Counseling Information ( 17 )] .
Contraindications
LYUMJEV is contraindicated: during episodes of hypoglycemia. in patients with hypersensitivity to insulin lispro-aabc or any of the excipients in LYUMJEV. During episodes of hypoglycemia. ( 4 ) Hypersensitivity to insulin lispro-aabc or any of the excipients in LYUMJEV. ( 4 )
Adverse Reactions
The following adverse reactions are also discussed elsewhere: Hypoglycemia [see Warnings and Precautions ( 5.3 )] . Hypoglycemia Due to Medication Errors [see Warnings and Precautions ( 5.4 )] Hypokalemia [see Warnings and Precautions ( 5.5 )] . Hypersensitivity Reactions [see Warnings and Precautions ( 5.6 )] . Adverse reactions observed with LYUMJEV include hypoglycemia, injection/infusion site reactions, allergic reactions, rash, pruritus, lipodystrophy, and weight gain. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug, and may not reflect the rates actually observed in clinical practice. Adverse Reaction Database – Adult Patients with Type 1 and Type 2 Diabetes The data in Table 1 reflect the exposure of 780 adult patients with type 1 diabetes to LYUMJEV with a mean exposure duration of 26 weeks [see Clinical Studies ( 14.2 )] . The mean age was 44 years, the mean duration of diabetes was 19 years, 55% were male, 77% were White, 2% were Black or African American, and 9% were Hispanic. The mean BMI was 26.6 kg/m 2 and the mean HbA 1c at baseline was 7.3%. The data in Table 2 reflect the exposure of 336 adult patients with type 2 diabetes to LYUMJEV with a mean exposure duration of 26 weeks [see Clinical Studies ( 14.3 )] . The mean age was 60 years, the mean duration of diabetes was 16 years, 55% were male, 69% were White, 4% were Black or African American, and 24% were Hispanic. The mean BMI was 32.1 kg/m 2 and the mean HbA 1c at baseline was 7.3%. The data in Table 3 reflect the exposure of 215 adult patients with type 1 diabetes to LYUMJEV via CSII administration with a mean exposure duration of 16 weeks [see Clinical Studies ( 14.4 )] . The mean age was 48 years, the mean duration of diabetes was 26 years, 44% were male, 94% were White, 3% were Black or African American, and 8% were Hispanic. The mean BMI was 27.0 kg/m 2 and the mean HbA 1c at baseline was 7.6%. Common adverse reactions, excluding hypoglycemia, were defined as events that occurred in ≥5% and at the same rate or greater for LYUMJEV-treated patients than HUMALOG-treated patients. Table 1. Adverse Reactions That Occurred in ≥5% of LYUMJEV-Treated Adult Patients with Type 1 Diabetes Mealtime LYUMJEV + basal insulin (N=451) % Postmeal LYUMJEV + basal insulin (N=329) % Nasopharyngitis 14.2 14.6 Table 2. Adverse Reactions That Occurred in ≥5% of LYUMJEV-Treated Adult Patients with Type 2 Diabetes Mealtime LYUMJEV + basal insulin (N=336) % Nasopharyngitis 12.5 Upper Respiratory Tract Infection 7.4 Table 3. Adverse Reactions That Occurred in ≥5% of LYUMJEV-Treated Adult Patients with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion CSII LYUMJEV administration (N=215) % Infusion site reaction 19.1 Infusion site pain 15.8 Nasopharyngitis 6.0 Adverse Reaction Database – Pediatric Patients with Type 1 Diabetes The data in Table 4 reflect the exposure of 418 pediatric patients with type 1 diabetes to LYUMJEV with a mean exposure duration of 26 weeks [see Clinical Studies ( 14.5 )] . The mean age was 12 years; 50% were male, 91% were White, 1% were Black or African American; and 24% of the US subpopulation in this trial were Hispanic. The mean BMI was 20.5 kg/m 2 , the mean duration of diabetes was 5 years, and the mean HbA 1c at baseline was 7.8%. Common adverse reactions, excluding hypoglycemia, were defined as events that occurred in ≥5% and at the same rate or greater for LYUMJEV-treated patients than HUMALOG-treated patients. Table 4. Adverse Reactions That Occurred in ≥5% of LYUMJEV-Treated Pediatric Patients with Type 1 Diabetes Mealtime LYUMJEV + basal insulin (N=280) % Postmeal LYUMJEV + basal insulin (N=138) % Nasopharyngitis 8.2 5.1 Upper Respiratory Tract Infection 5.4 1.4 Hypoglycemia Hypoglycemia is the most commonly observed adverse reaction in patients using insulin, including LYUMJEV. The rates of reported hypoglycemia depend on the definition of hypoglycemia used, diabetes type, insulin dose, intensity of glucose control, background therapies, and other intrinsic and extrinsic patient factors. For these reasons, comparing rates of hypoglycemia in clinical trials for LYUMJEV with the incidence of hypoglycemia for other products may be misleading and also may not be representative of hypoglycemia rates that occur in clinical practice. Incidence rates for severe hypoglycemia in adults with type 1 and type 2 diabetes mellitus and pediatric patients with type 1 diabetes mellitus treated with LYUMJEV in clinical trials are shown in Table 5 [see Clinical Studies ( 14 )] . Table 5. Proportion of Patients with Type 1 Diabetes and Type 2 Diabetes Who Experienced at Least One Episode of Severe Hypoglycemia in Adult and Pediatric Clinical Trials a Severe hypoglycemia: an episode requiring assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions PRONTO-T1D (Adult Type 1) PRONTO-T2D (Adult Type 2) PRONTO-Pump-2 (Adult Type 1 CSII) PRONTO-Peds (Pediatric Type 1) Mealtime LYUMJEV + basal insulin (N=451) % Postmeal LYUMJEV + basal insulin (N=329) % Mealtime LYUMJEV + basal insulin (N=336) % LYUMJEV (N=215) % Mealtime LYUMJEV + basal insulin (N=280) % Postmeal LYUMJEV + basal insulin (N=298) % Severe hypoglycemia a 5.5 4.6 0.9 1.4 1.1 0 Allergic Reactions Severe, life-threatening, generalized allergy, including anaphylaxis, generalized skin reactions, angioedema, bronchospasm, hypotension, and shock may occur with any insulin, including LYUMJEV, and may be life threatening. Generalized hypersensitivity reactions such as skin rashes and hypersensitivity were reported in adult patients treated with LYUMJEV: eczema (0.4%), rash (0.4%), dermatitis (0.3%), hypersensitivity (0.2%), and pruritus (0.2%). Generalized hypersensitivity reactions reported in more than 1 pediatric patient treated with LYUMJEV included: rhinitis (0.7%), dermatitis (0.7%), rash (0.5%), and hypersensitivity (0.5%). Lipodystrophy Administration of insulin, including LYUMJEV, has resulted in lipohypertrophy (enlargement or thickening of tissue) and lipoatrophy (depression in the skin). Lipodystrophy was reported in 0.2% of adult and pediatric patients treated with LYUMJEV [see Dosage and Administration ( 2.2 )] . Injection/Infusion Site Reactions Injection or infusion site reactions can occur with insulin therapy. With LYUMJEV, adult and pediatric patients have experienced rash, redness, inflammation, pain, bruising, or itching at the site of LYUMJEV injection or infusion. LYUMJEV contains treprostinil sodium and sodium citrate dihydrate as inactive ingredients [see Description ( 11 )] which have been associated with infusion and injection site reactions with other non-insulin products. Subcutaneous Injection Site-Related Reactions : In studies PRONTO-T1D and PRONTO-T2D, injection site-related reactions occurred in 2.7% of adult patients treated with LYUMJEV (mild in 2.2% and moderate in 0.5%). with <0.1% of patients discontinuing from treatment due to injection site-related reactions. In Study PRONTO-Peds, injection site-related reactions occurred in 6.2% of pediatric patients treated with LYUMJEV (mild in 5.7% and moderate in 0.5%), with <0.5% of patients discontinuing from treatment due to injection site-related reactions. Continuous Subcutaneous Insulin Infusion (CSII) Site-Related Reactions: In Study PRONTO-Pump-2, infusion site-related reactions were reported in 37.7% of adult patients treated with LYUMJEV (mild in 27.9%, moderate in 7.9%, and severe in 1.9%), with 3.3% of patients discontinuing from treatment due to infusion site-related reactions. See Table 4 . Weight Gain Weight gain can occur with insulin therapy, including LYUMJEV, and has been attributed to the anabolic effects of insulin and the decrease in glucosuria. Adult patients with type 1 diabetes treated with LYUMJEV gained an average of 0.6 kg and patients with type 2 diabetes treated with LYUMJEV gained an average of 1.5 kg. Peripheral Edema Insulin, including LYUMJEV, may cause sodium retention and edema, particularly if previous poor metabolic control is improved by intensified insulin therapy. Peripheral edema occurred in 0.2% of adult patients treated with LYUMJEV. 6.2 Postmarketing Experience The following additional adverse reactions have been identified during post-approval use of insulin lispro. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Localized cutaneous amyloidosis at the injection site has occurred with insulin use. Hyperglycemia has been reported with repeated insulin injections into areas of localized cutaneous amyloidosis; hypoglycemia has been reported with a sudden change to an unaffected injection site.
Drug Interactions
Table 6 includes clinically significant drug interactions with LYUMJEV. Table 6. Clinically Significant Drug Interactions with LYUMJEV Drugs That May Increase the Risk of Hypoglycemia Drugs: Antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analogs (e.g., octreotide), and sulfonamide antibiotics. Intervention: Dose reductions and increased frequency of glucose monitoring may be required when LYUMJEV is co-administered with these drugs. Drugs That May Decrease the Blood Glucose Lowering Effect of LYUMJEV Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. Intervention: Dose increases and increased frequency of glucose monitoring may be required when LYUMJEV is co-administered with these drugs. Drugs That May Increase or Decrease the Blood Glucose Lowering Effect of LYUMJEV Drugs: Alcohol, beta-blockers, clonidine, and lithium salts. Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia. Intervention: Dose adjustment and increased frequency of glucose monitoring may be required when LYUMJEV is co-administered with these drugs. Drugs That May Blunt Signs and Symptoms of Hypoglycemia Drugs: Beta-blockers, clonidine, guanethidine, and reserpine. Intervention: Increased frequency of glucose monitoring may be required when LYUMJEV is co-administered with these drugs. Drugs that Increase Hypoglycemia Risk or Increase or Decrease Blood Glucose Lowering Effect: Adjustment of dosage may be needed; closely monitor blood glucose. ( 7 ) Drugs that Blunt Hypoglycemia Signs and Symptoms (e.g., beta-blockers, clonidine, guanethidine, and reserpine): Increased frequency of glucose monitoring may be required. ( 7 )
Storage & Handling
16.2 Storage and Handling Dispense in the original sealed carton with the enclosed Instructions for Use. Refrigerate unopened LYUMJEV vials, pens, and cartridges between 36°F to 46°F (2°C to 8°C) until time of use and keep in the original carton to protect from light. Do not freeze or use LYUMJEV if it has been frozen. Do not expose to direct heat. Discard opened or unopened LYUMJEV vials, pens, and cartridges stored at room temperature below 86°F (30°C) after 28 days. The storage conditions for vials, pens, and cartridges are summarized in Table 13 . Table 13. Storage Conditions for Vials, Pens, and Cartridges a In-use (opened) vials, whether or not refrigerated, must be used within 28 days. b When stored at room temperature, LYUMJEV can only be used for a total of 28 days including both not in-use (unopened) and in-use (opened) storage time. LYUMJEV Presentation Not In-use (Unopened) In-use (Opened) Room Temperature (below 86°F [30°C]) Refrigerated (36°F to 46°F [2°C to 8°C]) Room Temperature (below 86°F [30°C]) Refrigerated (36°F to 46°F [2°C to 8°C]) 10 mL vial a,b 28 days Until expiration date 28 days 28 days 3 mL cartridge b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV KwikPen (U-100 and U-200) b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV Junior KwikPen b 28 days Until expiration date 28 days Do not refrigerate 3 mL LYUMJEV Tempo Pen b 28 days Until expiration date 28 days Do not refrigerate Storage of LYUMJEV in Insulin Pump Change the LYUMJEV U-100 in the pump reservoir at least every 9 days, or according to the pump user manual, whichever is shorter, or after exposure to temperatures that exceed 98.6°F (37°C). Storage of LYUMJEV in Intravenous Infusion Fluids Diluted LYUMJEV may be stored for up to 4 days when refrigerated at 36°F to 46°F (2°C to 8°C) until time of use. The same solution may be stored up to 12 hours at room temperature at 68°F to 77°F (20°C to 25°C) [see Dosage and Administration ( 2.2 )].
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