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Afrezza
insulin inhaled
Black Box Warnings .
Acute Bronchospasm Risk
contraindicated in chronic pulmonary disease patients such as asthma or COPD; acute bronchospasm observed in asthma and COPD patients; before tx start, assess all patients for potential pulmonary disease including history, physical exam, and spirometry (FEV1)
Adult Dosing .
Dosage forms: DPI: 4 units, 8 units, 12 units; DPI (pack): 8 units x90 and 12 units x90; DPI (titration pack): 4 units x90 and 8 units x90; DPI (titration pack): 4 units x60, 8 units x60, and 12 units x60
Special Note
- [additional info]
- Info: search Insulin Product Comparisons for comparison of onset, peak, duration, dosage form, and mixing compatibility
diabetes mellitus
- [insulin-naive patients]
- Dose: individualize dose inhaled at start of each meal; Start: 4 units inhaled at start of each meal; Info: consider D/C tx if FEV1 decr. >20% from baseline; dose adjustment may be needed during pregnancy and/or immediately postpartum; onset 0.2h, peak 0.6-0.9h, duration 1.5-4.5h (rapid-acting insulin)
- [conversion from SC prandial insulin]
- Dose: individualize dose inhaled at start of each meal; Start: individualize dose based on current SC prandial insulin intake; up to 3 units SC prandial insulin = 4 units inhaled; 4-5 units SC prandial insulin = 8 units inhaled; 6-7 units SC prandial insulin = 12 units inhaled; >8 units SC prandial insulin = 16 units inhaled; Info: consider D/C tx if FEV1 decr. >20% from baseline; dose adjustment may be needed during pregnancy and/or immediately postpartum; onset 0.2h, peak 0.6-0.9h, duration 1.5-4.5h (rapid-acting insulin)
renal dosing
- [see below]
- renal impairment: consider decr. usual start dose
- HD: consider decr. usual start dose; no supplement after dialysis; PD: consider decr. usual start dose; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: DPI: 4 units, 8 units, 12 units; DPI (pack): 8 units x90 and 12 units x90; DPI (titration pack): 4 units x90 and 8 units x90; DPI (titration pack): 4 units x60, 8 units x60, and 12 units x60
Special Note
- [additional info]
- Info: search Insulin Product Comparisons for comparison of onset, peak, duration, dosage form, and mixing compatibility
diabetes mellitus
- [6 yo and older, insulin-naive patients]
- Dose: individualize dose inhaled at start of each meal; Start: 4 units inhaled at start of each meal; Info: consider D/C tx if FEV1 decr. >20% from baseline; onset 0.2h, peak 0.6-0.9h, duration 1.5-4.5h (rapid-acting insulin)
- [6 yo and older, conversion from SC prandial insulin]
- Dose: individualize dose inhaled at start of each meal; Start: individualize dose based on current SC prandial insulin intake; up to 3 units SC prandial insulin = 4 units inhaled; 4-5 units SC prandial insulin = 8 units inhaled; 6-7 units SC prandial insulin = 12 units inhaled; >8 units SC prandial insulin = 16 units inhaled; Info: consider D/C tx if FEV1 decr. >20% from baseline; onset 0.2h, peak 0.6-0.9h, duration 1.5-4.5h (rapid-acting insulin)
renal dosing
- [see below]
- renal impairment: consider decr. usual start dose
- HD: consider decr. usual start dose; no supplement after dialysis; PD: consider decr. usual start dose; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised