Prescribing Tresiba® to pediatric patients
Tresiba® U-100 is the only basal insulin indicated for type 1 and type 2 diabetes in children as young as 1 year of age.1-5 See guidance below on how to start or convert your pediatric patients to once-daily Tresiba®.
Image is for illustrative purposes only.
Tresiba® dosing for pediatric patients with type 1 and type 2 diabetes already taking insulin1
START
Tresiba® at 80% of the current dose of basal insulin to minimize the risk of hypoglycemia
INJECT
Once daily at the same time of day
TITRATE
Every 3 to 4 days as needed
- If a pediatric patient misses a dose, they should contact their health care provider for guidance and monitor blood glucose levels more frequently until the next scheduled dose1
- Individualize the dose according to the patient’s metabolic needs, blood glucose monitoring results, and glycemic control goals, with 3 to 4 days between each dose increase1
Tresiba® dosing for insulin-naïve adult and pediatric patients with type 1 diabetes1
CALCULATE
total daily insulin dose (basal + bolus)
0.2 to 0.4
units per 1 kg of body weight
START
initial Tresiba® dose at
1/3 to 1/2 of total daily insulin dose
- If a pediatric patient misses a dose, they should contact their health care provider for guidance and monitor blood glucose levels more frequently until the next scheduled dose1
- Individualize the dose according to the patient’s metabolic needs, blood glucose monitoring results, and glycemic control goals, with 3 to 4 days between each dose increase1
- The recommended starting dose of Tresiba® in insulin-naïve pediatric and adult patients with type 2 diabetes is 10 units once daily
- Adults already taking insulin can start on the same unit dose as their current basal insulin and take their injection at any time of day1
- Adult patients who miss a dose of Tresiba® should inject their daily dose during waking hours upon discovering the missed dose, then continue with their regular dosing schedule. Ensure that at least 8 hours have elapsed between Tresiba® injections1
Add Tresiba® to your electronic prescribing system
Tresiba® FlexTouch® U-100
NDC:
0169-2660-15
Form/strength:
100 U/mL
Quantity per box:
5 pens
15 mL (5 x 3 mL)
1500 units total
Tresiba® U-100, 10-mL vial
NDC:
0169-2662-11
Form/strength:
100 U/mL
Quantity per box:
1 vial
10 mL
1000 units total
Tresiba® has ~82.2% national formulary coverage (commercial and Medicare Part D combined)6,a,b
aFormulary status subject to change. This information should not be used to make efficacy or safety comparisons between or among mentioned products.
bFormulary data are provided by Fingertip Formulary® and are current as of August 2020.
Indications and Usage for Tresiba® (insulin degludec injection) 100 U/mL, 200 U/mL
Tresiba® (insulin degludec injection) is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus.
Limitations of Use
Tresiba® is not recommended for treating diabetic ketoacidosis.
Important Safety Information
Contraindications
- Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients
Warnings and Precautions
- Never Share a Tresiba® FlexTouch® Pen, Needle, or Syringe Between Patients, even if the needle is changed. Patients using Tresiba® vials should never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens
- Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, or injection site or method of administration) may affect glycemic control and predispose to hypoglycemia 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. 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. Adjustments in concomitant anti-diabetic treatment may be needed.
- Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening. Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness or renal or hepatic impairment
- Accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. To avoid medication errors, always instruct patients to check the insulin label before each injection
- Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products, including Tresiba®
- As with all insulins, Tresiba® use can lead to life-threatening hypokalemia, which then may cause respiratory paralysis, ventricular arrhythmia, and death. Closely monitor potassium levels in patients at risk of hypokalemia and treat if indicated
- Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including Tresiba®. Patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of the TZD must be considered
Adverse Reactions
- Adverse reactions commonly associated with Tresiba® are hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain
Drug Interactions
- There are certain drugs that may cause clinically significant drug interactions with Tresiba®.
- Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors
- Drugs that may decrease the blood glucose lowering effect: 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
- Drugs that may increase or decrease the blood glucose lowering effect: alcohol, beta-blockers, clonidine, lithium salts, and pentamidine
- Drugs that may blunt the signs and symptoms of hypoglycemia: beta-blockers, clonidine, guanethidine, and reserpine
Please click here for Tresiba® Prescribing Information.
References:
- Tresiba [package insert]. Plainsboro, NJ: Novo Nordisk Inc; November 2019.
- Lantus [package insert]. Bridgewater, NJ: sanofi-aventis US LLC; November 2019.
- Levemir [package insert]. Plainsboro, NJ: Novo Nordisk Inc; March 2020.
- Toujeo [package insert]. Bridgewater, NJ: sanofi-aventis US LLC; November 2019.
- Basaglar [package insert]. Indianapolis, IN: Lilly USA LLC; November 2019.
- Fingertip Formulary. August 2020.