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Insulin lispro

PDB: 6NWV​
Clinical data
Trade names	Humalog, Liprolog, Admelog, others
Other names	URLi, LY900014, LY-275585, insulin lispro-aabc
AHFS/Drugs.com	Monograph
MedlinePlus	a697021
License data	US DailyMed: Insulin lispro
Pregnancy category	AU: A
Routes of administration	Subcutaneous
ATC code	A10AB04 (WHO) A10AD04 (WHO)
Legal status
Legal status	CA: ℞-only / Schedule D UK: POM (Prescription only) US: ℞-only EU: Rx-only , In general: ℞ (Prescription only)
Pharmacokinetic data
Onset of action	30 minutes
Duration of action	5 hours
Identifiers
CAS Number	133107-64-9
PubChem CID	16132438
DrugBank	DB00046
ChemSpider	none
UNII	GFX7QIS1II
KEGG	D04477
CompTox Dashboard (EPA)	DTXSID90157956
Chemical and physical data
Formula	C257H389N65O77S6
Molar mass	5813.68 g·mol
3D model (JSmol)	Interactive image
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InChI InChI=1S/C158H234N40O42S2.C99H155N25O35S4/c1-79(2)57-104(181-131(213)86(15)173-136(218)102(50-53-125(211)212)179-152(234)127(84(11)12)194-148(230)107(60-82(7)8)184-145(227)113(67-95-70-166-78-172-95)189-150(232)115(74-199)176-123(208)73-170-134(216)116(75-241)191-140(222)105(58-80(3)4)182-144(226)112(66-94-69-165-77-171-94)188-138(220)101(48-51-119(161)204)178-146(228)114(68-120(162)205)190-153(235)126(83(9)10)193-132(214)98(160)61-89-31-21-18-22-32-89)139(221)185-110(64-92-40-44-96(202)45-41-92)142(224)183-106(59-81(5)6)147(229)195-128(85(13)14)154(236)192-117(76-242)135(217)169-71-121(206)174-100(49-52-124(209)210)137(219)177-99(38-29-55-167-158(163)164)133(215)168-72-122(207)175-108(62-90-33-23-19-24-34-90)141(223)186-109(63-91-35-25-20-26-36-91)143(225)187-111(65-93-42-46-97(203)47-43-93)149(231)196-129(87(16)200)155(237)180-103(37-27-28-54-159)156(238)198-56-30-39-118(198)151(233)197-130(88(17)201)157(239)240;1-12-46(9)77(121-73(134)36-100)97(156)122-76(45(7)8)95(154)108-56(25-29-75(137)138)80(139)105-54(23-27-70(102)131)83(142)117-66(40-161)93(152)119-68(42-163)94(153)124-79(48(11)127)98(157)116-64(38-126)90(149)123-78(47(10)13-2)96(155)120-67(41-162)92(151)115-63(37-125)89(148)110-58(31-44(5)6)85(144)111-59(32-49-14-18-51(128)19-15-49)86(145)106-53(22-26-69(101)130)81(140)109-57(30-43(3)4)84(143)107-55(24-28-74(135)136)82(141)113-61(34-71(103)132)88(147)112-60(33-50-16-20-52(129)21-17-50)87(146)118-65(39-160)91(150)114-62(99(158)159)35-72(104)133/h18-26,31-36,40-47,69-70,77-88,98-118,126-130,199-203,241-242H,27-30,37-39,48-68,71-76,159-160H2,1-17H3,(H2,161,204)(H2,162,205)(H,165,171)(H,166,172)(H,168,215)(H,169,217)(H,170,216)(H,173,218)(H,174,206)(H,175,207)(H,176,208)(H,177,219)(H,178,228)(H,179,234)(H,180,237)(H,181,213)(H,182,226)(H,183,224)(H,184,227)(H,185,221)(H,186,223)(H,187,225)(H,188,220)(H,189,232)(H,190,235)(H,191,222)(H,192,236)(H,193,214)(H,194,230)(H,195,229)(H,196,231)(H,197,233)(H,209,210)(H,211,212)(H,239,240)(H4,163,164,167);14-21,43-48,53-68,76-79,125-129,160-163H,12-13,22-42,100H2,1-11H3,(H2,101,130)(H2,102,131)(H2,103,132)(H2,104,133)(H,105,139)(H,106,145)(H,107,143)(H,108,154)(H,109,140)(H,110,148)(H,111,144)(H,112,147)(H,113,141)(H,114,150)(H,115,151)(H,116,157)(H,117,142)(H,118,146)(H,119,152)(H,120,155)(H,121,134)(H,122,156)(H,123,149)(H,124,153)(H,135,136)(H,137,138)(H,158,159)/t86-,87+,88+,98-,99-,100-,101-,102-,103-,104-,105-,106-,107-,108-,109-,110-,111-,112-,113-,114-,115-,116-,117-,118-,126-,127-,128-,129-,130-;46-,47-,48+,53-,54-,55-,56-,57-,58-,59-,60-,61-,62-,63-,64-,65-,66-,67-,68-,76-,77-,78-,79-/m00/s1 Key:WNRQPCUGRUFHED-DETKDSODSA-N
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Insulin lispro, sold under the brand name Humalog among others, is a modified type of medical insulin used to treat type 1 and type 2 diabetes. It is delivered subcutaneously either by injection or from an insulin pump. Onset of effects typically occurs within 30 minutes and lasts about 5 hours. Often a longer-acting insulin like insulin NPH is also needed.

Common side effects include low blood sugar. Other serious side effects may include low blood potassium. Use in pregnancy and breastfeeding is generally safe. It works the same as human insulin by increasing the amount of glucose that tissues take in and decreasing the amount of glucose made by the liver.

Insulin lispro was first approved for use in the United States in 1996. It is a manufactured analogue of human insulin where two amino acids have swapped positions. In 2022, it was the 70th most commonly prescribed medication in the United States, with more than 9 million prescriptions.

Medical uses

Insulin lispro is used to treat people with type 1 diabetes or type 2 diabetes. People doing well on short-acting insulin should not routinely be changed to insulin lispro, but may benefit from some advantages like flexibility and responsiveness.

Side effects

Common side effects include skin irritation at the site of injection, hypoglycemia, hypokalemia, and lipodystrophy. Other serious side effects include anaphylaxis, and hypersensitivity reactions.

Mechanism of action

Through recombinant DNA technology, the final lysine and proline residues on the C-terminal end of the B-chain are reversed. This modification does not alter receptor binding, but blocks the formation of insulin dimers and hexamers. This allows larger amounts of active monomeric insulin to be immediately available for postprandial injections.

Chemistry

It is a manufactured form of human insulin where the amino acids lysine and proline have been switched at the end of the B chain of the insulin molecule. This switch of amino acids mimics Insulin-like growth factor 1 which also has lysine (K) and proline (P) in that order at positions 28 and 29.

History

Insulin lispro (brand name Humalog) was granted marketing authorization in the European Union in April 1996, and it was approved for use in the United States in June 1996.

Insulin lispro (brand name Liprolog) was granted marketing authorization in the European Union in May 1997, and again in August 2001.

Combination drugs combining insulin lispro and other forms of insulin were approved for use in the United States in December 1999.

Insulin lispro Sanofi was granted marketing authorization as a biosimilar in the European Union in July 2017.

Insulin lispro injection (brand name Admelog) was approved for use in the United States in December 2017.

In January 2020, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency recommended granting of a marketing authorization for insulin lispro acid (brand name Lyumjev) for the treatment of diabetes in adults. Insulin lispro (Lyumjev) was approved for use in the European Union in March 2020, and in the United States in June 2020.

Society and culture

Economics

In the United States, the price of for a vial of Humalog increased from US$35 in 2001 to $234 in 2015, or $10.06 and $29.36 per 100 units. In April 2019, Eli Lilly and Company announced they would produce a version selling for $137.35 per vial. The chief executive said that this was a contribution "to fix the problem of high out-of-pocket costs for Americans living with chronic conditions", but Patients for Affordable Drugs Now said it was just a public relations move, as "other countries pay $20 for a vial of insulin." In March 2023, Lilly announced a program capping their insulin prices at $35 per month.

References

1. "Insulin lispro Use During Pregnancy". Drugs.com. 7 October 2019. Archived from the original on 19 September 2020. Retrieved 23 February 2020.
2. "Humalog 100 units/ml, solution for injection in vial - Summary of Product Characteristics (SmPC)". (emc). 30 January 2020. Archived from the original on 23 February 2020. Retrieved 23 February 2020.
3. ^ "Humalog EPAR". European Medicines Agency (EMA). 11 February 2020. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
4. ^ "Liprolog EPAR". European Medicines Agency (EMA). 1 August 2001. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
5. ^ "Insulin Lispro Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 6 March 2019. Retrieved 3 March 2019.
6. British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 698. ISBN 9780857113382.
7. "Insulin lispro Pregnancy and Breastfeeding Warnings". Drugs.com. Archived from the original on 19 September 2020. Retrieved 3 March 2019.
8. ^ "Humalog- insulin lispro injection, solution Humalog Kwikpen- insulin lispro injection, solution Humalog Junior Kwikpen- insulin lispro injection, solution Humalog Tempo Pen- insulin lispro injection, solution". DailyMed. 25 November 2019. Archived from the original on 24 September 2019. Retrieved 23 February 2020.
9. ^ "Humalog approval" (PDF). U.S. Food and Drug Administration (FDA). 14 June 1996. Archived (PDF) from the original on 24 February 2020. Retrieved 23 February 2020.
10. ^ Koivisto VA (June 1998). "The human insulin analogue insulin lispro". Annals of Medicine. 30 (3): 260–6. doi:10.3109/07853899809005853. PMID 9677011.
11. "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
12. "Insulin Lispro Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
13. Noble SL, Johnston E, Walton B (January 1998). "Insulin lispro: a fast-acting insulin analog". American Family Physician. 57 (2): 279–86, 289–92. PMID 9456992. Archived from the original on 29 September 2007. Retrieved 5 September 2007.
14. Ratledge, C., & Kristiansen, B. (2007). Basic biotechnology. Cambridge: Cambridge University Press. Page 513 "insulin lispro, where, in analogy to the naturally occur- ring insulin homologue insulin-like growth factor-I (IGF-I), the order of the amino acid residues B28 and B29 was changed;"
15. "Humalog: FDA-Approved Drugs". U.S. Food and Drug Administration (FDA). Archived from the original on 27 November 2020. Retrieved 23 February 2020.
16. "Liprolog EPAR". European Medicines Agency (EMA). 11 February 2020. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
17. "Drug Approval Package: Humalog Mix (75/25 & 50/50) NDA# 21-017 & 21-018". U.S. Food and Drug Administration (FDA). 24 December 1999. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
18. "Humalog Mix50/50- insulin lispro injection, suspension Humalog Mix50/50 Kwikpen- insulin lispro injection, suspension". DailyMed. 19 November 2019. Archived from the original on 28 August 2021. Retrieved 23 February 2020.
19. "Humalog Mix75/25- insulin lispro injection, suspension Humalog Mix75/25 Kwikpen- insulin lispro injection, suspension". DailyMed. 3 February 2020. Archived from the original on 30 November 2020. Retrieved 23 February 2020.
20. "Insulin lispro Sanofi EPAR". European Medicines Agency (EMA). 17 June 2019. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
21. "Drug Approval Package: Admelog (insulin lispro)". U.S. Food and Drug Administration (FDA). 17 May 2018. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
22. "FDA Approves Sanofi's Admelog (insulin lispro injection)". Sanofi (Press release). 11 December 2017. Archived from the original on 24 February 2020. Retrieved 23 February 2020.
23. "FDA approves Admelog, the first short-acting "follow-on" insulin product to treat diabetes". U.S. Food and Drug Administration (FDA) (Press release). 11 December 2017. Archived from the original on 14 June 2019. Retrieved 12 December 2017.
24. "Lyumjev: Pending EC decision". European Medicines Agency (EMA). 30 January 2020. Archived from the original on 31 January 2020. Retrieved 23 February 2020.
25. "CHMP Recommends Approval of Lilly's New Fast-Acting Mealtime Insulin to Improve Glycemic Control in Adults with Diabetes". Eli Lilly and Company (Press release). 31 January 2020. Archived from the original on 28 August 2021. Retrieved 23 February 2020.
26. "Ljumjev EPAR". European Medicines Agency (EMA). 29 January 2020. Archived from the original on 28 August 2021. Retrieved 16 April 2020.
27. ^ Sullivan P (3 April 2019). "Drug company announces new version of insulin at half the price". The Hill. Archived from the original on 15 April 2019. Retrieved 15 April 2019.
28. Langreth R (29 June 2016). "Decoding Big Pharma's Secret Drug Pricing Practices". Bloomberg. Archived from the original on 13 July 2016. Retrieved 15 July 2016.
29. "Lilly Cuts Insulin Prices by 70% and Caps Patient Insulin Out-of-Pocket Costs at $35 Per Month". Eli Lilly and Company (Press release). 1 March 2023. Archived from the original on 14 April 2023. Retrieved 14 April 2023.

• Medicine

• Drugs developed by Eli Lilly and Company
• Human proteins
• Insulin receptor agonists
• Peptide hormones
• Peptide therapeutics
• Recombinant proteins