Insulin lispro and aspart… interchangeable?

What you say??

Medscape has an Ask Marilyn type of thing, and this one was a head-scratcher:

What is the relationship between NovoLog and Humalog? Molecular structure aside, can they be directly substituted for each other?

I don’t know who’s asking the question, but I think it’d almost have to be a prescriber, or someone who supervises prescribing physicians. Especially given the answer:

Any differences in pharmacokinetic parameters are unlikely to be clinically relevant, and as such, these 2 agents may be interchanged. However, it is important to keep in mind that the pharmacokinetics and clinical response to all insulin products can vary between individuals due to a variety of factors. Individual patients switched from 1 agent to the other should be especially cautious about monitoring their blood glucose initially after the change.

Emphasis mine.

I hope no pharmacists out in the real world think to themselves “Gee, I’m out of NovoLog, so I’ll just substitute Humalog.” In this context, a disclaimer would have been nice, don’t you think, Mario?

For the non-endocrine types, lispo and aspart swap a pair of amino acids to make insulin adhere to itself less, which results in a smoother pharmacokinetic profile. Patients tend to like it better than NPH. It is, unfortunately, much more expensive.

[tags]Medicine, pharmacy, insulin, diabetes[/tags]

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