Endocrinology Book

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Inhaled Insulin

Aka: Inhaled Insulin, Insulin Inhalation Powder, Exubera, Afrezza
  1. Background
    1. Exubera (listed for historical reasons)
      1. Off U.S. Market as of October 2007 (based on business decisions, not on recall)
  2. Indications
    1. Diabetes Mellitus when intollerant to SQ injection
  3. Contraindications
    1. COPD
    2. Asthma
    3. Lung Cancer
    4. Tobacco use
  4. Mechanism
    1. Dry powder form of rapid acting Insulin
    2. Delivery by oral inhalation
    3. Large doses needed due to inefficient absorption
      1. Most Insulin remains in lung and is inactive
  5. Preparations: Afrezza
    1. Released in 2014, as a Bolus Insulin substitute
    2. Does not replace basal Insulin
    3. Dose
      1. Delivered in 4 or 8 units cartridge
      2. Convert Insulin unit for unit, and round dose up to nearest 4 unit cartridge
    4. Cost
      1. Twice the cost of Bolus Insulin
    5. Activity
      1. Onset of activity is similar to SC injected Bolus Insulin
      2. Duration is shorter than SC injected Bolus Insulin
  6. Preparations: Exubera (off market as of 2007)
    1. Historical information only
    2. Dosing
      1. Powder 1 mg (in Blister pack) = Insulin 3 units
      2. Powder 3 mg (in Blister pack) = Insulin 8 units
    3. Preparations
      1. Starter: Inhaler/parts, 180 packs 1 mg, 90 packs 3 mg
      2. Refill 12: 90 packs 1 mg, 90 packs 3 mg (990 units)
      3. Refill 15: 180 packs 1 mg, 90 packs 3 mg (1260 units)
    4. Cost: Expensive (twice the cost of SQ Insulin)
      1. Starter: $190
      2. Refills: $140-180
  7. Efficacy
    1. Similar to SC Bolus Insulin
  8. Adverse Effects: Exubera
    1. Hypoglycemia (esp. when used with Oral Hypoglycemics)
    2. Cough (<5%)
    3. Chest Pain (<5%)
    4. Dyspnea (<5%)
    5. Dry Mouth (<5%)
  9. Monitoring: Pulmonary Function Tests
    1. Schedule: Baseline, 6 months and annually
    2. Stop Inhaled Insulin if FEV1 with >20% decline from baseline
  10. References
    1. (2015) Presc Lett 22(3): 13-4
    2. Borja (2007) Am Fam Physician 75: 1546-7 [PubMed]
    3. Cefalu (2001) Ann Intern Med 134:203-7 [PubMed]
    4. Quattrin (2004) Diabetes Care 27:2622-7 [PubMed]

Exubera (C1176237)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH C473734
English EXUBERA, Exubera
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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