Toujeo Dosage/Direction for Use

Posology: Toujeo is a basal insulin for once-daily administration at any time of the day, preferably at the same time every day.
The dose regimen (dose and timing) should be adjusted according to individual response.
In type 1 diabetes mellitus, Toujeo must be combined with short-/rapid-acting insulin to cover mealtime insulin requirements.
In patients with type 2 diabetes mellitus, Toujeo can also be given together with other anti-hyperglycaemic medicinal products.
The potency of this medicinal product is stated in units. These units are exclusive to Toujeo and are not the same as IU or the units used to express the potency of other insulin analogues (see Pharmacology: Pharmacodynamics under Actions).
Flexibility in dosing time: When needed, patients can administer Toujeo up to 3 hours before or after their usual time of administration (see Pharmacology: Pharmacodynamics under Actions).
Patients who forget a dose, should be advised to check their blood sugar and then resume their usual once-daily dosing schedule. Patients should be informed not to inject a double dose to make up for a forgotten dose.
Initiation: Patients with type 1 diabetes mellitus: Toujeo is to be used once-daily with meal-time insulin and requires individual dose adjustments.
Patients with type 2 diabetes mellitus: The recommended daily starting dose is 0.2 units/kg followed by individual dose adjustments.
Switch between insulin glargine 100 units/ml and Toujeo: Insulin glargine 100 units/ml and Toujeo are not bioequivalent and are not directly interchangeable.
When switching from insulin glargine 100 units/ml to Toujeo, this can be done on a unit-to-unit basis, but a higher Toujeo dose (approximately 10-18%) may be needed to achieve target ranges for plasma glucose levels.
When switching from Toujeo to insulin glargine 100 units/ml, the dose should be reduced (approximately by 20%) to reduce the risk of hypoglycaemia.
Close metabolic monitoring is recommended during the switch and in the initial weeks thereafter.
Switch from other basal insulins to Toujeo: When switching from a treatment regimen with an intermediate or long-acting insulin to a regimen with Toujeo, a change of the dose of the basal insulin may be required and the concomitant anti-hyperglycaemic treatment may need to be adjusted (dose and timing of additional regular insulins or fast-acting insulin analogues or the dose of non-insulin anti-hyperglycaemic medicinal products).
Switching from once-daily basal insulins to once-daily Toujeo can be done unit-to-unit based on the previous basal insulin dose.
Switching from twice-daily basal insulins to once-daily Toujeo, the recommended initial Toujeo dose is 80% of the total daily dose of basal insulin that is being discontinued.
Patients with high insulin doses because of antibodies to human insulin may experience an improved insulin response with Toujeo.
Close metabolic monitoring is recommended during the switch and in the initial weeks thereafter.
With improved metabolic control and resulting increase in insulin sensitivity a further adjustment in dose regimen may become necessary. Dose adjustment may also be required, for example, if the patient's weight or life-style changes, if there is a change in the timing of insulin dose or if other circumstances arise that increase susceptibility to hypo-or hyperglycaemia (see Precautions).
Switch from Toujeo to other basal insulins: Medical supervision with close metabolic monitoring is recommended during the switch and in the initial weeks thereafter. Please refer to the prescribing information of the medicinal product to which the patient is switching.
Special populations: Toujeo can be used in elderly people, renal and hepatic impaired patients, and children and adolescents from the age of 6 years.
Elderly population (≥65 years old): In the elderly, progressive deterioration of renal function may lead to a steady decrease in insulin requirements (see Adverse Reactions and Pharmacology: Pharmacodynamics under Actions).
Renal impairment: In patients with renal impairment, insulin requirements may be diminished due to reduced insulin metabolism (see Adverse Reactions).
Hepatic impairment: In patients with hepatic impairment, insulin requirements may be diminished due to reduced capacity for gluconeogenesis and reduced insulin metabolism.
Paediatric population: Toujeo can be used in adolescents and children from the age of 6 years based on the same principles as for adult patients (see Pharmacology: Pharmacodynamics and Pharmacokinetics under Actions). When switching basal insulin to Toujeo, dose reduction of basal and bolus insulin needs to be considered on an individual basis, in order to mimimize the risk of hypoglycaemia (see Precautions).
The safety and efficacy of Toujeo in children below 6 years of age have not been established. No data are available.
Method of administration: Toujeo is for subcutaneous use only.
Toujeo is administered subcutaneously by injection in the abdominal wall, the deltoid or the thigh. Injection sites must be rotated within a given injection area from one injection to the next in order to reduce the risk of lipodystrophy and cutaneous amyloidosis (see Precautions and Adverse Reactions).
Toujeo must not be administered intravenously. The prolonged duration of action of Toujeo is dependent on its injection into subcutaneous tissue. Intravenous administration of the usual subcutaneous dose could result in severe hypoglycaemia. Toujeo must not be used in insulin infusion pumps.
Toujeo is available in pre-filled pens. The dose window shows the number of units of Toujeo to be injected. The Toujeo SoloStar pre-filled pen has been specifically designed for Toujeo and no dose re-calculation is required.
Before using Toujeo SoloStar pre-filled pen, the Instructions for Use under Patient Counselling Information must be read carefully (see Special precautions for disposal and other handling under Cautions for Usage and also Patient Counselling Information).
With Toujeo SoloStar pre-filled pen, a dose of 1-80 units per single injection, in steps of 1 unit, can be injected.
Toujeo must not be drawn from the cartridge of the SoloStar pre-filled pen into a syringe or severe overdose can result (see Precautions, Overdosage and Special precautions for disposal and other handling under Cautions for Usage).
A new sterile needle must be attached before each injection. Re-use of needles increases the risk of blocked needles which may cause underdosing or overdosing (see Precautions and Special precautions for disposal and other handling under Cautions for Usage).
To prevent possible transmission of disease, insulin pens should never be used for more than one person, even when the needle is changed (see Special precautions for disposal and other handling under Cautions for Usage).