Help Patients on Levemir Switch to Another Insulin

You’ll need to be ready to help patients on insulin detemir find an alternative...since Levemir is being discontinued in the US in 2024.

Levemir FlexTouch was transitioned back to Levemir FlexPen last year...due to business decisions, not safety concerns.

Now ALL Levemir products are going away for similar reasons.

Anticipate supply disruptions of Levemir FlexPen soon...with market removal in April. Vials will be discontinued at year end.

You can continue to dispense insulin detemir until stock is depleted. But when your pharmacy and supplier run out, that’s it. Patients will need to make a switch...usually to another insulin.

Help make this transition smooth at your pharmacy.

Inform affected patients that Levemir will no longer be made...and explain how you can help them prepare for the change.

For example, you may be able to work with your pharmacist to get a new Rx from the prescriber for another long-acting insulin.

In many cases, insulin detemir will be switched to insulin glargine U-100 (Lantus, Semglee, etc) or insulin degludec (Tresiba)...and patients will start with the same daily dose.

For instance, a patient injecting 20 units of insulin detemir once daily may switch to 20 units of insulin glargine U-100 once daily.

But watch for differences in some situations.

For instance, patients switching from TWICE-daily Levemir to concentrated insulin glargine U-300 (Toujeo) will need to reduce the daily dose by 20%...and give glargine U-300 ONCE daily.

And look for changes when going to a new insulin type.

For example, a patient switching from insulin detemir to NPH will usually go from once-daily to twice-daily dosing.

Talk to your pharmacist about discontinuing older insulin Rxs when patients switch products. Accidentally doubling up can cause dangerous blood sugar drops...and lead to coma or death.

Use strategies to prevent errors. For example, apply a “change in Rx” label to a newly switched insulin Rx...and ensure patients receive pharmacist counseling on proper use, what to expect, etc.

For instance, patients may have blood glucose fluctuations after a switch...and should monitor their blood sugar more closely.

Point out any differences in storage or beyond-use dates when patients switch to another insulin.

For instance, Levemir vials and pens last 42 days once in use...but glargine U-100 lasts 28 days.

See our resource, Comparison of Insulins, for cost, stability, etc...and our resource, Dispensing Insulin and Other Injectable Diabetes Meds, for strategies to prevent errors.

Share our resource, How to Switch Insulin Products, with your pharmacist to help them navigate the changes.

Key References

  • Mehta R, Goldenberg R, Katselnik D, Kuritzky L. Practical guidance on the initiation, titration, and switching of basal insulins: a narrative review for primary care. Ann Med. 2021 Dec;53(1):998-1009.
  • Diabetes Disaster Response Coalition. Information for health care professionals. Switching between insulin products in disaster response situations. Approved by the American Diabetes Association, the Endocrine Society, and JDRF. August 2020. https://diabetes.org/sites/default/files/2020-09/Switching%20Between%20Insulin%20Products%20in%20Disaster%
    20Response%20Situations%202020%20-%20English.pdf (Accessed November 30, 2023).
  • FDA. Information regarding insulin storage and switching between products in an emergency. Content current as of September 19, 2017. https://www.fda.gov/drugs/emergency-preparedness-drugs/information-regarding-insulin-storage-and-switching-between-products-emergency (Accessed December 11, 2023).
Pharmacy Technician's Letter. January 2024, No. 400104



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