How do the doses of Lantus (insulin glargine) compare to Toujeo (insulin glargine)?

Comparison of Lantus and Toujeo: Dosing Considerations

When switching from Toujeo (insulin glargine 300 U/mL) to Lantus (insulin glargine 100 U/mL), the recommended starting Lantus dosage should be 80% of the Toujeo dosage that is being discontinued due to differences in concentration and pharmacokinetic profiles. 1

Key Differences Between Lantus and Toujeo

Both Lantus and Toujeo contain the same active ingredient (insulin glargine) but differ in concentration:

• Lantus: 100 units/mL (U-100)
• Toujeo: 300 units/mL (U-300)

Pharmacokinetic Differences

Toujeo has several distinct characteristics compared to Lantus:

• Longer duration of action than Lantus 2
• More stable and prolonged pharmacokinetic profile 3
• Flatter and more reproducible glucose-lowering effect 4
• Lower intra-/inter-variability in effect 4
• Modestly lower efficacy per unit administered 2

Dosing Conversion Guidelines

The FDA-approved drug label for insulin glargine provides specific guidance when switching between these formulations 1:

• Toujeo to Lantus conversion: When switching from once-daily Toujeo to once-daily Lantus, start with 80% of the Toujeo dose
• Example: If a patient is on 30 units of Toujeo daily, the initial Lantus dose would be 24 units

Clinical Considerations

Efficacy

• Both insulins provide comparable glycemic control 3
• Toujeo may be associated with a lower risk of nocturnal hypoglycemia in insulin-experienced patients with type 2 diabetes 3

Dosing Requirements

• Daily insulin requirement is typically higher with Toujeo than with Lantus 4
• When switching between formulations, dose adjustments and reinforced blood glucose monitoring are necessary 4

Administration

• Both are administered subcutaneously once daily at the same time each day 1
• Neither should be diluted or mixed with other insulins 1
• Both are available in prefilled pens for ease of administration 2

Common Pitfalls to Avoid

1. Dosing errors: Never assume a 1:1 conversion between Toujeo and Lantus
2. Inadequate monitoring: Increase frequency of blood glucose monitoring when switching between formulations 1
3. Mixing insulins: Do not mix either Lantus or Toujeo with other insulins in the same syringe 1
4. Inconsistent timing: Administer at the same time each day for optimal effect 1
5. Bioequivalence assumption: The two insulin formulations are not bioequivalent despite containing the same active ingredient 4

Practical Approach to Switching

1. Calculate 80% of current Toujeo dose to determine initial Lantus dose
2. Monitor blood glucose more frequently during the transition period
3. Adjust dosage based on individual metabolic needs and blood glucose monitoring results
4. Continue administering at the same time of day as the previous regimen
5. Be aware that further dose adjustments may be needed after the initial conversion

Remember that while both contain insulin glargine, the differences in concentration and pharmacokinetic profiles make them distinct products requiring careful consideration when switching between them.