Recommended Titration Schedule for Soliqua (Insulin Glargine and Lixisenatide)
The recommended titration schedule for Soliqua (insulin glargine and lixisenatide) should start with a low dose and gradually increase based on fasting plasma glucose measurements, with dose adjustments every 3-7 days until target glucose levels are achieved.
Initial Dosing and Pen Selection
- Soliqua is available in two different prefilled pens: one allowing titration up to 40 IU/day and another up to 60 IU/day, both with lixisenatide uptitrated to a maximum of 20 μg/day 1
- For insulin-naïve patients, start with 10 units per day or 0.1-0.2 units/kg per day 2
- For patients switching from basal insulin, the starting dose should be based on the previous basal insulin dose 3
Titration Schedule
- Set a fasting plasma glucose (FPG) target (typically <100 mg/dL or <5.6 mmol/L) 2
- Increase dose by 2 units every 3 days to reach FPG target without hypoglycemia 2
- If hypoglycemia occurs, determine the cause; if no clear reason is identified, lower the dose by 10-20% 2
- Continue titration until glycemic targets are achieved or maximum dose of 60 units/day is reached 3
Monitoring During Titration
- Monitor fasting blood glucose levels regularly during the titration phase 2
- Assess adequacy of insulin dose at every visit 2
- Watch for clinical signals of overbasalization (e.g., elevated bedtime-to-morning glucose differential, hypoglycemia, high glucose variability) 2
Special Considerations
- Gastrointestinal side effects (nausea, vomiting) may occur due to the lixisenatide component but are typically less severe than with lixisenatide alone due to the gradual titration 1
- No dosage adjustment is required for patients with renal impairment, unlike some other GLP-1 receptor agonists 2
- For patients switching from separate basal insulin and GLP-1 RA therapy, consider using a fixed-ratio combination product (iGlarLixi) for simplified dosing 2
Maximum Dosing Considerations
- The maximum daily dose of Soliqua is 60 units insulin glargine/20 μg lixisenatide 4
- Approximately 27-31% of patients may require the maximum dose of 60 units/day 4
- Patients requiring maximum doses typically have a more insulin-resistant phenotype (younger age, higher BMI, higher FPG, and higher baseline insulin requirements) 4
Common Pitfalls to Avoid
- Avoid delaying dose adjustments when glucose targets are not met, as this can lead to therapeutic inertia 2
- Do not increase doses too rapidly, as this may increase the risk of hypoglycemia and gastrointestinal side effects 1
- If hypoglycemia occurs, don't continue with the same dose; reduce by 10-20% and reassess 2
- Don't overlook the need for patient education on proper injection technique and timing (Soliqua should be administered once daily within the hour prior to the first meal of the day) 3