Mealtime insulins, or fast-acting insulins, are injected before or after each meal to regulate the blood sugar. Type 1 diabetics require mealtime insulin injections as their pancreas does not produce insulin, whereas type 2 diabetics may only require mealtime insulin if they struggle with blood sugar control after meals or are not achieving their target A1C.
What is Fiasp indicated for?
Fiasp is a rapid-acting insulin indicated to improve blood sugar control in adults with type 1 or type 2 diabetes.
It will be available as a 10 ml multi-d0se vial, and a 3 ml single-use disposable FlexTouch Pen.
What dose of Fiasp will I need?
Your doctor will determine your exact dose based on your metabolic needs, blood sugar monitoring results, and your blood sugar control goal.
Dose adjustments may be needed if you experience changes in kidney or liver function, physical activity or meal patterns.
Is there anything unique about Fiasp?
Yes. Fiasp is a new formulation of NovoLog, in which the addition of niacinamide (vitamin B3) helps to increase the speed of the initial insulin absorption, resulting in an onset of appearance in the blood in approximately 2.5 minutes.
Is Fiasp approved for kids?
No. At this time Fiasp is not approved in pediatric patients.
For more information, see the press release from the manufacturer Novo Nordisk.
Why do some medications come in tablets and others in capsules? Why are there ointments and creams? And why are some drugs delivered by injection or through an intravenous (IV) drip?
Like a lot of things in medicine, the answer can get complicated, but it boils down to this: where a drug needs to be, how quickly it needs to get there, and how long it needs to hang around. After a major surgery, your doctor could prescribe a powerful painkiller by IV drip, which gets the drug circulating right away, and to pain receptors throughout your body. But if you have a chronic condition, IV isn’t convenient – you probably don’t have time to sit for an hour after breakfast and before bedtime while medication drips slowly into your veins. So an oral formulation, like a tablet or a capsule, is better.
To get a sense of which formulations work for which purposes, it helps to think of the form — a pill, an ointment, or an injectable — as a vehicle, and the drug itself as a passenger along for the ride. Here’s a primer.
The passenger: The drug
The most important part of a medication is its active ingredient, such as ibuprofen for pain relief or rosuvastatin for cholesterol control. It is the drug (or chemical) that creates a therapeutic response in your body. How the drug gets where it’s going safely, and at the right speed, is the job of the vehicle, made of non-therapeutic inactive ingredients (also called excipients) that facilitate transport and uptake.
The vehicle: The dosage form
In a tablet, the drug is combined with substances to give the tablet its shape, texture, and color. These inactive ingredients keep the drug chemically stable so it can be shipped and stored, and they help dictate the way the pill is digested in your stomach and intestines, freeing the active ingredient. Tablets are durable, which is why so many medications come in tablet form. They can withstand the physical pressures of a pill bottle or your pocket, protecting the drug. They’re kind of like the transport truck of dosage forms.
An injectable medication, on the other hand, conveys the drug in a liquid form along with inactive ingredients. After injection, the fluid flows readily into the bloodstream (or body tissues) and the drug is easily freed. It’s more like a motorcycle: there’s not much protection for the passenger, but the ride tends to be faster and purer.
The road: Our bodies
Each drug needs to get from where you take it (the site of administration) to its ultimate intended destination (the site of action). The site of action might be as localized as a patch of skin or a particular organ, or as dispersed as chemical receptors found throughout your body. For example, morphine, a strong painkiller, acts on receptors found in the brain, spinal cord, limbic system, and even in your digestive tract.
Many medications need to get into the general circulation of fluids in your body — the bloodstream, in particular — in order to flow to their sites of action. Ideally, 100% of a drug gets to its destination. In practice, most medications need to pass through multiple barriers in your body (biologic membranes) and undergo a complex series of biochemical reactions along the way, some of which “use up” a portion of the active ingredient.
When a medication is given intravenously, it enters the circulation directly and is considered 100% available to your body. When taken by mouth, it has to go through part of your digestive system first. Only some of the drug makes it to the site of action; the rest is effectively processed as waste. This concept is called bioavailability: the portion of the drug that actually makes it into your circulation.
Choosing the right ride: Different forms for drugs
When scientists create medications, they choose a dosage form that marries biochemistry with convenience. The drug needs to do its job effectively and safely, but the medication has got to be practical, too. There are dozens of common routes of administration and dozens of dosage forms: patches that deliver drugs through the skin, solutions that are injected not just into veins but into muscles, beneath the skin or directly into organs, and liquids that are meant to be dropped into eyes and ears.
The most common oral dosage forms are tablets, capsules, and liquids.
- Tablets and capsules: In tablets and capsules, drugs are distributed as a chemical salt which keeps the active ingredient stable and solid. Both can be engineered to time-release medications more quickly or more slowly. Soft gels are a kind of capsule that transport the drug in a liquid form, digested more quickly, so the active ingredient can reach circulation faster.
- Liquids: Medicines like cough syrups feature their active ingredients in a liquid suspension or solution that’s easily bottled, meant to be swallowed — and, unfortunately, tasted. While it’s possible to deliver cough and cold medicines in tablets, it’s easier to imagine relief of a sore throat coming from a syrup than a pill. Conversely, many medicatio
- Oral disintegrating tablets (ODTs): Sublingual dissolving tablets are placed under the tongue and broken down by enzymes in your saliva, allowing the drug to absorb through the tissues in your mouth. Some medications come in this form as an alternative for people who have trouble swallowing pills. ODTs generally act faster than swallowed tablets.
- Release schedules: You may have seen words like regular release and extended release associated with medications. Extended or sustained release meds are chemically engineered to release the active ingredient at a particular rate, usually to keep the level of drug in your system steady and to increase convenience: instead of taking a pill every six hours, you might be able to take it every 12 hours instead. Sometimes the combination of active and inactive ingredients changes substantially to achieve the desired performance.
- The mystery of giant pills: Why are some tablets just huge, while others are positively tiny? Mostly because certain chemical properties of a drug require enough other ingredients to regulate how the tablet is digested. In other words, a big tablet might be the result of all the “stuff” that keeps the pill, and all the drug in it, from dissolving in your digestive system too soon, releasing the drug at the wrong place and the wrong time.
Nasal and oral inhalation
Breathing a drug in through your nose or mouth is a quick way to get a drug into your system: your airway and lungs have a lot of surface area to absorb the drug. Some drugs go to work right in the airway, so inhaling them gets them where they need to go, such as drugs that treat bronchial problems or asthma.
Drugs packaged for inhalation may come in liquid, solid, or gaseous form, assisted by all manner of useful excipients. Nasal anti-inflammatory drugs like fluticasone are distributed in spritzers that mist droplets of the drug into your nose for inhalation. Inhalers for treating asthma commonly employ two forms: the drug aerosolized in a chamber along with a propellant that forces it to spray out of the inhaler, or as a fine dust (dry powder). Anesthetic drugs used to “put you to sleep” before surgery are frequently given in gaseous form — a few breaths and you’re out cold. Laughing gas, or nitrous oxide, is another drug famously given as a gas.
Topical medications — commonly liquids, creams, or ointments — are applied directly to a surface, like your skin, right at the spot they’re needed. And because they don’t go through the digestive system, they tend to have fewer systemic effects or side effects.
Many ophthalmic drugs are also topical — for obvious reasons, liquid is a suitable form for eye drops. But why can you get the same medication, like clobetasol for treatment of psoriasis, in all three forms? Well, you wouldn’t want to rub a cream or ointment into your scalp if you’ve got a full head of hair. And while water-based creams readily absorb, getting the drug into the skin quickly, your particular condition might need a slow-and-steady release of medication; an oil-based ointment doesn’t absorb so easily and will “hang around” longer, letting the drug diffuse more slowly into the skin.
Transdermal patches are another form of topical medication, commonly used for nitroglycerin to treat angina, nicotine patches to help people quit smoking, and for some pain and birth control drugs. They may deliver a drug close to where it’s needed, but more commonly are used to deliver a steady dose of medication over a lengthy period of time — one that doesn’t go through your digestive system. Because these drugs bypass metabolism in the liver, this form is suitable for drugs like nitroglycerin, ensuring high bioavailability.
Many drugs are administered by injection. They’re distributed in a liquid solution or suspension and injected into a vein, organ, or tissue — wherever the drug is needed, or the best place to get it circulating.
Other drugs are injected between layers of skin (intradermal), into muscle tissue (intramuscular), or, in hospitals, even directly into organs like the heart (intracardiac) or brain (intracerebral). An ophthalmologist might even inject a medication directly into the cornea of the eye, in an intracorneal injection. These injections get a dose of drug straight to the site of action.
What does this all mean?
As you can see, medications come in many forms and there are just as many reasons for such. There is a whole discipline — pharmacokinetics — concerned with the biochemical journeys taken by drugs.
But for the average patient, the only time we need to think about different medication forms is if the treatment we were prescribed is not working well enough or if it’s too expensive. Not every medication comes in multiple forms, but you can ask your doctor (or check GoodRx) if they have another recommendation for you.
For people who need to take insulin, there are a couple of different types—long-acting, short-acting, rapid-acting, intermediate-acting, etc. That’s a lot of options!
One question I see most often is the difference between rapid-acting and long-acting insulins. So, let’s get into it.
What is rapid-acting insulin?
Rapid-acting, or meal-time insulin, is a type of insulin that’s usually taken before, during, or after a meal to lower your blood sugar levels associated with meals.
How long does it take rapid-acting insulin to begin working?
The onset of action varies between rapid-acting insulin products, but can begin working in as little as 5 minutes, or could take as long as 30 minutes, depending on the insulin.
The following are the typical onset of action times for each individual rapid-acting insulin products.
What is long-acting insulin?
Long-acting, or basal insulin, is a type of insulin that gives you a slow steady release of insulin that helps control your blood sugar between meals, and overnight.
How long does long-acting insulin last?
The duration of action varies between long-acting products but should last anywhere between 22-24 hours. The following are the typical duration of action times for each individual long-acting insulin product:
Do I need more than one insulin?
Maybe. It’s up to your doctor to determine the best medication regimen for you.
Some type 2 diabetes patients may only need to use a long-acting insulin to get their blood sugar control on track; whereas others may need a combination of meal-time and long-acting insulin to best control their blood sugar.
If you are using an insulin pump, you will only need to use a rapid or short-acting insulin. The pump is able to give you a slow and steady amount of insulin to cover you all day like a long-acting insulin would do. However, it’s a good idea to have a back-up of long-acting insulin on hand in case your pump should fail.
Is there anything in between rapid-acting and long-acting?
Yes. There are short-acting and intermediate-acting insulins available.
- Short-acting insulins are used like rapid-acting insulin to cover blood sugar elevation from eating.
- Intermediate-acting insulins are similar to long-acting insulins as they are used to cover blood sugar elevations when the rapid-acting or short-acting insulins finish working.
Are there any combination options available for those who don’t want to inject themselves so often?
Yes. Some insulin products combine fast and longer-acting insulins that work together to help manage blood sugar between meals and at night, as well as blood sugar “spikes” that happen when you eat. Here are a few examples of these:
- Humalog 50/50
- Humalog 75/25
- Novolog 70/30
- Humulin 70/30
- Novolin 70/30
- Ryzodeg (FDA approved but not yet available)
Combination insulin products typically only need to be injected twice daily since they are single insulin products that work in 2 ways.
Are there any insulin products that last longer than long-acting insulins?
Does all insulin need to be injected?
No. Currently, there’s 1 rapid-acting insulin product, Afrezza, that’s inhaled through the mouth.
Eliquis is a common anticoagulant medication that helps prevent blood clots, stroke, and pulmonary embolism. Common, but not cheap: cash prices average around $488 for a 30-day supply. Currently, there is no Eliquis generic alternative available, but one could be available as early as 2018. Since Eliquis tends to be a maintenance drug, taken for a longer period of time, it can break the bank.
If your doctor thinks Eliquis is right for you, how can you make it more affordable? Here’s some information on Eliquis and how you can save.
How popular is Eliquis?
Eliquis (apixaban) is the second most popular anticoagulant, a class of medications that also includes Coumadin (jantoven, warfarin), Xarelto, and Pradaxa. Commonly referred to as blood thinners, drugs in this class help to prevent blood clots that can cause deep vein thrombosis, pulmonary embolism, angina, stroke and heart attack.
When will generic Eliquis be available?
There are two things keeping generic Eliquis off the market for now. First, the FDA has granted Eliquis market exclusivity, which expires on December 24, 2017 (Market exclusivity prevents competitors from submitting new drug applications). There is also a patent on Eliquis which expires in February 2023. The patent prevents competitors from manufacturing and distributing alternatives.
This double-barreled protection means that we can’t be sure when generic Eliquis will be available. A generic alternative could be approved by the FDA as early as 2018, but the new generic might not hit pharmacies until 2022.
Another caveat: While generic manufacturers like Mylan are currently developing generic versions of Eliquis, multiple lawsuits from brand manufacturer Bristol-Myers Squibb are preventing these cheaper alternatives from making it to the market. With no end in sight for these lawsuits, it’s hard to say when we could see a generic alternative.
We will be sure to update with any information regarding a cheaper alternative for Eliquis.
Are there any cheaper alternative medications?
- Coumadin (warfarin, jantoven). Coumadin is a popular coagulant that has two affordable generic alternatives, warfarin and jantoven, that can cost less than $10, and often as little as $4. $4 a month vs $488 a month? What’s the downside? Well, Coumadin can raise your risk of bleeding and bruising and requires regular blood work to ensure its effectiveness.
- Other anticoagulants. Pradaxa or Xarelto are both still only available in brand form – so no cheaper generic versions. Still, these alternatives may be cheaper, especially considering your prescription insurance coverage.
- For more information on how Eliquis compares to other anticoagulants, check out Iodine’s page on Eliquis alternatives. As always, you’ll want to speak with your doctor if you think another medication might work better for you.
Eliquis works best for me—can I still save?
Once you find a medication that works for you, it can be difficult to switch. But don’t worry, there are still other ways to save.
- Fill a 90-day supply. This can help shave a little more off of your out-of-pocket costs. Be aware that you will need a new prescription from your doctor, and approval from your insurance to fill for a higher quantity. Check in with your doctor, insurance, and/or pharmacist.
- Use an Eliquis coupon from GoodRx. GoodRx offers discounts for Eliquis online which can usually save at least 15% off the full retail price.
- Save with a manufacturer coupon or the Eliquis patient assistance program. Eliquis’s two manufacturers, Pfizer and Bristol-Myers Squibb offer multiple ways to save. Manufacturer coupons can reduce your co-pay to as little as $10 per fill, while patient assistance programs can help you receive your medication at no cost. For more information on these programs, eligibility, and how to apply, be sure to read through our Eliquis Savings Tips or visit the Pfizer website.
- Split a higher dosage pill. This can help reduce costs, especially if two strengths are priced similarly. You’ll want to check in with your doctor to see if this is a safe option for you.
Try to appeal your coverage. If you have insurance and your plan doesn’t cover Eliquis, ask your doctor about submitting an appeal. Some plans require prior authorizations—meaning you need permission from your insurance plan and a special request from your doctor before you can fill your prescription. If you have insurance, call your provider and ask how to get this process started.
Currently, spironolactone is only available in tablet form, which is not an option for those who have difficulty swallowing pills. In order to make this drug more accessible to all, the FDA approved CaroSpir, the 1st liquid version of spironolactone.
What is CaroSpir indicated for?
CaroSpir is for the treatment of heart failure, high blood pressure, and water retention (edema) in certain patient populations.
How is CaroSpir sold?
CaroSpir is available as a liquid suspension in a 118 ml bottle with a strength of 25 mg/5 ml. It is banana flavored and can be stored at room temperature.
Before the approval of CaroSpir, what did patients do?
Before the approval of CaroSpir, if a patient needed liquid spironolactone the medication would need to be compounded. The compounding pharmacy would crush up spironolactone tablets and place them into a suspension formula typically using water for irrigation or propylene glycol and cherry flavored syrup.
The main disadvantage to compounded spironolactone liquid is dosing inconsistency which has been a persistent challenge for physicians.
How much will CaroSpir cost?
At the moment, patients can use a GoodRx Coupon and get CaroSpir for around $1000. Not cheap.
However, there is a way to make it more affordable! CaroSpir has a prescription savings program called the EasyPay Program so patients can lower the out-of-pocket costs associated with a CaroSpir prescription. Patients can save up to $75 on each prescription using their EasyPay Card.
For more information, see the CaroSpir website here.