SEMGLEE™ Insulin vial

SEMGLEE is also available as a 10 mL Vial (100 units/mL, U-100)

The following instructions are provided to patients for use. Click here for Instructions for Use.

Supplies needed for injection:

  • A SEMGLEE 10 mL vial
  • A U-100 insulin syringe and needle.
  • Alcohol wipes.
  • 1 sharps container for throwing away used needles and syringes.
Do not share SEMGLEE syringes with other people even if the needle has been changed. Doing so could give other people a serious infection, or get a serious infection from them.

Preparing SEMGLEE dose:

  • Wash hands with soap and water or with alcohol.
  • Check the SEMGLEE label to make sure taking the right type of insulin. This is especially important if using more than 1 type of insulin.
  • Check the insulin to make sure it is clear and colorless. Do not use SEMGLEE if it is colored or cloudy, or if particles are visible in the solution.
  • Do not use SEMGLEE after the expiration date stamped on the label or 28 days after first use.
  • Always use a syringe that is marked for U-100 insulin. Using a syringe other than a U-100 insulin syringe, patient may get the wrong dose of insulin.
  • Always use a new syringe or needle for each injection. Do not reuse or share syringes or needles with other people. Doing so may give other people a serious infection or get a serious infection from them.

Step 1:
If using a new vial, remove the protective cap. Do not remove the rubber stopper.

Step 1

Step 2:
Wipe the top of the vial with an alcohol wipe. Do not shake the vial of SEMGLEE before use.

Step 2

Step 3:
Draw air into the syringe equal to your insulin dose. Put the needle through the rubber top of the vial and push the plunger to inject the air into the vial.

Step 3

Step 4:
Leave the syringe in the vial and turn both upside down. Hold the syringe and vial firmly in 1 hand. Make sure the tip of the needle is in the insulin. With free hand, pull the plunger to withdraw the correct dose into the syringe.

Step 4

Step 5:
Before taking the needle out of the vial, check the syringe for air bubbles. If bubbles are in the syringe, hold the syringe straight up and tap the side of the syringe until the bubbles float to the top. Push the bubbles out with the plunger and draw insulin back in until patient has the correct dose.

Step 5

Step 6:
Remove the needle from the vial. Do not let the needle touch anything. Ready to inject.

Giving SEMGLEE injection:

  • -  Inject insulin exactly as healthcare provider has discussed.
  • -  Inject insulin under the skin (subcutaneously) of thigh, buttocks, upper arms, or stomach area
       (abdomen).
  • -  Change (rotate) injection site within the area chosen for each dose to reduce risk of getting pits in
       the skin or thickened skin (lipodystrophy) and skin with lumps (localized cutaneous amyloidosis) at the
       injection sites.
  • Do not inject where the skin has pits, is thickened, or has lumps.
  • Do not inject where the skin is tender, bruised, scaly or hard, or into scars or damaged skin.

Step 7:
Choose injection site. Wipe the skin with an alcohol wipe to clean the injection site. Let the injection site dry before injecting dose.

Step 7

Step 8:

  • - Pinch the skin.
  • - Insert the needle in the way the healthcare provider showed.
  • - Release the skin.
  • - Slowly push in the plunger of the syringe all the way, making sure all the insulin has been injected.  
  • - Leave the needle in the skin for about 10 seconds.
Step 8

Step 9:

  • - Pull the needle straight out of skin.
  • - Gently press the injection site for several seconds. Do not rub the area.
  • Do not recap the used needle. Recapping the needle can lead to a needle stick injury.
     Disposing of used needles and syringes:
  • - Put used needles and syringes in a FDA-cleared sharps disposal container right away after use. Do not
      throw away (dispose of) loose needles and syringes in household trash.

  • - If you do not have a FDA-cleared sharps container, use a household container that is:
    1. - made of a heavy-duty plastic,
    2. - can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out,
    3. - upright and stable during use,
    4. - leak resistant, and
    5. - properly labeled to warn of hazardous waste inside the container.

  • - When sharps disposal container is almost full, follow community guidelines for the right way to dispose of
      sharps disposal container. There may be state or local laws about how to throw away used needles
      and syringes. For more information about safe sharps disposal, and for specific information about sharps
      disposal in the state that you live in, go to the FDA’s website at: http://www.fda.gov/safesharpsdisposal.

  • Do not dispose of used sharps disposal container in household trash unless community guidelines permit
      this. Do not recycle used sharps disposal container.
     How to store SEMGLEE?
  • - Store unused SEMGLEE vials in the refrigerator between 36° to 46°F (2° to 8°C) until the expiration date.
      If the unopened SEMGLEE vial is stored at room temperature up to 86°F (30°C), it should be thrown
      away after 28 days.
  • - Store in-use (opened) SEMGLEE vials in a refrigerator or at room temperature up to 86°F (30°C).
  • - The SEMGLEE vials should be thrown away after 28 days, even if it still has insulin left in it.
  • Do not freeze SEMGLEE.
  • - Keep SEMGLEE out of direct heat and light.
  • - If a vial has been frozen or overheated, throw it away.

References:

  • SEMGLEE (insulin glargine injection). Prescribing Information. 2020. Mylan Pharmaceuticals Inc. Morgantown, WV. 
  • SEMGLEE (insulin glargine injection). Instructions for use. Mylan Pharmaceuticals Inc.

Adverse Events Reporting

This medicine is subject to additional monitoring. This will allow quick identification of new safety information. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare providers are asked to report any suspected adverse reactions. Reporting forms and information can be found at http://www.mhra.gov.uk/yellowcard. In order to support effective tracking and traceability of biologics including biosimilars, it is recommended that the brand name and batch number are recorded and used when reporting adverse events. You can also report adverse events direct to the marketing authorisation holder at ukpharmacovigilance@mylan.com.

Semglee® (Insulin glargine) 100 units/ml solution for injection in pre-filled pen

Prescribing information

Please refer to Summary of Product Characteristics (SmPC) before prescribing.

Indication: Semglee® is indicated in the treatment of diabetes mellitus in adults, adolescents and children aged 2 years and above. Presentation: Each ml contains 100 units insulin glargine* (equivalent to 3.64 mg). Each pen contains 3 ml of solution for injection, equivalent to 300 units. Dosage and administration: Semglee® (insulin glargine) has a prolonged duration of action. It should be administered once daily at any time but at the same time each day. The pre filled pen delivers insulin in increments of 1 unit up to a maximum single dose of 80 units. The dose regimen (dose and timing) should be individually adjusted. In patients with type 2 diabetes mellitus, Semglee® can also be given together with orally active antidiabetic medicinal products. The potency of Semglee® is stated in units and these units are exclusive to Semglee®. Special population: Elderly population (≤ 65 years old): progressive deterioration of renal function may lead to a steady decrease in insulin requirements. Renal impairment: insulin requirements may be diminished due to reduced insulin metabolism. Hepatic impairment: insulin requirements may be diminished due to reduced capacity for gluconeogenesis and reduced insulin metabolism. Paediatric population: For adolescents and children aged 2 years and older patients, the dose regimen (dose and timing) should be individually adjusted. For children below 2 years of age the safety and efficacy of Semglee® have not been established. No data are available. Switch from other insulins to Semglee® When switching from a treatment regimen with an intermediate or long acting insulin to a regimen with Semglee®, a change of the dose of the basal insulin may be required and the concomitant antidiabetic treatment may need to be adjusted (dose and timing of additional regular insulins or fast acting insulin analogues or the dose of oral antidiabetic medicinal products). Switch from twice daily NPH insulin to Semglee®: To reduce the risk of nocturnal and early morning hypoglycaemia, daily dose of once daily basal insulin should be reduced by 20-30% during the first weeks of treatment. Switch from insulin glargine 300 units/ml to Semglee®: Semglee® and insulin glargine 300 units/ml are not bioequivalent and are not directly interchangeable. To reduce the risk of hypoglycemia in this group, Semglee® dose should be reduced by approximately 20%. During the first weeks increase mealtime insulin, after this period the regimen should be adjusted individually. Close metabolic monitoring is recommended during the switch and in the initial weeks thereafter. A further adjustment in dose regimen may become necessary with improved metabolic control, change of timing of insulin, patient weight or life style changes. Patients with high insulin doses because of antibodies to human insulin may experience an improved insulin response with Semglee®. Method of administration Semglee® is administered subcutaneously only. Injection sites must be rotated within a given injection area from one injection to the next. Semglee® must not be mixed with any other insulin or diluted. Before using the pre filled pen, the instructions for use included in the package leaflet must be read carefully (see section 6.6). Contraindications: Known hypersensitivity to the active substances or to any of the excipients. Warnings and precautions: Warnings: Semglee® is not the insulin of choice for the treatment of diabetic ketoacidosis. In case of insufficient glucose control or a tendency to hyper- or hypoglycaemic episodes, the patient's adherence to the prescribed treatment regimen, injection sites and proper injection technique and all other relevant factors must be reviewed before dose adjustment is considered. Changes in insulin strength, manufacturer, type, origin, method of manufacture and/or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Hypoglycaemia Due to more sustained basal insulin supply with Semglee®, less nocturnal but more early morning hypoglycaemia can be expected. Intercurrent illness In many cases urine tests for ketones are indicated, and often it is necessary to adjust the insulin dose. The insulin requirement is often increased. Patients with type 1 diabetes must continue to consume at least a small amount of carbohydrates on a regular basis, even if they are able to eat only little or no food or are vomiting etc. and they must never omit insulin entirely. Insulin antibodies Rare chance of antibodies formation, may require insulin dose adjustment to avoid hyper- or hypoglycaemia. Handling of the pen Before using Semglee® pen, the instructions for use included in the package leaflet must be read carefully. Semglee® pen has to be used as recommended in the instructions for use. Medication errors Insulin label must always be checked before each injection to avoid medication errors between insulin glargine and other insulins. Interaction with other medicinal products: Pioglitazone should be discontinued if any deterioration in cardiac symptoms occurs when used with Semglee®. Substances that may enhance the blood glucose lowering effect include oral antidiabetic medicinal products, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase (MAO) inhibitors, pentoxifylline, propoxyphene, salicylates and sulfonamide antibiotics. Substances that may reduce the blood glucose lowering effect include corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, oestrogens and progestogens, phenothiazine derivatives, somatropin, sympathomimetic medicinal products (e.g. epinephrine [adrenaline], salbutamol, terbutaline), thyroid hormones, atypical antipsychotic medicinal products (e.g. clozapine and olanzapine) and protease inhibitors. Beta blockers, clonidine, lithium salts or alcohol may either potentiate or weaken the blood glucose lowering effect of insulin. Pentamidine may cause hypoglycaemia, which may sometimes be followed by hyperglycaemia. Pregnancy and lactation: Pregnancy For insulin glargine no clinical data on exposed pregnancies from controlled clinical studies are available. A large amount of data on pregnant women (more than 1000 pregnancy outcomes) indicate no specific adverse effects of insulin glargine on pregnancy and no specific malformative nor feto/neonatal toxicity of insulin glargine. Animal data do not indicate reproductive toxicity. The use of Semglee® may be considered during pregnancy, if clinically needed. The use of Semglee® may be considered during pregnancy, if clinically needed. Careful monitoring of glucose control is essential. Breast feeding It is unknown whether insulin glargine is excreted in human milk. Women may require adjustments in insulin dose and diet. Effects on ability to drive and use machines: The patient's ability to concentrate and react may be impaired as a result of hypoglycaemia or hyperglycaemia or, for example, as a result of visual impairment. Undesirable effects: Very common: Hypoglycaemia. Common: Lipohypertrophy, Injection site reactions Uncommon: Lipoatrophy. For rare and very rare undesirable effects, please refer to SmPC. Name and Address of Marketing Authorisation Holder: Mylan S.A.S., 117 allée des Parcs, 69800 Saint Priest, France. Marketing Authorisation Number: EU/1/18/1270/003 Basic NHS price: 3ml x 5 pens=£29.99 Legal Category: POM Date of Last Revision: October 2018

Detailed information on this medicinal product is available on the website of the European Medicines Agency http://www.ema.europa.eu. and from Mylan Medical Information, Building 4, Trident Place, Hatfield Business Park, Mosquito Way, Hatfield, Hertfordshire, AL10 9BW, phone no. 01707 853000, Email: info@mylan.co.uk

This medicine is subject to additional monitoring. This will allow quick identification of new safety information. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare providers are asked to report any suspected adverse reactions. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. In order to support effective tracking and traceability of biologics including biosimilars, it is recommended that the brand name and batch number are recorded and used when reporting adverse events. Adverse events should be reported to Pharmacovigilance, Mylan, Building 4, Trident Place, Hatfield Business Park, Mosquito Way, Hatfield, Hertfordshire, AL10 9UL, on phone no. 0800 121 8267, Email: ukpharmacovigilance@mylan.com

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INDICATIONS AND USAGE

Semglee is indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus (T1D) and in adults with type 2 diabetes mellitus (T2D).

Limitations of Use

Semglee is not recommended for the treatment of diabetic ketoacidosis.

CONTRAINDICATIONS
Semglee is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to insulin glargine or one of its excipients.

WARNINGS AND PRECAUTIONS
Never Share a Semglee Prefilled Pen, Syringe or Needle Between Patients

Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia or hyperglycemia. Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring.

Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia. Advise patients to rotate the injection site to unaffected areas and closely monitor for hypoglycemia.

Hypoglycemia is the most common adverse reaction associated with insulin, including SEMGLEE and may be life-threatening.

Medication errors, such as accidental mix-ups between long-acting insulin products and other insulins, particularly rapid-acting insulins, have been reported. To avoid medication errors between SEMGLEE and other insulins, instruct patients to always check the insulin label before each injection.

Severe, life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue SEMGLEE, treat and monitor until symptoms and signs resolve.

All insulin products, including SEMGLEE, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Monitor potassium levels in patients at risk for hypokalemia, if indicated.

Fluid retention, which may lead to or exacerbate heart failure can occur with concomitant use of thiazolidinediones (TZDs) with insulin. These patents should be observed for signs and symptoms of heart failure. If heart failure develops, dosage reduction or discontinuation of the TZD must be considered. 

Do not dilute or mix SEMGLEE with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer SEMGLEE via an insulin pump or intravenously because hypoglycemia can occur.

A reduction in the SEMGLEE dose may be required in patients with renal or hepatic impairment.

DRUG INTERACTIONS
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose. The signs hypoglycemia may be reduced in patients taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine). 

ADVERSE REACTIONS
Adverse reactions commonly associated with SEMGLEE include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritis, rash, edema and weight gain.