KW is a 69-year-old female patient presenting to the pharmacy with a new prescription to pick up. The prescription is for Lantus Solostar 100 units/mL Solution Pen-Injector. 

Past Medical History: Type 2 Diabetes, occasional knee pain, seasonal allergies

Allergies: Sulfa

Meds: Metformin 1000mg PO BID, daily multivitamin, Tylenol ES 500mg PO BID PRN knee pain

Which of the following storage recommendations would be appropriate to counsel KW? Select all that apply.

A. Store your unopened Lantus Solostar pen in the refrigerator until the expiration date.

B. Store your unopened Lantus Solostar pen at room temperature for a maximum of 28 days.

C. Store your opened pen that you are currently using in the refrigerator and use within 56 days.

D. Store your currently opened pen at room temperature and use within 28 days.

E. Store your unopened Lantus Solostar pens in the freezer to prolong the expiration date.

Brands/Generics:

Lantus Solostar/Insulin Glargine; Glucophage/Metformin; Tylenol/Acetaminophen

Rationale: 

Lantus Solostar is a prescription-only prefilled pen containing Insulin Glargine, a basal insulin. Insulin is a peptide hormone produced by beta cells in the pancreatic islets. It assists in transporting glucose from the blood into cells for use as energy by the cells. Basal insulin is used to control blood sugar in patients with Type 1 Diabetes. Insulin is necessary in these patients due to pancreatic dysfunction, leading to lack of insulin secretion. Basal insulin may also be used for Type 2 Diabetic patients if they require insulin support for additional blood glucose management when oral blood glucose lowering medications or subcutaneous GLP-1 agonists (e.g. semaglutide) or GLP-1 agonists/GIP agonists (e.g. tirzepatide) are not sufficient. In these patients, insulin is often initiated when A1c reaches a level above 10% despite oral therapy. Lantus Solostar is available as a 100 unit/mL prefilled pen injector. To ensure medication integrity and stability, it is important to counsel patients on the proper storage conditions.

The correct answer choices are A, B, and D.

Choice A is correct. Lantus Solostar may be stored as an unopened pen in the refrigerator until its labeled expiration date.

Choice B is also correct. Lantus Solostar may be stored as an unopened pen at room temperature so long as it is for a maximum of 28 days.

Choice C is not correct. The opened pen should only be stored at room temperature and should be used within 28 days of opening. It should not be refrigerated upon opening.

Choice D is correct. The opened pen should only be stored at room temperature and should be used within 28 days of opening.

Choice E is not correct. Lantus Solostar pens should never be frozen as it will break down the insulin, preventing it from working properly to lower blood sugar.

NAPLEX Competencies Covered: 

Area 2: Identify Drug Characteristics 

2.1 Pharmacology, mechanism of action, or therapeutic class

2.2 Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions; or how supplied 

Area 3: Develop or Manage Treatment Plans 

3.3 Medication reconciliation; indication or therapeutic uses; lack of indication; inappropriate indication; duplication of therapy; omissions 

Keep studying friends. It soon will pay off! See you for next week's question.

Dr. B