1. What NovoRapid® is and what it is used for
NovoRapid® is a modern insulin (insulin analogue) with a rapid–acting effect. Modern insulin products are improved versions of human insulin.
NovoRapid® is used to reduce the high blood sugar level in adults, adolescents and children aged 2 years and above with diabetes mellitus (diabetes). Diabetes is a disease where your body does not produce enough insulin to control the level of your blood sugar. Treatment with NovoRapid® helps to prevent complications from your diabetes.
NovoRapid® will start to lower your blood sugar 10–20 minutes after you inject it, a maximum effect occurs between 1 and 3 hours after the injection and the effect lasts for 3–5 hours. Due to this short action NovoRapid® should normally be taken in combination with intermediate–acting or long–acting insulin preparations.
Moreover NovoRapid® can be used for continuous infusion in a pump system.
2. What you need to know before you use NovoRapid®
Do not use NovoRapid®
- If you are allergic to insulin aspart, or any of the other ingredients in this medicine (see section 6, Contents of the pack and other information).
- If you suspect hypoglycaemia (low blood sugar) is starting (see a) Summary of serious and very common side effects in section 4).
- If FlexPen® is dropped, damaged or crushed.
- If it has not been stored correctly or been frozen (see section 5, How to store NovoRapid®).
- If the insulin does not appear water clear, colourless, and aqueous.
If any of these applies, do not use NovoRapid®. Talk with your doctor, nurse or pharmacist for advice.
Before using NovoRapid®
- Check the label to make sure it is the right type of insulin.
- Always use a new needle for each injection to prevent contamination.
- Needles and NovoRapid® FlexPen® must not be shared.
Warnings and precautions
Some conditions and activities can affect your need for insulin. Consult your doctor:
- If you have trouble with your kidneys or liver, or with your adrenal, pituitary or thyroid glands.
- If you exercise more than usual or if you want to change your usual diet, as this may affect your blood sugar level.
- If you are ill, carry on taking your insulin and consult your doctor.
- If you are going abroad, travelling over time zones may affect your insulin needs and the timing of your injections.
Other medicines and NovoRapid®
Tell your doctor, nurse or pharmacist if you are taking, have recently taken or might take any other medicines.
Some medicines affect the way blood sugar works in your body and this may influence your insulin dose. Listed below are the most common medicines which may affect your insulin treatment.
Your blood sugar level may fall (hypoglycaemia) if you take:
- Other medicines for the treatment of diabetes
- Monoamine oxidase inhibitors (MAOI) (used to treat depression)
- Beta–blockers (used to treat high blood pressure)
- Angiotensin converting enzyme (ACE) inhibitors (used to treat certain heart conditions or high blood pressure)
- Salicylates (used to relieve pain and lower fever)
- Anabolic steroids (such as testosterone)
- Sulphonamides (used to treat infections).
Your blood sugar level may rise (hyperglycaemia) if you take:
- Oral contraceptives (birth control pills)
- Thiazides (used to treat high blood pressure or excessive fluid retention)
- Glucocorticoids (such as ‘cortisone’ used to treat inflammation)
- Thyroid hormones (used to treat thyroid gland disorders)
- Sympathomimetics (such as epinephrine [adrenaline], or salbutamol, terbutaline used to treat asthma)
- Growth hormone (medicine for stimulation of skeletal and somatic growth and pronounced influence on the body’s metabolic processes)
- Danazol (medicine acting on ovulation).
Octreotide and lanreotide (used for treatment of acromegaly, a rare hormonal disorder that usually occurs in middle–aged adults, caused by the pituitary gland
producing excess growth hormone) may either increase or decrease your blood sugar level.
Beta–blockers (used to treat high blood pressure) may weaken or suppress entirely the first warning symptoms which help you to recognise low blood sugar.
Pioglitazone (tablets used for the treatment of type 2 diabetes)
Some patients with long–standing type 2 diabetes and heart disease or previous stroke who were treated with pioglitazone and insulin experienced the development of heart failure. Inform your doctor as soon as possible if you experience signs of heart failure such as unusual shortness of breath or rapid increase in weight or localised swelling (oedema).
If you have taken any of the medicines listed here, tell your doctor, nurse or pharmacist.
Drinking alcohol and taking NovoRapid®
- If you drink alcohol, your need for insulin may change as your blood sugar level may either rise or fall. Careful monitoring is recommended.
Pregnancy and breast–feeding
- If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. NovoRapid® can be used during pregnancy. Your insulin dose may need to be changed during pregnancy and after delivery.
Careful control of your diabetes, particularly prevention of hypoglycaemia, is important for the health of your baby.
- There are no restrictions on treatment with NovoRapid® during breast–feeding.
Ask your doctor, nurse or pharmacist for advice before taking this medicine while pregnant or breast–feeding.
Driving and using machines
- Please ask your doctor whether you can drive a car or operate a machine:
- If you have frequent hypoglycaemia.
- If you find it hard to recognise hypoglycaemia.
If your blood sugar is low or high, your concentration and ability to react might be affected and therefore also your ability to drive or operate a machine. Bear in mind that you
could endanger yourself or others.
NovoRapid® has a rapid onset of effect therefore if hypoglycaemia occurs, you may experience it earlier after an injection when compared to soluble human insulin.
NovoRapid® contains sodium
NovoRapid® contains less than 1 mmol sodium (23 mg) per dose, i.e. NovoRapid® is essentially ‘sodium–free’.
3. How to use NovoRapid®
Dose and when to take your insulin
Always use your insulin and adjust your dose exactly as your doctor has told you. Check with your doctor, nurse or pharmacist if you are not sure.
NovoRapid® is generally taken immediately before a meal. Eat a meal or snack within 10 minutes of the injection to avoid low blood sugar. When necessary, NovoRapid® can be given soon after a meal. See How and where to inject below for information.
Do not change your insulin unless your doctor tells you to. If your doctor has switched you from one type or brand of insulin to another, your dose may have to be adjusted by your doctor.
Use in children and adolescents
NovoRapid® can be used in children instead of soluble human insulin when a rapid onset of effect is preferred. For example, when it is difficult to dose the child in relation to meals.
No clinical studies with NovoRapid® have been carried out in children under the age of 2 years. Therefore only use NovoRapid® in children below this age, if your doctor have specifically told you to.
Use in special patient groups
If you have reduced kidney or liver function, or if you are above 65 years of age, you need to check your blood sugar more regularly and discuss changes in your insulin dose with your doctor.
How and where to inject
NovoRapid® is for injection under the skin (subcutaneously) or for continuous infusion in a pump system. Administration in a pump system will require a comprehensive instruction by your healthcare professional. You must never inject yourself directly into a vein (intravenously) or muscle (intramuscularly). If necessary NovoRapid® can be given directly into a vein but this must only be done by healthcare professionals.
With each injection, change the injection site within the particular area of skin that you use. This may reduce the risk of developing lumps or skin pitting (see section 4,
Possible side effects). The best places to give yourself an injection are: the front of your waist (abdomen), the upper arm or the front of your thighs. The insulin will work more quickly if you inject into the waist (abdomen). You should always measure your blood sugar regularly.
How to handle NovoRapid® FlexPen®
NovoRapid® FlexPen® is a pre-filled, colour–coded, disposable pen containing insulin aspart.
Read carefully the instructions for use included in this package leaflet. You must use the pen as described in the Instructions for Use.
Always ensure you use the correct pen before you inject your insulin.
If you take more insulin than you should
If you take too much insulin your blood sugar gets too low (hypoglycaemia). See a) Summary of serious and very common side effects in section 4.
If you forget to take your insulin
If you forget to take your insulin your blood sugar may get too high (hyperglycaemia). See c) Effects from diabetes in section 4.
If you stop taking your insulin
Do not stop taking your insulin without speaking with a doctor, who will tell you what needs to be done. This could lead to very high blood sugar (severe hyperglycaemia) and ketoacidosis. See c) Effects from diabetes in section 4.
If you have any further questions on the use of this medicine, ask your doctor, nurse or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
a) Summary of serious and very common side effects
Low blood sugar (hypoglycaemia)
is a very common side effect. It may affect more than 1 in 10 people.
Low blood sugar may occur if you:
- Inject too much insulin.
- Eat too little or miss a meal.
- Exercise more than usual.
- Drink alcohol (see Drinking alcohol and taking NovoRapid® in section 2).
Signs of low blood sugar: Cold sweat; cool pale skin; headache; rapid heart beat; feeling sick; feeling very hungry; temporary changes in vision; drowsiness; unusual
tiredness and weakness; nervousness or tremor; feeling anxious; feeling confused; difficulty in concentrating.
Severe low blood sugar can lead to unconsciousness. If prolonged severe low blood sugar is not treated, it can cause brain damage (temporary or permanent) and even death. You may recover more quickly from unconsciousness with an injection of the hormone glucagon by someone who knows how to use it. If you are given glucagon you will need glucose or a sugar snack as soon as you are conscious. If you do not respond to glucagon treatment, you will have to be treated in a hospital.
What to do if you experience low blood sugar:
- If you experience low blood sugar, eat glucose tablets or another high sugar snack (e.g. sweets, biscuits, fruit juice). Measure your blood sugar if possible and rest. Always carry glucose tablets or high sugar snacks with you, just in case.
- When symptoms of low blood sugar have disappeared or when blood sugar level is stabilised, continue insulin treatment as usual.
- If you have such a low blood sugar that makes you pass out, if you have had need for injection of glucagon, or if you have experienced many incidents of low blood sugar, talk with a doctor. The amount or timing of insulin, food or exercise may need to be adjusted.
Tell relevant people that you have diabetes and what the consequences may be, including the risk of passing out (become unconscious) due to low blood sugar. Let them know that if you pass out, they must turn you on your side and get medical help straight away. They must not give you any food or drink due to risk of suffocation.
Serious allergic reactions
to NovoRapid® or one of its ingredients (called a systemic allergic reaction) is a very rare side effect but can potentially be life threatening. It may affact less than 1 in 10,000 people.
Seek medical advice immediately:
- If signs of allergy spread to other parts of your body.
- If you suddenly feel unwell, and you: start sweating; start being sick (vomiting); have difficulty in breathing; have a rapid heart beat; feel dizzy.
- If you notice any of these signs, seek medical advice immediately.
b) List of other side effects
Uncommon side effects
May affect less than 1 in 100 people.
Signs of allergy: Local allergic reactions (pain, redness, hives, inflammation, bruising, swelling and itching) at the injection site may occur. These usually disappear after a few weeks of taking your insulin. If they do not disappear, or if they spread throughout your body, talk to your doctor immediately. See also Serious allergic reactions above.
Vision problems: When you first start your insulin treatment, it may disturb your vision, but the disturbance is usually temporary.
Changes at the injection site (lipodystrophy): The fatty tissue under the skin at the injection site may shrink (lipoatrophy) or thicken (lipohypertrophy). Changing the site
with each injection may help to reduce the risk of developing such skin changes. If you notice your skin pitting or thickening at the injection site, tell your doctor or nurse. These reactions can become more severe, or they may change the absorption of your insulin, if you inject in such a site.
Swollen joints: When you start taking insulin, water retention may cause swelling around your ankles and other joints. Normally this soon disappears. If not, talk to your doctor.
Diabetic retinopathy (an eye disease related to diabetes which can lead to loss of vision): If you have diabetic retinopathy and your blood sugar level improves very fast, the retinopathy may get worse. Ask your doctor about this.
Rare side effects
May affect less than 1 in 1,000 people.
Painful neuropathy (pain due to nerve damage): If your blood sugar level improves very fast, you may get nerve related pain, this is called acute painful neuropathy and is usually transient.
If you get any side effects, talk with your doctor, nurse or pharmacist. This includes any possible side effects not listed in this leaflet.
c) Effects from diabetes
High blood sugar (hyperglycaemia)
High blood sugar may occur if you:
- Have not injected enough insulin.
- Forget to inject your insulin or stop taking insulin.
- Repeatedly inject less insulin than you need.
- Get an infection and/or a fever.
- Eat more than usual.
- Exercise less than usual.
Warning signs of high blood sugar:
The warning signs appear gradually. They include: increased urination; feeling thirsty; losing your appetite; feeling sick (nausea or vomiting); feeling drowsy or tired; flushed; dry
skin; dry mouth and a fruity (acetone) smell of the breath.
What to do if you experience high blood sugar:
- If you get any of the above signs: test your blood sugar level, test your urine for ketones if you can, then seek medical advice immediately.
- These may be signs of a very serious condition called diabetic ketoacidosis (build–up of acid in the blood because the body is breaking down fat instead of sugar). If you do not treat it, this could lead to diabetic coma and eventually death.
5. How to store NovoRapid®
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the FlexPen® label and carton, after ‘EXP’. The expiry date refers to the last day of that month.
Always keep the pen cap on your FlexPen® when you are not using it in order to protect it from light. NovoRapid® must be protected from excessive heat and light.
Before opening: NovoRapid® FlexPen® that is not being used is to be stored in the refrigerator at 2°C to 8°C, away from the cooling element. Do not freeze.
During use or when carried as a spare: NovoRapid® FlexPen® that is being used or carried as a spare is not to be kept in the refrigerator. You can carry it with you and keep it at room temperature (below 30°C) for up to 4 weeks.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information
What NovoRapid® contains
- The active substance is insulin aspart. Each ml contains 100 Units of insulin aspart. Each pre–filled pen contains 300 Units of insulin aspart in 3 ml solution for injection.
- The other ingredients are glycerol, phenol, metacresol, zinc chloride, disodium phosphate dihydrate, sodium chloride, hydrochloric acid, sodium hydroxide and water
What NovoRapid® looks like and contents of the pack
NovoRapid® is presented as a solution for injection.
Pack sizes of 1 (with or without needles), 5 (without needles) and 10 (without needles) pre–filled pens of 3 ml.
Not all pack sizes may be marketed.
The solution is water clear, colourless and aqueous.
Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder:
Novo Nordisk A/S
The manufacturer can be identified by the batch number printed on the slip of the carton and on the label:
- If the second and third characters are S6, P5, K7, R7, VG, FG or ZF, the manufacturer is
Novo Nordisk A/S
- If the second and third characters are H7 or T6, the manufacturer is
Novo Nordisk Production SAS
45 Avenue d’Orléans F-28002 Chartres
Now turn over for information on how to use your FlexPen®.
Detailed information on this medicine is available on the European Medicines Agency website: http://www.ema.europa.eu.
NOVORAPID® solution for injection in a pre–filled pen. FlexPen®. INSTRUCTIONS FOR USE
Please read the following instructions carefully before using your NovoRapid® FlexPen®.
Your FlexPen® is a unique dial–a–dose insulin pen.
- You can select doses from 1 to 60 units in increments of 1 unit.
- FlexPen® is designed to be used with NovoFine® or NovoTwist® disposable needles up to a length of 8 mm.
- Always carry a spare insulin delivery device in case your FlexPen® is lost or damaged.
Preparing your NovoRapid® FlexPen®
Check the label to make sure that your FlexPen® contains the correct type of insulin.
A Pull off the pen cap.
B Take a new needle and tear off the paper tab.
Screw the needle straight and tightly onto your FlexPen®.
C Pull off the big outer needle cap and keep it for later.
D Pull off the inner needle cap and dispose of it.
- Always use a new needle for each injection to prevent contamination.
- Be careful not to bend or damage the needle before use.
- To reduce the risk of unexpected needle sticks, never put the inner needle cap back on when you have removed it from the needle.
Checking the insulin flow
Prior to each injection small amounts of air may collect in the cartridge during normal use. To avoid injection of air and ensure proper dosing:
E Turn the dose selector to select 2 units.
F Hold your FlexPen® with the needle pointing upwards and tap the cartridge gently with your finger a few times to make any air bubbles collect at the top of the cartridge.
G Keeping the needle upwards, press the push–button all the way in. The dose selector returns to 0.
A drop of insulin should appear at the needle tip. If not, change the needle and repeat the procedure no more than 6 times.
If a drop of insulin still does not appear, the pen is defective, and you must use a new one.
Selecting your dose
Check that the dose selector is set at 0.
H Turn the dose selector to select the number of units you need to inject.
The dose can be corrected either up or down by turning the dose selector in either direction until the correct dose lines up with the pointer. When turning the dose selector be careful not to push the push–button as insulin will come out.
You cannot select a dose larger than the number of units left in the cartridge.
- Do not use the residual scale to measure your dose of insulin.
- Your FlexPen® is designed to work accurately and safely. It must be handled with care.
If it is dropped or crushed, there is a risk of damage and leakage of insulin.
- You can clean the exterior of your FlexPen® by wiping it with a medicinal swab. Do not soak it, wash or lubricate it as it may damage the pen.
Do not refill your FlexPen®.
Making the injection
Insert the needle into your skin. Use the injection technique shown by your doctor or nurse.
I Inject the dose by pressing the push–button all the way in until 0 lines up with the pointer. Be careful only to push the push–button when injecting.
Turning the dose selector will not inject insulin.
- Keep the push–button fully depressed and let the needle remain under the skin for at least 6 seconds.
This will make sure you get the full dose.
- Withdraw the needle from the skin then release the pressure on the push–button.
K Lead the needle into the big outer needle cap without touching it. When the needle is covered, carefully push the big outer needle cap completely on and then unscrew the needle.
Dispose of it carefully and put the pen cap back on your FlexPen®.
- Remove and discard the needle after each injection. Always store your FlexPen® without the needle attached. Otherwise the liquid may leak out which can cause inaccurate dosing.
- Caregivers should be most careful when handling used needles to avoid needle sticks.
- Dispose of the used FlexPen® carefully without the needle attached.
- Needles and NovoRapid® FlexPen® must not be shared.