Afrezza Inhaler: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Afrezza Inhaler (insulin human inhaled) is a rapid-acting inhaled insulin used to improve blood sugar control in adults with type 1 or type 2 diabetes. It is breathed in through a special inhaler at the beginning of meals and works quickly to manage blood sugar rises after eating. It is not recommended for treating diabetic ketoacidosis or for people who smoke, and people with type 1 diabetes must also use a long-acting insulin alongside it.

What is Afrezza Inhaler

Afrezza is a fast-acting insulin powder that you breathe in through your mouth using a special inhaler. It helps control blood sugar in adults with diabetes.

Afrezza Inhaler uses

• Improve blood sugar control in adults with type 1 or type 2 diabetes mellitus
• In people with type 1 diabetes, must be used together with a long-acting insulin
• Not recommended for treating diabetic ketoacidosis
• Not recommended for people who smoke

Benefits of Afrezza Inhaler

• Works quickly to help control blood sugar rises after meals
• Fast absorption into the bloodstream after inhalation
• Provides rapid mealtime insulin action
• Avoids a mealtime injection
• Available in 4-unit, 8-unit, and 12-unit cartridges
• Helps improve overall glucose control when appropriately prescribed

How Afrezza Inhaler works

Afrezza is insulin that you inhale into your lungs. Once absorbed, the insulin helps your body's cells take in sugar from your blood for energy, and it also stops your liver from making more sugar.

Afrezza Inhaler dosage

Use Afrezza only with the Afrezza inhaler; do not try to inhale the powder any other way, and do not swallow the cartridges. Take Afrezza at the beginning of a meal. If you skip a meal, you can skip your dose.

Let a cartridge sit at room temperature for about 10 minutes before loading it into the inhaler. Keep the inhaler level with the white mouthpiece on top; do not turn it upside down, point the mouthpiece down, shake it, or drop it after loading a cartridge and before taking your dose, or you may lose some of the dose.

If your dose needs more than one cartridge, use a combination of cartridges to reach your total dose, and throw away each used cartridge before loading a new one. Use only one inhaler at a time for all cartridge strengths. Throw away the inhaler after 15 days of use and start a new one.

Dosing must be tailored to each person's individual needs. Your dose may need to change with changes in physical activity, weight, stress, illness, diet, or other medicines you take.

Available forms and strengths

• Single-use inhalation powder cartridges: 4 units (blue), 8 units (green), and 12 units
• Breath-powered inhaler device

Side effects of Afrezza Inhaler

Common

• Low blood sugar (hypoglycemia)
• Cough
• Sore throat or throat pain/irritation
• Headache
• Diarrhea
• Fatigue
• Nausea
• Bronchitis

Serious

• Sudden lung problems (acute bronchospasm), especially in people with asthma or COPD
• Decline in lung function over time
• Lung cancer (a few more cases seen with Afrezza in studies, though not proven to be caused by it)
• Diabetic ketoacidosis
• Severe, life-threatening allergic reactions including anaphylaxis
• Low potassium levels (hypokalemia), which can cause dangerous heart rhythm problems
• Fluid retention and heart failure when used with certain diabetes pills called thiazolidinediones (TZDs)
• Severe hypoglycemia, which can cause seizures, coma, or death

Warnings and precautions

• Afrezza can cause sudden, serious tightening of the airways (bronchospasm) in people with asthma or COPD. Because of this, it should not be used by people with these chronic lung conditions.
• Before starting Afrezza, your doctor must take your medical history, examine you, and do a breathing test (spirometry) to check for hidden lung disease.
• Afrezza can cause low blood sugar, which can be life-threatening and can cause seizures or death.
• Afrezza can cause a gradual decline in lung function over time, even without symptoms, so lung function should be checked regularly.
• Afrezza should not be used in people with active lung cancer; for those with a history of or risk for lung cancer, the benefits need to be weighed against this potential risk.
• People at risk for diabetic ketoacidosis experienced it more often with Afrezza in studies, so extra monitoring may be needed during illness.
• Severe, life-threatening allergic reactions, including anaphylaxis, can happen with Afrezza.
• Afrezza can cause low potassium levels, which can be life-threatening.
• Using Afrezza together with certain diabetes pills called TZDs can cause fluid buildup and worsen or trigger heart failure.
• It isn't known if Afrezza is safe during pregnancy. Afrezza should only be used in pregnancy if your doctor decides the benefits outweigh the risks to the baby.
• It's likely that Afrezza passes into breast milk. You and your doctor should decide whether you should stop breastfeeding or stop using Afrezza.
• People with kidney problems may need more frequent blood sugar monitoring and dose adjustments, and may have a higher risk of low blood sugar.
• People with liver problems may need more frequent blood sugar monitoring and dose adjustments, and may have a higher risk of low blood sugar.
• Do not drink alcohol or use over-the-counter medicines containing alcohol while using Afrezza, since alcohol can raise or lower blood sugar unpredictably.
• Do not drive or operate heavy machinery until you know how Afrezza affects you, since low blood sugar can affect your concentration and reaction time.

Storage

• Unopened foil package: store refrigerated at 36-46°F (2-8°C) until the expiration date
• If a foil package is not refrigerated, contents must be used within 10 days
• Opened blister cards/strips (still sealed): store at room temperature, excursions permitted 59-86°F (15-30°C), and must be used within 10 days
• Opened strips: must be used within 3 days
• Store the inhaler at 36-77°F (2-25°C); excursions permitted; inhaler may be refrigerated but should be at room temperature before use
• Before use, cartridges should sit at room temperature for 10 minutes
• Throw away the inhaler after 15 days from first use and replace with a new one
• Throw away used cartridges in regular household trash
• Keep Afrezza and all medicines out of reach of children

When to see a doctor

• Get emergency medical help right away if you have trouble breathing, shortness of breath, a fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, or confusion.
• Tell your doctor right away if you have any trouble breathing after using Afrezza.
• Contact your healthcare provider if your blood sugar control gets worse during illness or infection, as this could be a sign of diabetic ketoacidosis.
• Report any signs or symptoms that could be related to lung cancer to your doctor right away.
• Get medical help right away if you have symptoms of a severe allergic reaction, such as a rash over your whole body, trouble breathing, a fast heartbeat, or sweating.
• If you think you've used too much Afrezza, get medical help right away or contact a poison control center.

Alternatives

• Fiasp
• NovoLog / NovoRapid
• Humalog