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Onswik ™ (insulin efsitora alfa-gobe) injection
500 units/mL (U-500), 1,000 units/mL (U-1,000)
This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.
Can ONSWIK™ (insulin efsitora alfa) interact with other medications?
Efsitora may be given alone or with oral and injectable antidiabetic medicines. A number of drugs affect glucose metabolism and may increase or decrease the glucose-lowering effect of efsitora, which may require insulin dose adjustment.
Content Overview
- Can efsitora be used in combination with non-insulin antidiabetic medications?
- How may other medications affect the glucose-lowering effect of efsitora?
- Drugs That May Increase the Risk of Hypoglycemia
- Drugs That May Decrease the Glucose-Lowering Effect of Efsitora
- Drugs That May Reduce the Effectiveness of Efsitora
- Drugs That May Increase or Decrease the Glucose-Lowering Effect of Efsitora
- Drugs That May Blunt the Signs and Symptoms of Hypoglycemia
- What is the risk of using efsitora with thiazolidinediones?
- Enclosed Prescribing Information
- References
Can efsitora be used in combination with non-insulin antidiabetic medications?
Efsitora may be administered alone or in any combination with oral and injectable antidiabetic medicines and rapid-acting or short-acting insulin products.1
Administer efsitora by subcutaneous injection once weekly on the same day each week. Individualize and adjust the dosage of efsitora based on metabolic needs, glucose monitoring results and glycemic control goal.1
When switching from once- or twice-daily basal insulin to efsitora, close glucose monitoring is recommended during the switch and until the dosage and glycemic control are stable. Doses and timing of concurrent mealtime insulin products or other concomitant antidiabetic medications may require adjustments.1
How may other medications affect the glucose-lowering effect of efsitora?
Clinically significant drug interactions with efsitora include drugs that may increase the risk of hypoglycemia, drugs that may decrease the glucose-lowering effect of efsitora, drugs that may increase or decrease the glucose-lowering effect of efsitora, drugs that may blunt the signs and symptoms of hypoglycemia, and drugs that may reduce the effectiveness of efsitora (see below). Adjustment of dosage may be needed; closely monitor glucose.1
Drugs That May Increase the Risk of Hypoglycemia
Drugs that may increase the risk of hypoglycemia when co-administered with efsitora are
- antidiabetic agents (including glucagon-like peptide-1 (GLP-1) receptor agonists, glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonists, and sodium-glucose co-transporter 2 (SGLT2) inhibitors)
- angiotensin converting enzyme (ACE) inhibitors
- angiotensin II receptor blocking agents
- disopyramide
- fibrates
- monoamine oxidase inhibitors
- pentoxifylline
- salicylates
- selective serotonin re-uptake inhibitors (SSRIs)
- somatostatin analogs, and
- sulfonamide antibiotics.1
Dose reductions and increased frequency of glucose monitoring may be required when efsitora is co-administered with these drugs.1
Drugs That May Decrease the Glucose-Lowering Effect of Efsitora
Drugs that may decrease the glucose-lowering effect of efsitora are
- atypical antipsychotics (e.g., olanzapine and clozapine)
- corticosteroids
- danazol
- diazoxide
- diuretics
- estrogens
- glucagon
- isoniazid
- niacin
- oral contraceptives
- pasireotide
- phenothiazine
- protease inhibitors
- somatropin
- sympathomimetic agents (e.g., albuterol, epinephrine, and terbutaline), and
- thyroid hormones.1
Dose increases and increased frequency of glucose monitoring may be required when efsitora is co-administered with these drugs.1
Drugs That May Reduce the Effectiveness of Efsitora
Neonatal Fc receptor (FcRn) inhibitors (for example, efgartigimod, rozanolixizumab, nipocalimab) may lower systemic exposure of efsitora and reduce its effectiveness. 1
If treatment with an FcRn inhibitor is required, consider switching to an alternative basal insulin.1
Drugs That May Increase or Decrease the Glucose-Lowering Effect of Efsitora
Drugs that may increase or decrease the glucose-lowering effect of efsitora are alcohol, beta-blockers, clonidine, lithium salts, and octreotide or lanreotide.1
Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.1
Dose adjustment and increased frequency of glucose monitoring may be required when efsitora is co-administered with these drugs.1
Drugs That May Blunt the Signs and Symptoms of Hypoglycemia
Drugs that may blunt the signs and symptoms of hypoglycemia include beta-blockers, clonidine, guanethidine, and reserpine.1
Increased frequency of glucose monitoring may be required when efsitora is co-administered with these drugs.1
What is the risk of using efsitora with thiazolidinediones?
Thiazolidinediones (TZDs), which are peroxisome proliferator activated receptor (PPAR)-gamma agonists, can cause dose-related fluid retention, when used in combination with insulin. Fluid retention may lead to or exacerbate heart failure. 1
Patients treated with insulin, including efsitora and a PPAR-gamma agonist should be observed for signs and symptoms of heart failure. If heart failure develops, it should be managed according to current standards of care and discontinuation or dose reduction of the PPAR-gamma agonist must be considered.1
Enclosed Prescribing Information
References
- ONSWIK [package insert]. Indianapolis, IN: Eli Lilly and Company; 2026.
Date of Last Review: August 25, 2026