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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.
What is the starting dosage of ONSWIK™ (insulin efsitora alfa-gobe)?
The starting dosage of efsitora depends on prior insulin use. Insulin-naïve patients start with a fixed or flexible titration, and patients switching from basal insulin may use a one-time starting dose in the first week.
Content Overview
- What is the starting dosage of efsitora in insulin-naïve patients?
- What is the starting dosage of efsitora in patients switching from once- or twice-daily basal insulin?
- Is the starting dosage of efsitora adjusted in special populations?
- Enclosed Prescribing Information
- Reference
What is the starting dosage of efsitora in insulin-naïve patients?
Efsitora is administered by subcutaneous injection once weekly on the same day each week. The potency of insulin analogs, including efsitora, is expressed in units, and 1 unit of efsitora corresponds to 1 international unit of human insulin.1
There are 2 dosing options for insulin-naïve patients, a fixed-dosage titration and a flexible-dosage titration.1
In the fixed-dosage titration
- the recommended starting dosage is 100 units injected subcutaneously once weekly on the same day each week
- after a minimum of 4 weeks on a stable dose, the dosage is titrated sequentially to the next higher dose (150, 250, then 400 units) if the fasting glycemic goal has not been reached and the fasting blood glucose (FBG) is above 130 mg/dL
- further dosage increases are withheld if the patient experiences hypoglycemia within the prior week, until the cause has been addressed and hypoglycemia has resolved
- the dosage is titrated by 20 to 40 units per week as necessary if the FBG is below 130 mg/dL and the fasting glycemic goal has not been reached, and
- the dosage is titrated by 20 to 40 units per week as necessary if a dosage greater than 400 units once weekly is required to reach the glycemic goal.1
In the flexible-dosage titration
- the 300-unit one-time starting dose is only administered during the first week
- the dosage in the second week is 100 units, without repeating the one-time starting dose, and
- the dosage in the third and subsequent weeks is adjusted by 20 to 40 units per week as necessary, based on the patient’s fasting glycemic goal.1
What is the starting dosage of efsitora in patients switching from once- or twice-daily basal insulin?
When switching from once- or twice-daily basal insulin, the first dose of efsitora is administered on the day after the last dose of basal insulin. Close glucose monitoring is recommended during the switch and until the dosage and glycemic control are stable, and the doses and timing of concurrent mealtime insulin products or other concomitant antidiabetic medications may require adjustments.1
Dosage calculations and important considerations when switching patients to efsitora are shown in Table 1.1
Weekly Dosage |
Dosage Calculation, Unitsa |
Important Considerations |
|---|---|---|
First week |
one-time starting dose: multiply the total daily basal insulin dosage by 7, then multiply by 3; for patients who have FBG values ≤120 mg/dL on daily basal insulin, consider omitting the one-time starting dose, in which case the first-week dose is the total daily basal insulin dosage multiplied by 7 |
the one-time starting dose is only administered during the first week; if the one-time starting dose is omitted, transient hyperglycemia may occur and last 4 to 6 weeks |
Second week |
multiply the previous total daily basal insulin dosage by 7 |
do not repeat the one-time starting dose |
Third and subsequent weeks |
adjust the dosage by 20 to 40 units per week, as necessary based on the fasting glycemic goal |
if the one-time starting dose was omitted, do not adjust the weekly dosage until FBG levels have stabilized; if the FBG level is stable and remains above the goal, the dosage may be adjusted as necessary based on the fasting glycemic goal |
Abbreviations: FBG = fasting blood glucose; NPH = neutral protamine Hagedorn.
Notes: Round calculated doses to the nearest 5 units for the U-500 KwikPen and 10 units for the U-1,000 KwikPen.
a For patients switching from once-daily insulin glargine 300 units/mL or twice-daily NPH insulin, use 80% of the total daily insulin glargine or NPH insulin dosage when calculating efsitora dosages.
Is the starting dosage of efsitora adjusted in special populations?
Greater caution should be exercised when efsitora is administered to geriatric patients, because greater sensitivity of some older individuals to the effects of efsitora cannot be ruled out. The initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemia, and more frequent glucose monitoring is recommended.1
Additional dose adjustment should not be necessary for patients with renal or hepatic impairment. However, as with all insulin products, glucose monitoring should be intensified and the efsitora dosage adjusted on an individual basis in these patients.1
Safety and effectiveness of efsitora have not been established in pediatric patients.1
Enclosed Prescribing Information
ONSWIK™ (insulin efsitora alfa-gobe) injection, for subcutaneous use, Lilly
Reference
- Onswik [package insert]. Indianapolis, IN: Eli Lilly and Company; 2026.
Date of Last Review: October 22, 2026