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Monotard
Lente by Novo Nordisk
intermediate-acting r-DNA/GE/GM
U100 Zinc
Line Novo
Also known as Novolin L
Similar to Humulin L
Action in cats  
  • onset 2-5h,
  • peak 8-10h[1]
  • duration: 10-16h
Action in dogs  
  • onset 2-10h,
  • peak 6-24h,
  • duration 14-24h
Use and Handling
Type cloudy
Shelf Life 30 months
When opened 6 weeks
In pen N/A
Notes  

Monotard was Novo Nordisk's Euro brand name for their U100 lente-type insulin[2] which is intermediate-acting. As of early 2006, this insulin was discontinued[3].

It was known asNovolin L[4] in North America; Eli Lilly made a comparable product, Humulin L[5], discontinued in the EU/UK in July 2004[6], also discontinued in North America in July 2005[7][8].

Like all Lente insulins[9], regardless of species or strength, Monotard was a suspension of crystalline (ultralente) and amorphous (semilente) insulin in a ratio of 7 crystalline parts to 3 amorphous parts.

What Lente Is NotEdit

No Lente-type insulin regardless of species can contain any NPH/isophane insulin[10] or any R/Neutral insulin[11][12].

Both are chemically impossible: the phenol preservative present in NPH/isophane alters the action of Lente-type insulins, creating a mixture with an approximate action of R/Neutral[13].

The zinc suspension of Lente-type insulin binds R/Neutral, causing the short-acting insulin to slow, losing its short-acting effect[14][15][16].

Combining Lente Family InsulinsEdit

None of the Lente family of insulins (semilente, Lente, Ultralente) can be combined with[17] NPH/isophane insulins. The phenol preservatives present in NPH-type insulins alters the Lente-types to the point where they become a close approximation of R/neutral, with regard to action[18].

Keeping the phenol preservatives in mind, all protamine-suspended insulin mixes would be "off limits" regarding same syringe mixing with any Lente-type insulins[19].


Insulin manufacturers[20] indicate that R/neutral and semilente, Lente, ultralente insulins are able to be combined in the same syringe, but only just before injection. In pre-filled syringes, the zinc suspension of the Lente-type insulins binds the R/neutral, causing it to lose its short-acting effect. Various studies have documented this, and some doctors advise against using R/neutral in the same syringe with the Lente family of insulins[21][22][23][24].

The Novo insulins, Ultratard and Monotard, were available slightly longer in Europe.

From the announcement: Monotard and Ultratard will not be available in the UK after February 2006. The discontinuation of these insulins was initially announced in September 2004. Initially the discontinuation was scheduled for February 2006, however this date has now been brought forward to October 2005.

Further ReadingEdit

Wikicat3Wikidog3

See also Substitutes_for_Humulin_U_and_L.

ReferencesEdit

  1. Insulins-North American Veterinary Conference-2005
  2. Prescribing Novo Insulins
  3. Photo of Monotard Insulin
  4. US-FDA-Novolin L Discontinuation Notice-2003
  5. Humulin L, etc.-Lente Human Insulin Remedyfind.com
  6. Discontinuation of Humulin L July 2004
  7. Lilly EU/UK Product Sheet & Time Activity Profiles
  8. US-FDA-Humulin L Discontinuation Notice
  9. EMEA Scientific Discussion-Monotard
  10. Combining Lente-type Insulins with Phenol-Preserved Insulins
  11. Lente Zinc Suspension Causes Loss Of R/Neutral Short-Acting Effect
  12. Availability of Soluble (R/Neutral) Insulin in Mixed Preparations of Crystalline (Lente) & Ultralente GE Insulins-Clinical Therapeutics-1991
  13. Lente-Type Insulins & NPH/Isophane Insulins-A Bad Combination
  14. Intermediate-Acting Insulin Preparations: NPH (Isophane) & Lente--Diabetes Care-1980
    Note: in 1980 there was only beef Lente insulin--no pork or r-DNA/GE/GM Lente types.
  15. Absorption Kinetics & Action Profiles-Single Subcutaneous Administration of Human Soluble (R/Neutral) & Lente Insulin-Diabetes Care-1987
  16. Resource Guide 2005-American Diabetes Association
  17. Phenol Preservatives & Lente-type Insulins--A Bad Combination
  18. RxEd.org-Insulin Therapy-Mixing Precautions
  19. RxEd.org-Insulin Therapy-Mixing Precautions
  20. Insulin Producers vs Doctors Re:Combining R/Neutral & Lente-type Insulins
  21. Availability of Soluble (R/Neutral) Insulin in Mixed Preparations of Crystalline (Lente) & Ultralente GE Insulins-Clinical Therapeutics-1991
  22. Absorption Kinetics & Action Profiles-Single Subcutaneous Administration of Human Soluble (R/Neutral) & Lente Insulin-Diabetes Care-1987
  23. Delayed Onset of Action of Soluble (R/Neutral) Insulin After Premixing With Lente Insulin Diabetes Research & Clinical Practice-1983
  24. RxEd.org-Insulin Therapy-Mixing Precautions

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