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insulin glargine

Sold as Basaglar, Lantus, Toujeo. Class: Insulins and analogues for injection, long-acting. First FDA approval 12/16/2015: 11 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (84/100)

Safety ×35%
B
Evidence ×25%
B
Regulatory ×15%
A
Money & lawsuits ×15%
B
Options ×10%
C

Safety: 87

Evidence: 76

Regulatory history: 100

Money & lawsuits: 85

Options: 70

Independent reviews and post-approval warnings

FDA Drug Safety Communications

Warnings the FDA chose to announce publicly after approval, as opposed to quiet label edits. Class-wide items name the drug's class, not this drug specifically.

WHO Essential Medicine

Listed on the WHO Model List of Essential Medicines: a global expert panel judged it among the medicines a health system should always have, on evidence of value, not marketing.

What the FDA label says

Approved uses

is indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. LANTUS is a long-acting human insulin analog indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. ( 1 ) Limitations of Use Not recommended for the treatment of diabetic ketoacidosis. ( 1 ) Limitations of Use LANTUS is not recommended for the treatment of diabetic ketoacidosis.

Contraindications

is contraindicated: During episodes of hypoglycemia [see Warnings and Precautions (5.3) ] In patients with hypersensitivity to insulin glargine or any of the excipients in LANTUS [see Warnings and Precautions (5.5) ] During episodes of hypoglycemia ( 4 ) Hypersensitivity to insulin glargine or any of the excipients in LANTUS ( 4 )

Warnings and precautions

Never share a LANTUS SoloStar prefilled pen, insulin syringe, or needle between patients, even if the needle is changed. ( 5.1 ) Hyperglycemia or hypoglycemia with changes in insulin regimen : Make changes to a patient's insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) under close medical supervision with increased frequency of blood glucose monitoring. ( 5.2 ) Hypoglycemia : May be life-threatening. Increase frequency of glucose monitoring with changes to: insulin dosage, concomitant drugs, meal pattern, physical activity; and in patients with renal or hepatic impairment and hypoglycemia unawareness. ( 5.3 ) Hypoglycemia due to medication errors : Accidental mix-ups between insulin products can occur. Instruct patients to check insulin labels before injection. ( 5.4 ) Hypersensitivity reactions : Severe, life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue LANTUS. Monitor and treat if indicated. ( 5.5 ) Hypokalemia : May be life-threatening. Monitor potassium levels in patients at risk of hypokalemia and treat if indicated. ( 5.6 ) Fluid retention and heart failure with concomitant use of thiaz...

Adverse reactions (label)

The following adverse reactions are discussed elsewhere: Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen [see Warnings and Precautions (5.2) ] Hypoglycemia [see Warnings and Precautions (5.3) ] Hypoglycemia Due to Medication Errors [see Warnings and Precautions (5.4) ] Hypersensitivity Reactions [see Warnings and Precautions (5.5) ] Hypokalemia [see Warnings and Precautions (5.6) ] Adverse reactions commonly associated with LANTUS include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact sanofi-aventis at 1-800-633-1610 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trial of another drug and may not reflect the rates observed in practice. The data in Table 1 reflect the exposure of 2,327 patients with type 1 diabetes to LANTUS or NPH in Studies A, B, C, and D [see Clinical Studies (14.2) ] . The type 1 diabetes population had the follo...

Source: FDA SPL label for Lantus Solostar (sanofi-aventis U.S. LLC), effective 20250602. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

200,846reports that mention this drug
200,440of those blame this drug, not another one the person was taking
47%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
4.9%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Blood Glucose Increased · 31,354Off Label Use · 13,264Inappropriate Schedule Of Product Administration · 10,220Product Storage Error · 8,901Drug Ineffective · 8,795Visual Impairment · 7,832Blood Glucose Decreased · 7,667Nausea · 6,659Incorrect Dose Administered · 6,336Diarrhoea · 5,930Hypoglycaemia · 5,695Fatigue · 5,631Injection Site Pain · 5,450Malaise · 5,311Dyspnoea · 4,839

Reports per year

20192020202120222023202420252026
19,62417,58115,87814,49512,80314,48618,0918,757

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

0recall actions on file
0 / 0brand / generic applications
0label changes since 2021
NoREMS program

Evidence base

482randomized trials (PubMed)
62systematic reviews
726registered trials
49%of completed trials posted results
9%terminated or withdrawn
71%industry-funded

Independent Cochrane reviews

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $350,531 in payments to US physicians and hospitals tied to this drug across 2,090 transactions (Toujeo $338,618, Lantus $10,686, Basaglar $1,227).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

Not in the Medicare Part D spending file (typically hospital-administered or very new drugs).

Same-class alternatives

insulin icodecinsulin, regular, pork

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. In 2011 the FDA issued a safety communication about this drug (Lantus - Update to ongoing safety review of Lantus (insulin glargine) and possible risk of cancer). Does that risk apply to me?
  2. The most-reported problems in FDA's adverse event data are blood glucose increased, inappropriate schedule of product administration, product storage error. How would we recognize and handle those?
  3. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  4. Why this one over insulin degludec, insulin detemir, insulin icodec? What would make you pick one of those instead?
  5. There is no generic. Is there an older generic in the same class that works as well for my situation?
  6. What result are we expecting, by when, and what is the plan if it does not happen?
  7. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)