FIASP

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FIASP (FIASP).

How it works

FIASP is an insulin aspart formulation with faster absorption due to added L-arginine and niacinamide. It activates insulin receptor tyrosine kinase, promoting glucose uptake via GLUT4 translocation.

What the body does with it

Metabolism	Insulin aspart is metabolized by proteolytic degradation; no specific CYP450 involvement.
Excretion	Renal: Approximately 60-80% of insulin aspart is excreted via the kidneys following degradation. Fecal/biliary excretion accounts for <10%.
Half-life	0.7-1.0 hours (ultra-rapid acting insulin; terminal half-life from subcutaneous absorption, not intravenous elimination).
Protein binding	<5% (minimal reversible binding to plasma proteins, primarily albumin; not clinically significant).
Volume of Distribution	0.2-0.4 L/kg (approximately 15-30 L for a 70 kg individual, reflecting distribution into extracellular fluid).
Bioavailability	Subcutaneous: 50-70% (incomplete due to local degradation; exact value varies with injection site and technique).
Onset of Action	Subcutaneous: 2.5-5 minutes (time to initial glucose-lowering effect, faster than regular insulin).
Duration of Action	3-5 hours (subcutaneous injection; dose-dependent, shorter duration than regular insulin, suitable for mealtime coverage).

Classification & Brands

Dosing & administration

Subcutaneous injection at mealtimes, dose individualized. Typical starting total daily dose 0.5-1 unit/kg/day, given as 50% bolus and 50% basal. Bolus dose: 1-2 units or 0.1-0.2 units/kg per meal.

Dosage form	SOLUTION
Renal impairment	No specific GFR-based dose adjustment required. For severe renal impairment (eGFR <30 mL/min), monitor glucose closely and reduce dose due to decreased insulin clearance.
Liver impairment	No specific Child-Pugh based dose adjustment. In severe hepatic impairment (Child-Pugh class C), dose reduction may be needed due to impaired gluconeogenesis; start with lower doses and titrate.
Pediatric use	Children ≥1 year: subcutaneous injection, dose individualized. Usual total daily dose 0.5-1 unit/kg/day, given as basal-bolus. Bolus dose: 0.1-0.2 units/kg per meal. Children <1 year: limited data; use with caution.
Geriatric use	Start with lower doses (e.g., 0.5 units/kg/day total) due to increased risk of hypoglycemia. Titrate slowly based on glucose monitoring. Monitor renal function as clearance may decrease.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for FIASP (FIASP).

Breastfeeding	Endogenous insulin and insulin aspart are excreted in breast milk in negligible amounts. No adverse effects on nursing infant expected. M/P ratio not established; considered compatible with breastfeeding.
Teratogenic Risk	Insulin aspart (FIASP) does not cross the placenta in significant amounts. Animal studies have not shown teratogenicity. Poorly controlled diabetes during pregnancy increases risk of fetal anomalies, macrosomia, and neonatal hypoglycemia. Use in all trimesters is considered safe when indicated.

Warnings & precautions

■ FDA Black Box Warning

Never share a FIASP FlexTouch pen or syringe between patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens.

Side Effect Profile

Common Effects	Hypoglycemia low blood glucose level Headache Nasopharyngitis inflammation of the throat and nasal passages Upper respiratory tract infection
Serious Effects

Absolute Contraindications

["Hypersensitivity to insulin aspart or any excipients","During episodes of hypoglycemia"]

Clinical Precautions

Precautions

["Hypoglycemia is the most common adverse reaction","Changes in insulin regimen may cause hyperglycemia or hypoglycemia","Accidental mix-ups between insulin products can occur","Hypokalemia may occur","Fluid retention and heart failure with concomitant thiazolidinediones","Risk of hypoglycemia due to medication errors"]

Clinical Tips & Counseling

Drug interactions

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FIASP

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FIASP (FIASP).

How it works

FIASP is an insulin aspart formulation with faster absorption due to added L-arginine and niacinamide. It activates insulin receptor tyrosine kinase, promoting glucose uptake via GLUT4 translocation.

What the body does with it

Metabolism	Insulin aspart is metabolized by proteolytic degradation; no specific CYP450 involvement.
Excretion	Renal: Approximately 60-80% of insulin aspart is excreted via the kidneys following degradation. Fecal/biliary excretion accounts for <10%.
Half-life	0.7-1.0 hours (ultra-rapid acting insulin; terminal half-life from subcutaneous absorption, not intravenous elimination).
Protein binding	<5% (minimal reversible binding to plasma proteins, primarily albumin; not clinically significant).
Volume of Distribution	0.2-0.4 L/kg (approximately 15-30 L for a 70 kg individual, reflecting distribution into extracellular fluid).
Bioavailability	Subcutaneous: 50-70% (incomplete due to local degradation; exact value varies with injection site and technique).
Onset of Action	Subcutaneous: 2.5-5 minutes (time to initial glucose-lowering effect, faster than regular insulin).
Duration of Action	3-5 hours (subcutaneous injection; dose-dependent, shorter duration than regular insulin, suitable for mealtime coverage).

Classification & Brands

Dosing & administration

Subcutaneous injection at mealtimes, dose individualized. Typical starting total daily dose 0.5-1 unit/kg/day, given as 50% bolus and 50% basal. Bolus dose: 1-2 units or 0.1-0.2 units/kg per meal.

Dosage form	SOLUTION
Renal impairment	No specific GFR-based dose adjustment required. For severe renal impairment (eGFR <30 mL/min), monitor glucose closely and reduce dose due to decreased insulin clearance.
Liver impairment	No specific Child-Pugh based dose adjustment. In severe hepatic impairment (Child-Pugh class C), dose reduction may be needed due to impaired gluconeogenesis; start with lower doses and titrate.
Pediatric use	Children ≥1 year: subcutaneous injection, dose individualized. Usual total daily dose 0.5-1 unit/kg/day, given as basal-bolus. Bolus dose: 0.1-0.2 units/kg per meal. Children <1 year: limited data; use with caution.
Geriatric use	Start with lower doses (e.g., 0.5 units/kg/day total) due to increased risk of hypoglycemia. Titrate slowly based on glucose monitoring. Monitor renal function as clearance may decrease.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for FIASP (FIASP).

Breastfeeding	Endogenous insulin and insulin aspart are excreted in breast milk in negligible amounts. No adverse effects on nursing infant expected. M/P ratio not established; considered compatible with breastfeeding.
Teratogenic Risk	Insulin aspart (FIASP) does not cross the placenta in significant amounts. Animal studies have not shown teratogenicity. Poorly controlled diabetes during pregnancy increases risk of fetal anomalies, macrosomia, and neonatal hypoglycemia. Use in all trimesters is considered safe when indicated.

Warnings & precautions

■ FDA Black Box Warning

Never share a FIASP FlexTouch pen or syringe between patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens.

Side Effect Profile

Common Effects	Hypoglycemia low blood glucose level Headache Nasopharyngitis inflammation of the throat and nasal passages Upper respiratory tract infection
Serious Effects

Absolute Contraindications

["Hypersensitivity to insulin aspart or any excipients","During episodes of hypoglycemia"]