Toujeo vs. Lantus: Differences, similarities, and which is better for you

Main differences between Toujeo and Lantus | Conditions treated by Toujeo and Lantus | Is Toujeo or Lantus more effective? | Coverage and cost comparison | Common side effects | Drug interactions | Warnings | FAQ

Diabetes mellitus is a nationally significant health topic as it affects nearly 35 million Americans of all ages, gender, and race. As you may know, there are two types of diabetes mellitus: Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM). People with Type 1 diabetes are unable to produce insulin, a hormone needed to maintain blood sugar balance in their cells for energy. Type 2 diabetics are able to produce insulin, but their body doesn’t respond to it appropriately. This allows blood sugar levels to get too high. Over 80 million Americans have prediabetes—meaning they are at a very high risk of developing T2DM. The impact of uncontrolled diabetes can affect the health of your entire body. It can lead to heart disease, heart failure, stroke, blindness, kidney failure, and lower extremity amputation. For these reasons, having effective medication to help control blood sugar is imperative.

Toujeo and Lantus are two prescriptions, injectable insulins indicated in the treatment of T1DM and T2DM. Both medications are forms of insulin glargine, a long-acting basal insulin analog produced by the manufacturer Sanofi-Aventis. Overall, these formulations offer the advantage of fewer injections daily while providing a relatively constant level of glycemic control. While they are somewhat similar in composition, there are some differences between these two medications, and we will discuss those here.

What are the main differences between Toujeo and Lantus?

Toujeo (insulin glargine) is a long-acting basal insulin approved for use in both T1DM and T2DM. It is produced by a chemical modification of regular human insulin which ultimately allows for delayed onset of action and continuous release from the adipose tissue. The result is relative constant insulin levels with no major peaks or troughs in levels over up to 24 hours. Toujeo is available in Toujeo Solostar pens and Toujeo Max Solostar pens in a concentration of 300 units/ml. The advantage of these pens is that they only require a disposable pen needle to administer each dose. This eliminated the need for syringes. The difference between the two formulations is in the volume of the pen size, with the Max Solostar holding twice as much solution as the Solostar. Toujeo Max Solostar is also more expensive.

Lantus (insulin glargine) is also a long-acting basal insulin. Lantus was the first insulin glargine to be approved by the Food and Drug Administration (FDA) and come to the U.S. market. It is available in a 100 unit/ml solution and first came to the market in vials which required a separate needle and syringe. It now has a pen formulation as well known as Lantus Solostar. Both of these products were on the market before Toujeo.

Main differences between Toujeo and Lantus
	Toujeo	Lantus
Drug class	Long-acting basal insulin	Long-acting basal insulin
Brand/generic status	Brand only	Brand and generic alternatives available
What is the generic name?	Insulin glargine	Insulin glargine
What form(s) does the drug come in?	Prefilled insulin pens	Vials and prefilled insulin pens
What is the standard dosage?	0.1 to 0.2 unit/kg/day	0.1 to 0.2 unit/kg/day
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Children ages 6 and up, adults	Children ages 6 and up, adults

Conditions treated by Toujeo and Lantus

Toujeo and Lantus are both approved in the treatment of Type 1 diabetes mellitus and Type 2 diabetes mellitus. They each also can be used in the treatment of gestational diabetes, a type of diabetes that manifests when a woman is pregnant. They have been used off-label, or without the approval of the FDA, in transient, neonatal diabetes as well. Toujeo and Lantus are not indicated in the treatment of diabetic ketoacidosis.

Condition	Toujeo	Lantus
Type 1 diabetes mellitus	Yes	Yes
Type 2 diabetes mellitus	Yes	Yes
Gestational diabetes	Yes	Yes
Transient neonatal diabetes	Off-label	Off-label

Is Toujeo or Lantus more effective?

Toujeo has been compared to Lantus with regard to their pharmacokinetic and pharmacodynamic profiles. One published study shows that Toujeo provides more stable and long-lasting insulin levels as compared to Lantus. This leads to better and more consistent blood glucose control. This type of long-term control is best measured by a value known as hemoglobin A1c (HbA1c). Patients on Toujeo had a lower HbA1c measurement indicating better long-term control. 

Although insulin glargine was designed to be a long-acting basal insulin that could be given once daily, Lantus has been shown to provide better glucose control when given twice daily. Lantus has been shown to provide better control and has decreased the need for rapid insulin dosing when given twice daily instead of just once daily. Toujeo is effective at once-daily dosing.

Toujeo was compared to Lantus and other long-acting insulins in an analysis known as the LIGHTENING study. Toujeo and Lantus have each been shown to be effective at lowering blood sugar, but the concern amongst healthcare providers is the risk for severe hypoglycemia. This analysis showed that the risk of hypoglycemia is considerably lower with Toujeo than with Lantus or other long-acting insulins in Type 2 diabetes mellitus patients. 

Given this information, your prescriber may consider prescribing Toujeo first for its advantages of once-daily dosing and low risk of hypoglycemia. However, your insurance or third-party payor may prefer Lantus or its similar, lower-priced alternatives. This is not meant to be medical advice, and you should discuss all treatment options with your healthcare provider.

Coverage and cost comparison of Toujeo vs. Lantus

Toujeo is a prescription medication covered by most Medicare and commercial insurance providers. Some insurance companies may prefer one long-acting basal insulin over another. Your pharmacist can help you determine if that is the case. The out-of-pocket cost of Toujeo can be as much as $565 per box (containing three 1.5 ml pre-filled pens). A SingleCare savings card can bring this down to $287.

Lantus is also covered by some commercial insurance providers, but few Medicare providers. Providers may prefer you use one of the generic alternatives such as Basaglar Kwikpen. Basaglar Kwikpen is not an approved generic to Lantus but is considered a lower-cost equivalent type product. Your doctor would have to prescribe Basaglar specifically, as your pharmacist can not substitute it for Lantus. The out-of-pocket cost for Lantus Solostar can be expensive, over $100 for one box (containing 5, 3 ml pre-filled pens). A free coupon from SingleCare can help you save and lower the cost to approximately $64 per box.

	Toujeo	Lantus
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	3, 1.5 ml prefilled pens	5, 3 ml prefilled pens
Typical Medicare copay	$25-$447	Typically not covered
SingleCare cost	$287+ per pen	$64+ per pen

Common side effects of Toujeo vs. Lantus

Hypoglycemia is the most commonly observed adverse reaction to insulin therapy across insulin types including insulin glargine. It is defined by low blood glucose levels and symptomatically causes confusion, blurred vision, shakiness, anxiety, and heart palpitations. The occurrence of hypoglycemia may require a dose adjustment in Toujeo or Lantus. It can be reversed by administering glucose in a form that is quickly absorbed.

Patients always sometimes retain sodium causing pooling of fluid in the extremities. This is referred to as peripheral edema. 

The subcutaneous administration of insulin can cause local reactions at the injection site or lipodystrophy. Lipodystrophy is an indentation or thickening of tissue at the injection site. Allergic reactions, though rare, are possible. You should consult your physician or pharmacist for a complete list of possible side effects of Toujeo and Lantus. 

	Toujeo		Lantus
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Hypoglycemia	Yes	5-6.6%	Yes	10.4-23%
Peripheral edema	Yes	Not reported	Yes	22.7%
Lipodystrophy	Yes	Not reported	Yes	Not reported
Weight gain	Yes	Not reported	Yes	Not reported
Allergic reaction	Yes	Not reported	Yes	Not reported
Nasopharyngitis	Yes	7.1-12.8%	No	N/A
Upper respiratory tract infection	Yes	5.7-9.5%	Yes	11.4-29%
Hypertension	No	N/A	Yes	18.9%
Cataract	No	N/A	Yes	15.9%

Source: Toujeo (DailyMed) Lantus (DailyMed)

Drug interactions of Toujeo vs. Lantus

There are classes of drugs that may increase the risk of hypoglycemia occurring with Toujeo and Lantus. Not surprisingly, taking other drugs which are designed to control diabetes in addition to insulin can increase hypoglycemic risk. Common medications are given for high blood pressure, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The combinations of these drugs may require adjustments in the dose of Toujeo or Lantus and more frequent monitoring of blood sugar levels. 

Alternatively, some medications inhibit Toujeo and Latus’ ability to lower blood glucose, and therefore the insulin dosing may need to be increased. Atypical antipsychotics are one such class of drugs, and patients who are on these medications typically require a higher dose of insulin to control their blood sugar.

Beta-blockers, a class of drugs used for a variety of cardiovascular conditions, may mask the symptoms of hypoglycemia, so it is important to monitor your blood glucose regularly when on beta-blockers.

Drug	Drug Class	Toujeo	Lantus
Benazepril Captopril Enalapril Fosinopril Lisinopril Quinapril	Angiotensin-converting enzyme (ACE) inhibitors	Yes	Yes
Candsartan Irbesartan Losartan Olmesartan Telmisartan Valsartan	Angiotensin receptor blockers (ARBs)	Yes	Yes
Isocarboxazid Phenelzine Selegiline	Monoamine oxidase inhibitors (MAOIs)	Yes	Yes
Sulfamethoxazole	Sulfonamide antibiotics	Yes	Yes
Clozapine Aripiprazole Risperidone Quetiapine Ziprasidone	Atypical antipsychotics	Yes	Yes
Dexamethasone Methylprednisolone Prednisone	Corticosteroids	Yes	Yes
Acebutolol Atenolol Bisoprolol Metoprolol Nadolol Nebivolol Propranolol	Beta-blockers	Yes	Yes

Warnings of Toujeo and Lantus

Toujeo and Lantus are pre-filled pens that require a new, disposable pen needle with each use. It is important not to reuse pen needles. Pens are intended for single-patient use only. You should never share your Toujeo or Lantus pens with anyone else.

Changes between insulin types can increase the risk of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). Changes to insulin regimens should be closely monitored by your healthcare professionals. 

Many patients are on more than one insulin product for adequate blood glucose control. Confusing the timing or type of insulin to be given can have serious consequences, including severe hypoglycemia. Always check your product label before administering.

Insulin products, including Toujeo and Lantus, cause a shift of potassium from the extracellular space to the intracellular space. This leads to low levels of potassium circulating known as hypokalemia. This can be very dangerous as it can make it difficult to breathe, cause cardiac ventricular arrhythmias, and even death.

Injection site reactions, hypersensitivity, and severe, life-threatening allergic reactions are all possible with Toujeo and Lantus, although they are rare. You should contact your healthcare professional if this happens and discontinue further use until instructed on next steps by your prescriber.

Frequently asked questions about Toujeo vs. Lantus

What is Toujeo?

Toujeo is a long-acting basal insulin analog designed for prolonged, consistent insulin levels. Toujeo is indicated in the treatment of Type 1 diabetes mellitus, Type 2 diabetes mellitus, and gestational diabetes. It is available in prefilled pens in 1.5 ml each of 300 unit/ml (Solostar) and 3ml prefilled pens of 300 unit/ml (Max Solostar).

What is Lantus?

Lantus is a long-acting basal insulin analog designed for prolonged, consistent insulin levels. Toujeo is indicated in the treatment of Type 1 diabetes mellitus, Type 2 diabetes mellitus, and gestational diabetes. It is available in prefilled pens of 3ml each of 100 units/ml (Solostar) and vials in 10ml of 100 units/ml each.

Are Toujeo and Lantus the same?

Toujeo and Lantus are both long-acting insulin glargine, but are not the same prescription product. Toujeo is insulin glargine in a concentration of 300 units/ml, and Lantus is in a concentration of 100 units/ml. Toujeo is only available in prefilled pens, while Lantus is available in both prefilled pens and vials.

Is Toujeo or Lantus better?

Toujeo has been shown to be associated with a lower risk of hypoglycemia and can consistently be given once daily. Some patients will require twice-daily dosing of Lantus or similar products. While both are effective at lowering blood sugar, Toujeo therapy may offer more benefits than Lantus.

Can I use Toujeo or Lantus while pregnant?

Insulin glargine products are considered primary insulin options in the treatment of gestational diabetes. They should only be used when the benefit outweighs the risk. Uncontrolled blood sugar in pregnancy can have serious consequences for both mother and baby, and insulin glargine products can provide consistent control.

Can I use Toujeo or Lantus with alcohol?

Alcohol can alter the glucose control of insulin, causing blood sugar levels to go up or down unpredictably. Alcohol intake should be limited when taking insulin, and increased blood sugar monitoring may be necessary.

What is the best time of day to take Toujeo?

Toujeo can be given at any time of the day, but most importantly it must be given at the same time each day. Some healthcare professionals do recommend morning dosing in order to avoid nocturnal hypoglycemia (low blood sugar in your sleep).

What are the common side effects of Toujeo?

Hypoglycemia is a common adverse event of Toujeo and all insulins. Toujeo is also known to be associated with upper respiratory tract infections and nasopharyngitis, also referred to as the common cold.

Who should not take Toujeo?

Toujeo should never be taken in patients who are experiencing hypoglycemia. Toujeo is contraindicated in patients with a history of an allergic reaction to insulin glargine.