Insuman Komb 25 GT - instructions for use, dose, side effects, contraindications

Excipients: protamine sulfate 0.095 mg, m-cresol 1500 mg, phenol 0.600 mg, zinc chloride 0.017 mg, sodium dihydrogen phosphate dihydrate 2,100 mg, glycerol (85%) 18.824 mg, sodium hydroxide (used to adjust the pH) 0.461 mg, hydrochloric acid . (used to adjust the pH) 0.097 mg, water for injection 978.877 mg.

Insuman® Comb 25 Gt 100 IU / mL

1 ml of the suspension contains:

active substance: human insulin (HR 1799) (25% soluble insulin and 75% crystalline protamine insulin) 3.571 mg (100 IU);

Excipients: protamine sulfate 0.238 mg, m-cresol 1.500 mg, phenol 0.600 mg, zinc chloride 0.042 mg, sodium dihydrogen phosphate dihydrate 2,100 mg, glycerol 85% 8,824 mg, sodium hydroxide (used to adjust the pH) 0.576 mg, hydrochloric acid concentrated used to adjust the pH), water for injection 977.307 mg.

Description:The suspension is white or almost white, easily dispersible.

Pharmacotherapeutic group:A hypoglycemic agent is a combination of insulin of short and medium duration

ATX: & nbsp

A.10.A.C Insulins and their analogues of average duration of action

Pharmacodynamics:

Insuman® Comb 25 GT contains insulin, identical in structure to human insulin and obtained by genetic engineering using a K12 strain E.Coli K12 135 pINT90d.

Hypoglycemic effect occurs within 30-60 minutes and reaches a maximum within 2-4 hours after subcutaneous administration of the drug. The effect lasts for 12-19 hours.

Mechanism of action of insulin:

- reduces the concentration of glucose in the blood, promotes anabolic effects and reduces catabolic effects;

- Increases the transport of glucose into cells and the formation of glycogen in muscles and liver and improves the utilization of pyruvate, inhibits glycogenolysis and glycoeogenesis;

- increases lipogenesis in the liver and adipose tissue and inhibits lipolysis;

- promotes the entry of amino acids into cells and protein synthesis;

- increases the flow of potassium into the cells.

Insuman® Comb 25 GT is an average-acting insulin with a gradual onset of action. After subcutaneous administration, the hypoglycemic effect occurs within 30-60 minutes and reaches a maximum within 2-4 hours. The effect lasts for 12-19 hours.

Pharmacokinetics:

In healthy individuals, the half-life of insulin from the plasma is approximately 4-6 minutes. In patients with severe renal insufficiency, it is more prolonged. However, it should be noted that the pharmacokinetics of insulin does not reflect its metabolic action.

Indications:Diabetes, requiring insulin treatment.

Contraindications:

- Hypoglycemia;

- a hypersensitivity reaction to insulin or to any of the auxiliary components of the drug, except where insulin therapy is vital.

Carefully:

- With renal insufficiency (there may be a decrease in insulin requirements due to a decrease in insulin metabolism);

- in elderly patients (gradual decrease in kidney function may lead to an ever-increasing decrease in insulin requirements);

- in patients with hepatic insufficiency (the need for insulin can decrease due to a decrease in the ability to gluconeogenesis and decrease metabolism of insulin);

- in patients with severe stenosis of the coronary and cerebral arteries (in these patients hypoglycemic episodes can be of particular clinical significance, since there is an increased risk of cardiac or cerebral complications of hypoglycemia);

- in patients with proliferative retinopathy, especially those who were not treated with photocoagulation (laser therapy), since they have hypoglycemia risk of transient amaurosis - complete blindness;

- in patients with intercurrent diseases (as in intercurrent diseases, the need for insulin often increases).

Pregnancy and lactation:

Treatment of Insuman® Comb 25 GT should be continued when pregnancy occurs.Insulin does not penetrate the placental barrier.

Effective maintenance of metabolic control throughout pregnancy is mandatory for women who had diabetes before pregnancy, or for women who developed gestational diabetes.

The need for insulin during pregnancy can decrease during the first trimester of pregnancy and usually rises during the second and third trimester of pregnancy. However, immediately after childbirth, the need for insulin decreases rapidly (an increased risk of developing hypoglycemia). In pregnancy and especially after childbirth, careful monitoring of the concentration of glucose in the blood is mandatory.

When pregnancy occurs or when planning pregnancy, it is necessary to inform the doctor.

During the period of breastfeeding, there are no restrictions on insulin therapy. However, dosage and diet adjustments may be required.

Dosing and Administration:

The target blood glucose concentration, the insulin preparations that should be used, the insulin dosage regimen (doses and timing of administration) should be determined and adjusted individually to match the diet,the level of physical activity and lifestyle of the patient.

Treatment with insulin requires appropriate self-treatment of the patient. The doctor should give the necessary instructions how often to determine the concentration of glucose in the blood, and also give appropriate recommendations in case of any changes in the diet or in the mode of insulin therapy.

There are no strictly regulated dosing rules for insulin. However, the average daily dose of insulin is 0.5-1.0 IU per kg of body weight per day, and the share of human insulin prolonged action accounts for 60% of the required daily dose of insulin.

Switching from another type of insulin to Insuman® Comb 25 GT

When transferring patients from one type of insulin to another, it may be necessary to adjust the dosage regimen of insulin: for example, when switching from animal insulin to human insulin, or from one preparation of human insulin to another, or from the treatment with soluble human insulin to regimen , which includes longer-acting insulin.

After switching from animal insulin to human insulin, it may be necessary to reduce the dose of insulin, especially in patients,which were previously conducted at sufficiently low concentrations of glucose in the blood; in patients with a tendency to develop hypoglycemia; in patients who previously required high doses of insulin due to the presence of antibodies to insulin.

The need for correction (reduction) of the dose can occur immediately after switching to a new type of insulin or develop gradually over several weeks.

When switching from one type of insulin to another and then in the following first weeks, careful monitoring of the concentration of glucose in the blood is recommended. In patients who required high doses of insulin because of the presence of antibodies, it is recommended to switch to another type of insulin under medical supervision in the hospital.

Additional change in the dose of insulin

Improving metabolic control can lead to an increase sensitivity to insulin, as a result of which the body's need for insulin may decrease.

A dose change may also be required when:

- change in patient's body weight;

- lifestyle changes (including diet, level of physical activity, etc.);

- other circumstances that may increase predisposition to hypo- or hyperglycemia (see section "Special instructions").

Dosing regimen in special patient groups

Elderly people

In elderly people, the need for insulin may decrease (see the sections "With caution", "Special instructions").

It is recommended that initiation of treatment, increasing doses and selection of maintenance doses in elderly patients with diabetes mellitus be carried out with caution in order to avoid hypoglycemic reactions.

Patients with hepatic or renal insufficiency

In patients with hepatic or renal insufficiency, the need for insulin may decrease.

Introduction of Insuman® Comb 25 GT

Insuman® Comb 25GT is usually injected deeply subcutaneously 30-45 minutes before meals. Place the injection within one area of the injection each time you need to change. Change in the area of insulin administration (for example, from the abdomen to the thigh area) should only be done after consultation with the doctor, since the absorption of insulin and, accordingly, the effect of reducing blood glucose concentration may vary depending on the area of administration (eg, abdominal region or thigh area) .

Insuman® Comb 25 GT is not used in various kinds of insulin pumps (including implanted ones).

Intravenous administration of the drug is absolutely impossible!

Do not mix Insuman® Comb 25 GT with animal insulin, insulin analogs, insulin intended for insulin pumps or other medications.

Insuman® Comb 25 HT can be mixed with all human preparations insulin company Sanofi-aventis groups, but remember that the contents of 10 ml bottles at a concentration of 40 IU / ml can not be mixed with insulin with a concentration of 100 IU / ml, and the contents of 5 ml bottles or cartridges can not be mixed with 40 IU / ml insulin .

It should be remembered that the concentration of insulin in bottles of 10 ml is 40 IU / ml, and in bottles of 5 ml or cartridges 3 ml - 100 IU / ml, therefore it is necessary to use only plastic syringes, calculated for the appropriate concentration of insulin in case of using vials (for vials 10 ml - syringes calculated for a concentration of 40 IU / ml, in the case of using 5 ml vials with syringes calculated for a concentration of 100 IU / ml),or with OptiPen Pro1 syringes when using cartridges; Cartridges Insuman® Comb 25 Gt should only be used with an Optipen Pro 1 syringe pen and should not be used with other reusable syringes, since the accuracy of insulin dosing was only established with an Optipen Pro1 syringe pen.

A plastic syringe should not contain any other drug or its residual quantities.

Before the first set of insulin from the vial, it is necessary to remove the plastic cap (the presence of a cap is evidence of an unopened vial). Immediately before the set, the suspension should be well mixed, without the formation of foam. This is best done by turning the bottle, holding it at an acute angle between the palms. After mixing, the slurry should have a uniform consistency and a milky white color. The suspension can not be used if it has any other form, i.e. if it remains clear or flakes or lumps in the liquid itself, on the bottom or walls of the vial. In such cases, you should use a different vial that meets the above conditions, and also inform the doctor.

Before dialing insulin from the vial, a volume of air equal to the prescribed dose of insulin is sucked into the syringe and injected into the vial (not into the liquid). Then the vial with the syringe is turned with a syringe down and the necessary amount of insulin is collected. Before injection, it is necessary to remove air bubbles from the syringe.

At the injection site, take a skin fold, inject the needle under the skin, and slowly inject insulin. After injection, the needle is slowly removed and the injection site is pressed with a cotton swab for a few seconds.

The date of the first set of insulin from the vial should be written on the label of the vial.

After opening, the vials can be stored at a temperature of no higher than + 25 ° C for 4 weeks in a place protected from light and heat.

Before installing the cartridge (100 IU / ml) into the Optipen Pro1 syringe pen, let it stand for 1-2 hours at room temperature. After this, softly turning the cartridge (up to 10 times), obtain a homogeneous suspension. Each cartridge additionally has three metal balls for faster mixing of its contents. After installing the cartridge in the syringe pen, before each injection of insulin several times turn the syringe handle to obtain a homogeneous suspension.After mixing, the slurry should have a uniform consistency and a milky white color. The suspension can not be used if it has any other form, i.e. if it remains clear or flakes or lumps form in the liquid itself, on the bottom or walls of the cartridge. In such cases, you should use a different cartridge that meets the above conditions, and also inform the doctor.

Remove any air bubbles from the cartridge before injection (see the OptiPro Pro1 syringe instructions manual).

The cartridge is not designed to mix Insuman® Comb 25 GT with other insulins.

Empty cartridges can not be refilled.

In the event that the syringe pen has failed, you can enter the required dose from the cartridge using a conventional syringe. It should be remembered that the concentration of insulin in the cartridge is 100 IU / ml, so it is necessary to use only plastic syringes, calculated for this concentration of insulin. The syringe should not contain any other drug or its residual quantities.

After installing the cartridge, it can be used for 4 weeks.It is recommended to store at a temperature not higher than + 25 ° C in a place protected from light and heat. In the process of using the cartridge syringe pen do not store in the refrigerator.

After installing a new cartridge, check that the syringe pen is operating correctly before the first dose is injected (see the instructions for using the Optipen Pro1 syringe pen).

Side effects:

Hypoglycaemia

Hypoglycemia, the most common side effect of insulin therapy, can develop if the dose of insulin administered exceeds the need for it (see "Special instructions"). Severe repeated episodes of hypoglycemia can lead to the development of neurological symptoms, including coma, convulsions (see also the section "Overdose"). Prolonged or severe episodes of hypoglycemia can endanger the lives of patients.

In many patients, the symptoms and manifestations of neuroglycopenia can be preceded by symptoms of reflex (in response to developing hypoglycemia) activation of the sympathetic nervous system. Usually, with a more pronounced or faster decrease in the concentration of glucose in the blood, the phenomenon of reflex activation of the sympathetic nervous system and its symptoms are more pronounced.

With a sharp decrease in the concentration of glucose in the blood may develop hypokalemia (complications of the cardiovascular system) or the development of cerebral edema.

The undesirable phenomena observed in clinical studies that are classified according to the system-organ classes and in order of decreasing incidence are listed below: very frequent (≥1 / 10); Frequent (≥1 / 100 and <1/10); infrequent (≥1 / 1000 and <1/100); Rare (≥1 / 10000 and <1/1000); very rare (<1/10000); the frequency is unknown (according to available data, it is not possible to determine the incidence of side effects).

Immune system disorders

Allergic reactions of the immediate type to insulin or to the auxiliary substances of the drug (the frequency is unknown) can manifest as generalized skin reactions (frequency unknown), angioedema (frequency unknown), bronchospasm (unknown frequency), lowering of arterial pressure (frequency unknown) and anaphylactic shock (infrequent reactions) and may endanger the patient's life. Allergic reactions require immediate immediate emergency measures.

The use of insulin can cause the formation of antibodies to insulin (the frequency is unknown). In rare cases, the presence of such antibodies to insulin may require a change in the dose of insulin to correct the tendency to hyper- or hypoglycemia.

Disorders from the metabolism and nutrition

Insulin can cause sodium retention (the frequency is unknown) and swelling (often), especially when improving previously inadequate metabolic control through the use of more intensive insulin therapy.

Disturbances on the part of the organ of sight

Significant changes in glycemic control can cause transient visual disorders (the frequency is unknown) due to a temporary change in the turgor of the lens of the eyes and their refractive index.

Long-term improvement in glycemic control reduces the risk of progression of diabetic retinopathy. However, more intensive insulin therapy with a sharp improvement in glycemic control may be associated with a temporary deterioration in the course of diabetic retinopathy (the frequency is unknown). In patients with proliferative retinopathy, especially if they do not receive treatment with photocoagulation (laser therapy), severe hypoglycemic episodes can cause a transient amaurosis (complete loss of vision) (the frequency is unknown).

Disturbances from the skin and subcutaneous tissues

As with any insulin therapy, it is possible to develop lipodystrophy at the injection site (the frequency is unknown) and slow the local absorption of insulin. Continuous injection site changes within the recommended area of administration may help to reduce or eliminate these reactions.

General disorders and disorders at the site of administration

Frequent moderate reactions occur at the site of administration. These include redness at the injection site (frequency unknown), pain at the injection site (frequency unknown), itching at the injection site (frequency unknown), urticaria at the injection site (frequency unknown), swelling at the injection site (frequency unknown), or inflammatory reaction at the injection site (frequency unknown).

The most pronounced reactions to insulin at the injection site usually disappear after a few days or a few weeks.

Overdose:

Symptoms

An overdose of insulin, for example, the introduction of excessive amounts of insulin compared to consumed food or energy expenditure, can lead to severe and sometimes prolonged and life-threatening hypoglycemia.

Treatment

Light episodes of hypoglycemia (the patient is conscious) can be stopped by ingesting carbohydrates. You may need to adjust the dose of insulin, the diet and physical activity.

Severe episodes of hypoglycemia with coma, convulsions or neurologic disorders can be stopped by intramuscular or subcutaneous administration of glucagon or by intravenous administration of a concentrated dextrose solution.

In children, the amount of dextrose administered is proportional to the body weight of the child. After increasing the concentration of glucose in the blood, it may be necessary to maintain carbohydrate intake and observation, since after the apparent clinical elimination of symptoms of hypoglycemia, its re-development is possible.

In cases of severe or prolonged hypoglycemia, following injection of glucagon or the administration of dextrose, it is recommended that infusion be administered with a less concentrated dextrose solution in order to prevent the re-development of hypoglycemia. Young children should carefully monitor the concentration of glucose in the blood, due to the possible development of severe hyperglycemia.

Under certain conditions, hospitalization of patients in intensive care units is recommended for more careful monitoring of their condition and control of ongoing therapy.

Interaction:

Combined use with hypoglycemic agents for oral administration, angiotensin converting enzyme inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, propoxyphene, salicylates, amphetamine, anabolic steroids and male sex hormones, cibenzoline, cyclophosphamide, fenfluramine, guanethidine, ifosfamide, phenoxybenzamine, phentolamine , somatostatin and its analogs, sulfonamides, tetracyclines, tritokvaline or trophosphamide may strengthen ь hypoglycemic action of insulin and increases the predisposition to the development of hypoglycemia.

Joint use with corticotropin, glucocorticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, estrogens and progestogens (eg, present in combination contraceptives), phenothiazine derivatives, somatotropin, sympathomimetic agents (eg, epinephrine,salbutamol, terbutaline), thyroid hormones, barbiturates, nicotinic acid, phenolphthalein, phenytoin derivatives, doxazosin may weaken the hypoglycemic effect of insulin.

Beta-blockers, clonidine, lithium salts can either potentiate or weaken the effect of hypoglycemic action of insulin.

With ethanol

Ethanol can either potentiate or weaken the hypoglycemic action of insulin. The use of ethanol can cause hypoglycemia or reduce the already low blood glucose to a dangerous level. The tolerance of ethanol in patients receiving insulin is reduced. The permissible quantities of alcohol consumed must be determined by the doctor.

With pentamidine

With simultaneous admission, it is possible to develop hypoglycemia, which can sometimes turn into hyperglycemia.

When combined with sympatholytic agents, such as beta-blockers, clonidine, guanethidine and reserpine the weakening or complete absence of reflex symptoms (in response to hypoglycemia) of the activation of the sympathetic nervous system is possible.

Special instructions:

In case of insufficient glycemic control or a tendency to episodes of hyper or hypoglycemia, before making a decision to correct the dose of insulin, it is necessary to check the performance of the prescribed mode of insulin administration, to make sure that insulin is injected into the recommended area, to check the correctness of the injection technique and all other factors , which can affect the effect of insulin.

Since the simultaneous use of a number of drugs (see the section "Interaction with other drugs") can weaken or intensify the hypoglycemic effect of the preparation Insuman® Comb 25 GT, no other drugs should be taken with its application without the special permission of the doctor.

Hypoglycaemia

Hypoglycemia occurs if the dose of insulin exceeds the need for it.

The risk of hypoglycemia is high at the beginning of treatment with insulin, when another insulin preparation, patients with low maintenance concentration of glucose in the blood.

As with all insulins, special care should be taken and intensive monitoring of blood glucose levels in patients,for which hypoglycemic episodes can be of particular clinical importance, such as patients with severe stenosis of the coronary or cerebral arteries (risk of cardiac or cerebral complications of hypoglycemia), as well as in patients with proliferative retinopathy, especially if they have not been photocoagulated (laser therapy), since they have a risk of transient amaurosis (complete blindness) with the development of hypoglycemia.

There are certain clinical signs and symptoms that should indicate to the patient or others about developing hypoglycemia. These include: increased sweating, skin moisture, tachycardia, heart rhythm disturbances, increased blood pressure, chest pains, tremor, anxiety, hunger, sleepiness, sleep disorders, feelings of fear, depression, irritability, unusual behavior, anxiety, paresthesia in the mouth and around the mouth, pallor of the skin, headache, movement coordination disorders, as well as transient neurological disorders (speech and vision disorders, paralytic symptoms) and unusual sensations .With an increasing decrease in glucose concentration, the patient may lose self-control and even consciousness. In such cases, there may be a cold snap, skin moisture, and convulsions may also appear.

Therefore, every patient with diabetes who receives insulin should learn to recognize unusual symptoms that are a sign of developing hypoglycemia. Patients who regularly monitor the concentration of glucose in the blood are less likely to develop hypoglycemia. The patient himself can correct the observed decrease in blood glucose concentration by taking sugar or food with a high carbohydrate content. For this purpose, the patient should always carry 20 g of glucose. In more severe conditions of hypoglycemia, a glucocaine injection is indicated (which can be done by a doctor or average medical personnel). After sufficient improvement, the patient should eat. If hypoglycemia can not be immediately remedied, then it is urgent to call a doctor. It is necessary to inform the doctor immediately about the development of hypoglycemia, so that he makes a decision about the need to correct the dose of insulin.

Failure to follow a diet, insulin injections, increased insulin requirements due to infectious or other diseases, decreased physical activity may lead to an increase in blood glucose (hyperglycemia), possibly with an increase in the concentration of ketone bodies in the blood (ketoacidosis). Ketoacidosis can develop within a few hours or days. At the first symptoms of metabolic acidosis (thirst, frequent urination, loss of appetite, fatigue, dry skin, deep and rapid breathing, high concentrations of acetone and glucose in the urine), urgent medical intervention is necessary.

When a doctor changes (for example, during hospitalization for an accident, illness during a vacation), the patient should inform the doctor that he has diabetes mellitus.

Patients should be warned about conditions that may change, be less pronounced, or completely absent symptoms warning of hypoglycemia, for example:

- with a significant improvement in glycemic control;

- with gradual development of hypoglycemia;

- in elderly patients;

- in patients with autonomic neuropathy;

- in patients with a long history of diabetes mellitus;

- in patients who are simultaneously receiving treatment with certain medications (see section "Interaction with other drugs.") Such situations can lead to the development of severe hypoglycemia (and possibly with loss of consciousness) earlier than the patient realizes that he is developing, hypoglycemia.

In case of detection of normal or reduced values of glycosylated hemoglobin, consideration should be given to the possibility of developing recurring, unrecognized (especially nocturnal) episodes of hypoglycemia.

To reduce the risk of hypoglycemia, it is required that the patient accurately follow the prescribed dosing regimen and diet, properly administered insulin injections and be warned about the symptoms of developing hypoglycemia.

Factors that increase predisposition to the development of hypoglycemia require careful monitoring and may require dose adjustment.

These factors include:

- change in the area of insulin administration;

- Increased sensitivity to insulin (eg, elimination of stress factors);

- unusual, increased or prolonged physical activity;

- intercurrent pathology (vomiting, diarrhea);

- Inadequate intake of food;

- skipping meals;

- alcohol consumption;

- Some uncompensated endocrine diseases (such as hypothyroidism and insufficiency of the anterior lobe of the pituitary gland or insufficiency of the adrenal cortex);

- simultaneous intake of certain medicines (see section "Interaction with other drugs").

Intercurrent diseases

Intercurrent diseases require intensive metabolic control. In many cases, urine samples are shown for the presence of ketone bodies and insulin dose adjustment is often necessary. The need for insulin is often increased. Patients with type 1 diabetes must continue to regularly consume at least a small amount of carbohydrates, even if they can take only a small amount of food or if they have vomiting; they should never completely stop the introduction of insulin.

Cross immunological reactions

In a fairly large number of patients with hypersensitivity to animal insulin, the transition to human insulin is difficult due to the cross-immunological reaction of human insulin and insulin of animal origin.With increased sensitivity of the patient to insulin of animal origin, as well as to m-cresol, tolerability of the drug Insuman® Comb 25 Gt should be evaluated in the clinic with the help of intradermal tests. If a hypersensitivity to human insulin (an immediate reaction of the Arthus type) is detected during the intradermal test, further treatment should be carried out under medical supervision.

Effect on the ability to drive transp. cf. and fur:

The patient's ability to concentrate and the speed of psychomotor reactions can be compromised by hypoglycemia or hyperglycemia, as well as by visual disorders. This can pose a certain risk in situations where these capabilities are important (driving or other mechanisms).

Patients should be advised to use caution and avoid hypoglycemia while driving. This is especially important in patients who have reduced or no awareness of symptoms indicating the development of hypoglycemia, or there are frequent episodes of hypoglycemia. Such patients shouldindividually address the issue of the ability to drive vehicles or engage in other potentially hazardous activities.

Form release / dosage:

Suspension, 40 IU / ml and 100 IU / ml.

Packaging:

Suspension 40 IU / ml:

For 10 ml of the drug in a bottle of clear and colorless glass (type I). The bottle is sealed with a cork, crimped with an aluminum cap and covered with a protective plastic lid. 5 vials with instructions for use in a cardboard box.

A suspension of 100 IU / ml:

1) For 5 ml of the drug in a bottle of clear and colorless glass (type 1). The bottle is sealed with a cork, crimped with an aluminum cap and covered with a protective plastic lid. 5 vials with instructions for use in a cardboard box.

2) 3 ml of the drug in a cartridge of transparent and colorless glass (type I).

The cartridge is sealed on one side with a stopper and crimped with an aluminum cap, on the other side by a plunger. Additionally, three metal balls are placed in the cartridge. For 5 cartridges along with instructions for use in a cardboard box.

Storage conditions:

Store at temperatures from +2 to +8 ° C. Do not freeze! Avoid contact with the walls of the refrigerator.

Keep out of the reach of children!

Shelf life:

2 years.

Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:П N011993 / 01

Date of registration:24.08.2011

Expiration Date:Unlimited

Date of cancellation:2018-02-09

The owner of the registration certificate:Aventis Pharma Deutschland GmbHAventis Pharma Deutschland GmbH Germany

Manufacturer: & nbsp

AVENTIS PHARMA Deutschland, GmbH Germany

Representation: & nbspSanofi Aventis GroupSanofi Aventis Group

Information update date: & nbsp09.02.2018

Illustrated instructions

Instructions

Insuman® Comb 25 GT (Insuman® Comb 25 GT)