Drugs Facts: Fixed Ratio Combinations

Tired of injecting multiple medications into your body to help manage your blood sugars? Wouldn’t it be convenient if they could be administered all in the same injection? Enter fixed ratio combination drugs! Similar to how premixed insulins are a combination of basal insulin and bolus insulin, fixed ratio combination drugs are a mix of basal insulin and GLP-1 receptor agonists.

Let’s take a few steps back as all of these different medications can make your head spin! Again, these fixed ratio combination drugs are a mix of insulin and GLP-1 receptor agonists. The type of insulin used is basal insulin, which is “background” insulin that lasts all day. GLP-1 receptor agonists are injectable medications, but they are not insulin. They help lower blood sugars by 1) helping the body secrete insulin 2) decreasing how much sugar the liver produces and 3) slowing down the digestion of food. Due to how they work, they can also help with weight loss.

Many people with type 2 diabetes, especially if they’ve had diabetes for a while, benefit from these two separate types of medications. Unfortunately, both types of medications can be expensive. Many people end up saving money by using a combination product as they then only have to pay one copay, not two. There’s also only one script to pick up from the pharmacy and one medication to inject. Overall, these fixed ratio combination drugs can potentially save time and money.

The two medications in this drug class currently available are Soliqua and Xultophy and were both FDA approved in 2016. Both come in pens, not vial and syringe. Soliqua is to be taken within one hour of your first meal of the day, while Xultophy can be taken at any time. Both medications are to be taken once daily and it’s important you take them around the same time every day. Just like with insulin, you will take a certain amount that is prescribed to you by your healthcare provider. Be aware that this dose may change over time. Since the medications are mixed in the pen already, if the number of units you take is increased, you will be taking more of both types of drugs. There is no way to change the dose of one medication without changing the other, hence “fixed ratio”.

Although these combination drugs are extremely helpful for some people, they’re not a good fit for others. If you require more than 50 or 60 units of basal insulin, this drug is not for you as those are the max amount that can be taken of Xultophy and Soliqua, respectively. If you only need a small amount of insulin this drug may not make sense either, as then you’d only be getting a small amount of the GLP-1 receptor agonist with each use. For people in either of these situations, taking the medications separately would be better, as the dosage of one medication wouldn’t be dependent on the other.

Insulin generally causes weight gain, while GLP-1 receptor agonists actually cause weight loss, so your experience with these medications could vary. You could potentially experience weight gain, weight loss or have no change at all. Insulin may also cause low blood sugars, so this is a potential side effect. GLP-1 receptor agonists can cause gastrointestinal side effects such as nausea, vomiting and diarrhea but often improve over time.