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Novolin N Human Insulin 100 [iU]/mL Injection, Suspension — NDC 00169-3004-15 package photo

Novolin N Human Insulin 100 [iU]/mL Injection, Suspension

by Novo Nordisk · 5 SYRINGE, PLASTIC in 1 CARTON (0169-3004-15) / 3 mL in 1 SYRINGE, PLASTIC (0169-3004-01)
NDC 00169-3004-15
🏷️ FDA NDC (as labeled) 0169-3004-15 billing pads the labeler segment with a zero
This package
Contains3 mL in 1 syringe, plastic Cost per mL$5.82 NADAC Per package$87.35 / 15 ml Pack sizes2 compare ↓
Also priced by: Medicaid pays $6.61/unit · Part D plans $5.81/unit — full pricing hub ↓
Also comes in: 5 syringes 00169-3004-25
OTC Brand On market Non-controlled
🗂️ Data synced Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

🆔 Identity & classification

FDA NDC (as labeled) 0169-3004-15
Product NDC 0169-3004
11-digit billing NDC 00169300415
NCPDP billing unit ML — per mL (volume)
UNII 1Y17CTI5SR
Application # BLA019959
SPL Set ID 82f1445c-b2c6-445a-82cf-ba8825fac776
Established class (EPC) Insulin
Chemical class Insulin
DEA schedule Non-controlled
Marketing category BLA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2019-09-06
Route SUBCUTANEOUS
Dosage form INJECTION, SUSPENSION
Substance INSULIN HUMAN
GPI-14 2710402000D320
GPI class NovoLIN N FlexPen
GCN Seq No 051292
GCN 18488
HICL code 000780
Ingredient (HICL) Insulin Nph Human Isophane
HIC1 code C
Therapeutic class — broad (HIC1) Electrolyte Balance/Metabolism/Nutrition
HIC2 code C4
Therapeutic class — intermediate (HIC2) Antihyperglycemics
HIC3 code C4G
Therapeutic class — specific (HIC3) Insulins
AHFS code 68:20.08.00
AHFS class Insulins
FDB label name NOVOLIN N 100 UNIT/ML FLEXPEN
FDB brand name Novolin N Flexpen
Legend status O — Over-the-counter (OTC) drug or device
Biologic (Purple Book) 351(a)
Why two NDCs? The FDA registers this code as 0169-3004-15 — a 4-4-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the labeler segment → 00169-3004-15. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

🏭 Manufacturer & labeler

LabelerNovo Nordisk
FDA applicationBLA019959 (BLA)
Labeler code00169
First marketedSep 2019
Product typeHuman Otc Drug
Portfolio74 products on file
The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

🩺 Clinical

Label name NOVOLIN N 100 UNIT/ML FLEXPEN Ingredient Insulin Nph Human Isophane
📖 What it is MedlinePlus · NLM

Human insulin is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is too high because the body does not produce or use insulin normally) that cannot be controlled with oral medications alone. Human insulin is in a class of medications called hormones. Human insulin is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other...

Read the full MedlinePlus article ↗
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

🧪 Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

  • UNII PDC6A3C0OX
    Glycerin is a clear, thick liquid derived from plant oils or fats. It acts as a humectant to retain moisture, a sweetener, and a solvent in medications.
  • UNII QTT17582CB
    A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.
  • UNII GGO4Y809LO
    Metacresol is a preservative derived from coal tar or petroleum. It prevents bacterial and fungal growth in liquid medicines, helping keep the product safe and stable during storage.
  • UNII 339NCG44TV
    Phenol is a chemical compound derived from coal tar or petroleum. It serves as a preservative and antimicrobial agent in medicines, helping prevent bacterial and fungal growth to keep the product stable and safe during storage.
  • UNII 0DE9724IHC
    Protamine sulfate is a protein derived from fish sperm that acts as a binder and stabilizer in medications. It helps hold tablet ingredients together and can improve the stability of certain drug formulations.
  • UNII 55X04QC32I
    A strong alkaline chemical used to adjust and maintain the pH balance of liquid medicines. It helps keep the medicine stable and ensures it stays effective during storage.
  • UNII GR686LBA74
    Sodium phosphate, dibasic is a salt derived from phosphoric acid. It acts as a buffer to help maintain the medicine's pH balance and may serve as a binder or filler in tablets and capsules.
  • UNII 059QF0KO0R
    Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.
  • UNII J41CSQ7QDS
    A mineral element that strengthens tablet structure and acts as a processing aid. Zinc helps bind ingredients together and may improve the medicine's stability during manufacturing and storage.

9 inactive ingredients listed in the exact product block matched to this NDC.

Where does this data come from?
Data sourced from official FDA Structured Product Labeling (SPL) via DailyMedingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

💲 Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer mLPer package
Retail pharmacies payNADAC · weekly $5.824 $87.35 / 15 ml
Medicaid paysCMS SDUD · 12 mo $6.61 $99.12 / 15 ml
Medicare drug plans payPart D · Q2 2026 $5.81 $87.12 / 15 ml
NADAC price history (per mL) — tap or hover for the price & month
Jun 2021 Dec 2025 Apr 2026 Aug 2026 $16.757 $5.820
▼ Down 65% over the last 13 months.
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

🔁 Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Novolin R 100 [iU]/mL 00169-3003-15 Novo 5 syringes $5.816 Availability likely +0%
Novolin N 100 [iU]/mLthis 00169-3004-15 Novo 5 syringes $5.823 Availability likely
Novolin 70/30 100 [iU]/mL 00169-3007-15 Novo 5 syringes $5.826 Availability likely +0%
Humulin N 100 [iU]/mL 00002-8805-59 Eli 5 syringes $9.035 Availability likely +55%
Novolin N 100 [iU]/mL 50090-6565-00 A-S 5 syringes Discontinued
Novolin R 100 [iU]/mL 00169-1833-02 Novo 1 vial FDA listed
Novolin N 100 [iU]/mL 00169-1834-02 Novo 1 vial FDA listed
Novolin 70/30 100 [iU]/mL 00169-1837-02 Novo 1 vial FDA listed
Novolin 70/30 100 [iU]/mL 50090-0403-00 A-S 1 vial FDA listed
About this product: this is a biologic. Biologics don't have small-molecule generics — competition comes from FDA-licensed biosimilars (shown above), not generics.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & biosimilar status

🏛️
1991
First FDA approval
Jul 1991
📍
2026
Currently FDA-listed
35 years listed
🧬
·
Biosimilars
see Purple Book
🧬Biologic — competition comes from biosimilars

Biologics have no small-molecule generics; biosimilar competition is tracked in the FDA Purple Book.

Where does this data come from?
Patents and exclusivity from the FDA Purple Book (biologics), refreshed from public FDA data. Biosimilar launch timing is an estimate, not a guarantee.

🗺️ Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for 00169-3004-15, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q4 2025 · 4 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
14.5K
Units reimbursed last 4 qtrs
229.5K
Gross reimbursed last 4 qtrs
$1.52M
Avg / prescription
$104.52
Avg / unit
$6.6080
Latest quarter Q4 2025
3KRx
Medicaid pays / mL
$6.6080
gross reimbursed
vs
NADAC / mL
$5.8235
acquisition cost
=
Spread
+$0.7845
+13% vs cost
What Medicaid paid per mL (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care
42% FFS 58% MCO
Fee-for-service · 6,061 Rx Managed care · 8,451 Rx
State Medicaid map
Alaska: no data reported AK Maine: 576 units · 41.3 per 100k residents ME Washington: 420 units · 5.4 per 100k residents WA Idaho: no data reported ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: 2,493 units · 43.5 per 100k residents MN Wisconsin: no data reported WI Michigan: 14,604 units · 146 per 100k residents MI New York: 21,669 units · 111 per 100k residents NY Vermont: 189 units · 29.2 per 100k residents VT New Hampshire: no data reported NH Oregon: 5,526 units · 131 per 100k residents OR Nevada: 2,934 units · 91.9 per 100k residents NV Wyoming: no data reported WY South Dakota: 816 units · 88.8 per 100k residents SD Iowa: 4,611 units · 144 per 100k residents IA Illinois: 492 units · 3.9 per 100k residents IL Indiana: 10,029 units · 146 per 100k residents IN Ohio: 4,206 units · 35.7 per 100k residents OH Pennsylvania: 10,767 units · 83.1 per 100k residents PA New Jersey: 2,310 units · 24.9 per 100k residents NJ Massachusetts: 21,498 units · 307 per 100k residents MA California: 36,825 units · 94.5 per 100k residents CA Utah: 450 units · 13.2 per 100k residents UT Colorado: 11,385 units · 194 per 100k residents CO Nebraska: no data reported NE Missouri: 177 units · 2.9 per 100k residents MO Kentucky: 984 units · 21.7 per 100k residents KY West Virginia: 3,096 units · 175 per 100k residents WV Virginia: 1,380 units · 15.8 per 100k residents VA Maryland: 5,277 units · 85.4 per 100k residents MD Connecticut: 1,263 units · 34.9 per 100k residents CT Rhode Island: no data reported RI Arizona: 699 units · 9.4 per 100k residents AZ New Mexico: 7,836 units · 371 per 100k residents NM Kansas: 1,794 units · 61.0 per 100k residents KS Arkansas: no data reported AR Tennessee: 5,238 units · 73.5 per 100k residents TN North Carolina: 2,541 units · 23.5 per 100k residents NC South Carolina: 687 units · 12.8 per 100k residents SC Delaware: 2,784 units · 270 per 100k residents DE Oklahoma: 3,765 units · 92.9 per 100k residents OK Louisiana: 336 units · 7.3 per 100k residents LA Mississippi: 177 units · 6.0 per 100k residents MS Alabama: 2,643 units · 51.7 per 100k residents AL Georgia: 5,499 units · 49.9 per 100k residents GA D.C.: no data reported DC Hawaii: 3,114 units · 217 per 100k residents HI Texas: 25,413 units · 83.3 per 100k residents TX Florida: 3,033 units · 13.4 per 100k residents FL
Units reimbursed · per 100k residents
2.9371
gray = no data reported
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 New Mexico 371 /100k
2 Massachusetts 307 /100k
3 Delaware 270 /100k
4 Hawaii 217 /100k
5 Colorado 194 /100k
6 West Virginia 175 /100k
7 Indiana 146 /100k
8 Michigan 146 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

💊 Medicaid utilization by pack size

Medicaid (SDUD) totals over the four most recent reported quarters for every package size of this drug — handy when a specific package (e.g. a starter/titration pack) carries little or no Medicaid volume on its own.
5 syringes this page00169-3004-15 14,512 Rx · $1,516,768
5 syringes00169-3004-25 1,635 Rx · $80,941
Drug total (last 4 qtrs): 16,147 Rx · 254,199 units · $1,597,709 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.

📊 Medicare Part D spend CMS · PART D · 2026 (Q1)

Medicare Part D (outpatient prescription) spending for Novolin N — the program that covers self-administered drugs. 2 manufacturers.
⚠️ Drug-level data: CMS publishes Part D spending by drug, not by NDC — these figures combine every manufacturer, strength and package size sold under the name Novolin N. That’s a different level of aggregation than the Medicaid card above, which is specific to this exact 11-digit NDC (pack size included), so the two aren’t directly comparable.
Period
Total Part D spend
$2.47M
Claims incl. refills
19.2K
Beneficiaries
12.7K
Spend / beneficiary
$194.28
Spend / claim
$128.86
Trend by period
💵 About the dollar figures: spending is what Part D plans paid before confidential manufacturer rebates, so the program’s real net cost is lower. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part D Spending by Drug (data.cms.gov), updated quarterly.

🔬 Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Human Insulin — the ingredient across all brands.

Top reported reactions

Blood Glucose Increased2,027
Blood Glucose Decreased723
Nausea693
Diarrhoea513
Dyspnoea501
Dizziness466
Fatigue455

Reporter sex

12,419 reports
Male · 48%
Female · 52%
Unknown · 0%

Serious outcomes

Death1,207
Life-threatening506
Disabling377
Reports over time (by year) — tap or hover for the count & year
2023 2024 2025 2026 557 159
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

📦 Packaging — all sizes for this product

Package NDCDescription Per unit Per pack Marketing startStatus
00169-3004-15 You're viewing this 5 SYRINGE, PLASTIC in 1 CARTON (0169-3004-15) / 3 mL in 1 SYRINGE, PLASTIC (0169-3004-01) $5.82 / mL $87.35 2019-09-06 Active
00169-3004-25 5 SYRINGE, PLASTIC in 1 CARTON (0169-3004-25) / 3 mL in 1 SYRINGE, PLASTIC (0169-3004-12) 2019-09-06 Active

In Medicaid, this is the most-dispensed pack of this product — about 90% of fills over the last four reported quarters. See all packs ↓

Pack size FAQ

What quantity is in NDC 00169-3004-15?
NDC 00169-3004-15 is listed by the FDA — 5 syringe, plastic in 1 carton / 3 ml in 1 syringe, plastic.
What NDC number is used to bill for this package of Novolin N Human Insulin 100 [iU]/mL Injection, Suspension?
Bill NDC 00169-3004-15 — the 11-digit billing format is 00169300415. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.

📄 FDA label — Drug Facts FDA SPL

The complete FDA label for this product — the official Drug Facts labeling, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage 43 words

1 INDICATIONS AND USAGE NOVOLIN N is indicated to improve glycemic control in adults and pediatric patients with diabetes mellitus. NOVOLIN N is an intermediate-acting human insulin indicated to improve glycemic control in adults and pediatric patients with diabetes mellitus. ( 1 )

⏱️ Dosage and Administration ~2 min read

2 DOSAGE AND ADMINISTRATION • See Full Prescribing Information for important administration instructions. ( 2.1 ) • Inject subcutaneously in abdominal wall, thigh, upper arm, or buttocks and rotate injection sites to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. ( 2.1 ) • Individualize and adjust dosage based on metabolic needs, blood glucose monitoring results and glycemic control goal.

( 2.2 ) • Administer NOVOLIN N once or twice daily. ( 2.2 ) • In patients with type 1 diabetes, NOVOLIN N should generally be used in regimens that include a short-acting insulin. ( 2.2 ) • NOVOLIN N can be mixed with NOVOLIN R.

( 2.4 )

2.1Important Administration Instructions • Always check insulin labels before administration [see Warnings and Precautions ( 5.4 )]. • NOVOLIN N is a suspension that must be resuspended immediately before use. Resuspension is easier when the insulin has reached room temperature. • To resuspend vial, roll the vial gently in your hands in a horizontal position 10 times until the suspension appears uniformly white and cloudy. Inject immediately. • To resuspend FlexPen, gently move the pen up and down 20 times so the glass ball moves from one end of the cartridge to the other until the suspension appears uniformly white and cloudy.

Inject immediately. • Inspect NOVOLIN N visually before use. Do not use NOVOLIN N if discoloration or particulate matter is seen. • Administer NOVOLIN N by subcutaneous injection in the abdominal wall, thigh, upper arm, or buttocks. • Rotate the injection site within the same region from one injection to the next to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. Do not inject into areas of lipodystrophy or localized cutaneous amyloidosis [see Warnings and Precautions ( 5.2 ), Adverse Reactions ( 6 )] . • During changes to a patient’s insulin regimen, increase the frequency of blood glucose monitoring [see Warnings and Precautions ( 5.2 )] . • Do not administer NOVOLIN N intravenously and do not use in an insulin infusion pump.

2.2Dosage Information • Individualize and adjust the dosage of NOVOLIN N based on the individual's metabolic needs, blood glucose monitoring results and glycemic control goal. • Administer NOVOLIN N once or twice daily. • In patients with type 1 diabetes, NOVOLIN N should generally be used in regimens that include a short-acting insulin. • Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), changes in renal or hepatic function or during acute illness [see Warnings and Precautions ( 5.2 , 5.3 ) and Use in Specific Populations ( 8.6 , 8.7 )]. • Dosage adjustment may be needed when switching from another insulin to NOVOLIN N [see Warnings and Precautions ( 5.2 )].

2.3Dosage Adjustment due to Drug Interactions • Dosage adjustment may be needed when NOVOLIN N is co-administered with certain drugs [see Drug Interactions ( 7 )] .

2.4Instructions for Mixing with Other Insulins • NOVOLIN N can be mixed in the same syringe with NOVOLIN R. • When mixing, the NOVOLIN R should be drawn into the syringe first, followed by the NOVOLIN N. The mixture should be injected immediately after mixing.

💊 Dosage Forms and Strengths 58 words

3 DOSAGE FORMS AND STRENGTHS Injectable suspension: 100 units/mL (U-100) white and cloudy suspension available as: • 10 mL multiple-dose vial • 3 mL single-patient-use NOVOLIN N FlexPen prefilled pen Injectable suspension: 100 units/mL (U-100) is available as: • 10 mL multiple-dose vial ( 3 ) • 3 mL single-patient-use NOVOLIN N FlexPen prefilled pen ( 3 )

Contraindications 61 words

4 CONTRAINDICATIONS NOVOLIN N is contraindicated: • During episodes of hypoglycemia [see Warnings and Precautions ( 5.3 )] • In patients who have hypersensitivity reactions to NOVOLIN N or any of its excipients [see Warnings and Precautions ( 5.5 )] • During episodes of hypoglycemia ( 4 ) • Hypersensitivity to NOVOLIN N or any of its excipients ( 4 )

⚠️ Warnings and Cautions ~3 min read

5 WARNINGS AND PRECAUTIONS • Never share a NOVOLIN N FlexPen or syringe 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 blood glucose monitoring with changes to: insulin dosage, co-administered glucose lowering medications, meal pattern, physical activity; in patients with renal or hepatic impairment; and in patients with 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 NOVOLIN N, monitor, and treat if indicated. ( 5.5 ) • Hypokalemia: May be life-threatening.

Monitor potassium levels in patients at risk for hypokalemia and treat if indicated. ( 5.6 ) • Fluid Retention and Heart Failure with Concomitant Use of Thiazolidinediones (TZDs) : Observe for signs and symptoms of heart failure; consider dosage reduction or discontinuation if heart failure occurs. ( 5.7 )

5.1Never Share a NOVOLIN N FlexPen or Syringe between Patients NOVOLIN N FlexPen must never be shared between patients, even if the needle is changed. Patients using NOVOLIN N vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens.

5.2Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia [see Warnings and Precautions ( 5.3 )] or hyperglycemia. Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia [see Adverse Reactions ( 6 )] .

Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring. Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to unaffected areas and closely monitor for hypoglycemia. For patients with type 2 diabetes, dosage adjustments of concomitant anti-diabetic products may be needed.

5.3Hypoglycemia Hypoglycemia is the most common adverse reaction of all insulins, including NOVOLIN N. Severe hypoglycemia can cause seizures, may lead to unconsciousness may be life threatening or cause death. Hypoglycemia can impair concentration ability and reaction time; this may place the patient and others at risk in situations where these abilities are important (e.g., driving or operating other machinery).

Hypoglycemia can happen suddenly and symptoms may differ in each patient and change over time in the same patient. Symptomatic awareness of hypoglycemia may be less pronounced in patients with longstanding diabetes in patients with diabetic neuropathy, in patients using medications that block the sympathetic nervous system (e.g., beta-blockers) [see Drug Interactions ( 7 )] , or in patients who experience recurrent hypoglycemia. Risk Factors for Hypoglycemia The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal.

As with all insulins, the glucose lowering effect time course of NOVOLIN N may vary in different individuals or at different times in the same individual and depends on many conditions, including the are…

🤒 Adverse Reactions ~2 min read

6 ADVERSE REACTIONS The following adverse reactions are also discussed elsewhere in the labeling: • 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 from Clinical Studies or Postmarketing Reports The following additional adverse reactions have been identified during clinical studies or from postmarketing reports with use of NOVOLIN N.

Because some of these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or to establish a causal relationship to drug exposure. Adverse reactions associated with insulin initiation and glucose control intensification Intensification or rapid improvement in glucose control has been associated with a transitory, reversible ophthalmologic refraction disorder, worsening of diabetic retinopathy, and acute painful peripheral neuropathy. Over the long-term, improved glycemic control decreases the risk of diabetic retinopathy and neuropathy.

Hypersensitivity reactions Severe, life-threatening, generalized allergy, including anaphylaxis. Hypoglycemia Hypoglycemia is the most commonly observed adverse reaction in NOVOLIN N. Hypokalemia NOVOLIN N can cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia.

Injection site reactions NOVOLIN N can cause local injection site reactions including redness, swelling, or itching at the site of injection. These reactions usually resolve in a few days to a few weeks, but in some occasions, may require discontinuation. Localized reactions and generalized myalgias have been reported with the use of metacresol, which is an excipient in NOVOLIN N.

Lipodystrophy Administration of insulin subcutaneously, including NOVOLIN N, has resulted in lipoatrophy (depression in the skin) or lipohypertrophy (enlargement or thickening of tissue) [see Dosage and Administration ( 2.1 )] in some patients. Localized Cutaneous Amyloidosis Localized cutaneous amyloidosis at the injection site has occurred. Hyperglycemia has been reported with repeated insulin injections into areas of localized cutaneous amyloidosis; hypoglycemia has been reported with a sudden change to an unaffected injection site.

Medication Errors Medication errors in which other insulins have been accidentally substituted for NOVOLIN N have been identified during postapproval use. Peripheral edema Insulins, including NOVOLIN N, may cause sodium retention and edema, particularly if previously poor metabolic control is improved by intensified insulin therapy. Weight gain Weight gain can occur with insulins including NOVOLIN N, and has been attributed to the anabolic effects of insulin and the decrease in glucosuria.

Immunogenicity As with all therapeutic proteins, insulin administration may cause anti-insulin antibodies to form. The incidence of antibody formation with NOVOLIN N is unknown. Adverse reactions observed with NOVOLIN N include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, weight gain and edema.

( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Novo Nordisk Inc. at 1-800-727-6500 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

🔄 Drug Interactions ~1 min read

7 DRUG INTERACTIONS Table 1: Clinically Significant Drug Interactions with NOVOLIN N Drugs that May Increase the Risk of Hypoglycemia Drugs: Antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), and sulfonamide antibiotics Intervention: Dose adjustment and increased frequency of glucose monitoring may be required when NOVOLIN N is co-administered with these drugs.

Drugs that May Decrease the Blood Glucose Lowering Effect of NOVOLIN N Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. Intervention: Dose adjustment and increased frequency of glucose monitoring may be required when NOVOLIN N is co-administered with these drugs.

Drugs that May Increase or Decrease the Blood Glucose Lowering Effect of NOVOLIN N Drugs: Alcohol, beta-blockers, clonidine, and lithium salts. Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia. Intervention: Dose adjustment and increased frequency of glucose monitoring may be required when NOVOLIN N is co-administered with these drugs.

Drugs that May Blunt Signs and Symptoms of Hypoglycemia Drugs: Beta-blockers, clonidine, guanethidine, and reserpine Intervention: Increased frequency of glucose monitoring may be required when NOVOLIN N is co-administered with these drugs. • Drugs that Affect Glucose Metabolism: Adjustment of insulin dosage may be needed. ( 7 ) • Antiadrenergic Drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine): Signs and symptoms of hypoglycemia may be reduced or absent. ( 5.3 , 7 )

👥 Use in Specific Populations ~2 min read

8 USE IN SPECIFIC POPULATIONS

8.1Pregnancy Risk Summary Available data from published studies over decades have not established an association with human insulin use during pregnancy and major birth defects, miscarriage or adverse maternal or fetal outcomes (see Data). There are risks to the mother and fetus associated with poorly controlled diabetes in pregnancy (see Clinical Considerations). Animal reproduction studies were not performed.

The estimated background risk of major birth defects is 6-10% in women with pre-gestational diabetes with a HbA 1c >7 and has been reported to be as high as 20-25% in women with a HbA 1c >10. The estimated background risk of miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia-related morbidity. Data Human Data While available studies cannot definitively establish the absence of risk, published data from retrospective studies, open-label, randomized, parallel studies and meta-analyses have not established an association with human insulin use during pregnancy and major birth defects, miscarriage, or adverse maternal or fetal outcomes.

All available studies have methodological limitations including lack of blinding, unclear methods of randomization, and small sample size.

8.2Lactation Risk Summary Available data from published literature suggests that exogenous human insulin products, including NOVOLIN N, are transferred into human milk. There are no adverse reactions reported in the breastfed infants in the literature. There are no data on the effects of exogenous human insulin products, including NOVOLIN N, on milk production.

The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for NOVOLIN N and any potential adverse effects on the breastfed infant from NOVOLIN N or from the underlying maternal condition.

8.4Pediatric Use NOVOLIN N is indicated to improve glycemic control in pediatric patients with diabetes mellitus. The dosage of NOVOLIN N must be individualized in pediatric patients based on metabolic needs and frequent monitoring of blood glucose to reduce the risk of hypoglycemia [see Dosage and Administration ( 2.2 ) and Warnings and Precautions ( 5.2 , 5.3 )] .

8.5Geriatric Use The effect of age on the pharmacokinetics and pharmacodynamics of NOVOLIN N has not been studied. Elderly patients using insulin, including NOVOLIN N, may be at increased risk of hypoglycemia due to co-morbid disease [see Warnings and Precautions ( 5.3 )] .

8.6Renal Impairment The effect of renal impairment on the pharmacokinetics and pharmacodynamics of NOVOLIN N has not been studied. Patients with renal impairment are at increased risk of hypoglycemia and may require more frequent NOVOLIN N dose adjustment and more frequent blood glucose monitoring [see Warnings and Precautions ( 5.3 )] .

8.7Hepatic Impairment The effect of hepatic impairment on the pharmacokinetics and pharmacodynamics of NOVOLIN N has not been studied. Patients with hepatic impairment are at increased risk of hypoglycemia and may require more frequent NOVOLIN N dose adjustment and more frequent blood glucose monitoring [see Warnings and Precautions ( 5.3 )] .

🤰 Pregnancy ~1 min read

8.1Pregnancy Risk Summary Available data from published studies over decades have not established an association with human insulin use during pregnancy and major birth defects, miscarriage or adverse maternal or fetal outcomes (see Data). There are risks to the mother and fetus associated with poorly controlled diabetes in pregnancy (see Clinical Considerations). Animal reproduction studies were not performed.

The estimated background risk of major birth defects is 6-10% in women with pre-gestational diabetes with a HbA 1c >7 and has been reported to be as high as 20-25% in women with a HbA 1c >10. The estimated background risk of miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia-related morbidity. Data Human Data While available studies cannot definitively establish the absence of risk, published data from retrospective studies, open-label, randomized, parallel studies and meta-analyses have not established an association with human insulin use during pregnancy and major birth defects, miscarriage, or adverse maternal or fetal outcomes.

All available studies have methodological limitations including lack of blinding, unclear methods of randomization, and small sample size.

🆘 Overdosage 83 words

10 OVERDOSAGE Excess insulin administration may cause hypoglycemia and hypokalemia. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise may be needed.

More severe episodes with coma, seizure, or neurologic impairment can be treated with intramuscular or subcutaneous glucagon or intravenous glucose. Sustained carbohydrate intake and observation may be necessary because hypoglycemia may recur after apparent clinical recovery. Hypokalemia must be corrected appropriately [see Warnings and Precautions ( 5.3 , 5.6 )] .

🧬 Clinical Pharmacology 139 words

12 CLINICAL PHARMACOLOGY

12.1Mechanism of Action The primary activity of insulin, including NOVOLIN N is the regulation of glucose metabolism. Insulins lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin inhibits lipolysis and proteolysis, and enhances protein synthesis.

12.2Pharmacodynamics The time course of insulin action (i.e., glucose lowering) may vary considerably in different individuals or within the same individual. NOVOLIN N is an intermediate-acting insulin with a variable and dose dependent duration of action of up to 24 hours. When injected subcutaneously, the glucose-lowering effect of NOVOLIN N begins approximately 1 to 2 hours post-dose.

12.3Pharmacokinetics The pharmacokinetics of NOVOLIN N have been established. The effects of gender, age, obesity, renal and hepatic impairment on the pharmacokinetics of NOVOLIN N have not been studied.

🧬 Mechanism of Action 48 words

12.1Mechanism of Action The primary activity of insulin, including NOVOLIN N is the regulation of glucose metabolism. Insulins lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin inhibits lipolysis and proteolysis, and enhances protein synthesis.

📦 How Supplied / Storage and Handling ~1 min read

16 HOW SUPPLIED/STORAGE AND HANDLING

16.1How Supplied NOVOLIN N (insulin isophane human) injectable suspension, 100 units/mL (U-100), is a white and cloudy suspension available as: 10 mL multiple-dose vial NDC 0169-1834-11 ReliOn ® brand NDC 0169-1834-02 3 mL single-patient-use FlexPen prefilled pen NDC 0169-3004-15 ReliOn ® brand NDC 0169-3004-25 The NOVOLIN N FlexPen dials in 1-unit increments.

16.2Storage and Handling Dispense in the original sealed carton with the enclosed Instructions for Use. Do not expose NOVOLIN N vials and NOVOLIN N FlexPen to excessive heat or light. Do not freeze.

Do not use after the expiration date. NOVOLIN N FlexPen must never be shared between patients, even if the needle is changed. Always remove and discard the needle after each injection from the NOVOLIN N FlexPen and store without a needle attached.

Patients using NOVOLIN N vials must never share needles or syringes with another person. Always use a new disposable syringe or needle for each injection to prevent contamination. Table 2: Storage Conditions and Expiration Dates for NOVOLIN N Not In-use (Unopened) Refrigerated (36°F - 46°F [2°C - 8°C]) Not In-use (Unopened) Room Temperature (see temperature below) In-use (Opened) Room Temperature (see temperature below) 10 mL multiple-dose vial Until expiration date 42 days up to 77°F (25°C) 42 days up to 77°F (25°C) (Do not refrigerate) 3 mL single-patient-use FlexPen Until expiration date 28 days up to 86°F (30°C) 28 days up to 86°F (30°C) (Do not refrigerate)

📋 Description 185 words

11 DESCRIPTION Insulin isophane human is produced by recombinant DNA technology, utilizing Saccharomyces cerevisiae (baker’s yeast) as the production organism. Insulin isophane human is a suspension of crystals produced from combining human insulin and protamine sulfate under appropriate conditions for crystal formation. The amino acid sequence of insulin isophane human is identical to human insulin and has the empirical formula C 257 H 383 N 65 O 77 S 6 and a molecular weight of 5808 Da.

Figure 1: Structural formula of human insulin NOVOLIN N (insulin isophane human) injectable suspension is an intermediate acting human insulin. It is a sterile, white and cloudy suspension that contains insulin isophane human suspension (NPH) for subcutaneous use. Each milliliter of Novolin N contains 100 units of insulin human, dibasic sodium phosphate (1.9 mg), glycerin (16 mg), metacresol (1.5 mg), phenol (0.65 mg), protamine sulfate (approximately 0.35 mg), zinc (33.5 mcg for the vial or 33.2 mcg for the FlexPen), and Water for Injection.

Hydrochloric acid 2N and sodium hydroxide 2N may be added to adjust the pH. The pH is 7.1 to 7.5. Structural Formula Novolin R

💬 Information for Patients ~2 min read

17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use). Never Share a NOVOLIN N FlexPen or Syringe between Patients Advise patients using NOVOLIN N vials or NOVOLIN N FlexPen not to share needles, syringes, or FlexPen with another person. Sharing poses a risk for transmission of blood-borne pathogens [see Warnings and Precautions (5.1)] .

Hyperglycemia or Hypoglycemia Inform patients that hypoglycemia is the most common adverse reaction with insulin. Instruct patients on self-management procedures including glucose monitoring, proper injection technique, and management of hypoglycemia and hyperglycemia, especially at initiation of NOVOLIN N therapy. Instruct patients on handling of special situations such as intercurrent conditions (illness, stress, or emotional disturbances), an inadequate or skipped insulin dose, inadvertent administration of an increased insulin dose, inadequate food intake, and skipped meals.

Instruct patients on the management of hypoglycemia [see Warnings and Precautions ( 5.3 )] . Inform patients that their ability to concentrate and react may be impaired as a result of hypoglycemia. Advise patients who have frequent hypoglycemia or reduced or absent warning signs of hypoglycemia to use caution when driving or operating machinery.

Advise patients that changes in insulin regimen can predispose to hyperglycemia or hypoglycemia and that changes in insulin regimen should be made under close medical supervision [see Warnings and Precautions ( 5.2 )] . Hypoglycemia due to Medication Errors Instruct patients to always check the insulin label before each injection to avoid mix-ups between insulin products [see Warnings and Precautions ( 5.4 )] . Hypersensitivity Reactions Advise patients that hypersensitivity reactions have occurred with NOVOLIN N.

Inform patients on the symptoms of hypersensitivity reactions and to seek medical attention if they occur [see Warnings and Precautions ( 5.5 )] . Novolin ® , FlexPen ® and Novo Nordisk ® are registered trademarks of Novo Nordisk A/S. ReliOn ® is a registered trademark of Walmart Inc. and is used under license by Novo Nordisk Inc.

Patent Information: http://novonordisk-us.com/products/product-patents.html © 2022 Novo Nordisk Manufactured by: Novo Nordisk Inc. 800 Scudders Mill Road Plainsboro, NJ 08536 1-800-727-6500 U.S. License Number 1261 For information about NOVOLIN N contact: Novo Nordisk Inc.

800 Scudders Mill Road Plainsboro, NJ 08536 www.novonordisk-us.com 1-800-727-6500 (Se habla español)

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.