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Overview: Onswik is a long-acting insulin that is injected under the skin once weekly. It is used to control blood sugar levels in people with type 2 diabetes. Common side effects include low blood sugar, weight gain, and pain, itching, or swelling at the injection site. Contact your health care provider right away if you have severe or frequent low blood sugar or if you feel weak or unusually tired.

Uses

What is Onswik used for?

Onswik (insulin efsitora alfa-gobe) is commonly used to help manage blood sugar levels in people with type 2 diabetes. 

Onswik may also be used for other conditions as determined by your health care provider.

How does Onswik work (mechanism of action)?

Onswik is a type of insulin. Like the insulin your body naturally makes, it helps sugar (glucose) move from your blood into your muscles and other tissues where your body can use it for energy. It also reduces how much sugar your liver makes.

Onswik is designed to stay active in the body longer than regular human insulin. The body removes it more slowly, and it is protected from being broken down too quickly. This allows Onswik to work steadily for a full week.

How is Onswik supplied (dosage forms)?

Brands and other names

  • Onswik

Dosage forms and strengths

  • 500 units/mL solution for injection (KwikPen)
  • 1,000 units/mL solution for injection (KwikPen)

How should I store Onswik?

Store Onswik in the refrigerator at 36 F and 46 F (2 C and 8 C). If needed, Onswik can be kept at room temperature, up to 86 F (30 C), for up to 14 days total. The total time at room temperature should be no more than 14 days, including before and after you open the pen.

After first use, the pen can be used for up to 16 weeks as long as it has not spent more than 14 total days at room temperature. Throw it away after 16 weeks, even if medicine remains.

Do not freeze Onswik or use it if it has been frozen. Keep it away from heat and light, and do not store the pen with a needle attached.

Side Effects

What are the most common side effects of Onswik?

The most common side effects of Onswik are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Low blood sugar (see below)
  • Allergic reactions (see below)
  • Pain, itching, swelling, redness, or discoloration near the injection site
  • Lumpy, thickened, or sunken skin at the injection site
  • Itchiness or rash
  • Fluid retention
  • Weight gain

There may be other side effects of Onswik that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Onswik?

While less common, the most serious side effects of Onswik are described below, along with what to do if they happen.

Severe Allergic Reactions. Onswik may cause allergic reactions, which can be serious. Stop using Onswik and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Low Blood Sugar (Hypoglycemia). Onswik can cause low blood sugar, which can be serious and may lead to death. The risk of hypoglycemia may be higher during the first several weeks after starting or increasing the dose and in people with kidney or liver problems. Because of the long-acting effect of Onswik, low blood sugar may take longer to improve than with shorter-acting insulins. You may need to check your blood sugar more often if you have changes to your diet, meal timing, exercise regimen, or medicines for diabetes. Do not use Onswik and call your health care provider right away if you have any of the following symptoms of hypoglycemia.

  • Headache
  • Crankiness or anxiety
  • Hunger
  • Dizziness or confusion
  • Blurry vision
  • Slurred speech
  • Sweating
  • Feeling jittery or shakiness
  • Fast heartbeat
  • Seizures

Low Potassium Levels (Hypokalemia). Onswik can cause a low potassium level, which can be serious and may lead to death. Your health care provider may check your potassium levels, especially if you take other medicines that can lower potassium. Keep all appointments to have your blood checked. Call your health care provider if you have any of the following symptoms of a low potassium level.

  • Weakness
  • Unusual tiredness
  • Muscle cramps or twitching
  • Constipation

Warnings & Precautions

Who should not use Onswik?

Allergies to Ingredients. People who are allergic to any of the following should not use Onswik.

  • Insulin efsitora alfa-gobe
  • Onswik
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Onswik.

Low Blood Sugar (Hypoglycemia). Onswik should not be used when you have low blood sugar. Be familiar with the symptoms of low blood sugar, including dizziness, sweating, confusion, and shakiness. Ask your health care provider how often to check your blood sugar and what to do when it is low.

What should I know about Onswik before using it?

Do not use Onswik unless it has been prescribed to you by a health care provider. Use it as prescribed.

Always use a new needle for each injection. Do not share Onswik or needles with other people, even if they have the same condition as you. It may harm them or you.

Keep Onswik out of the reach of children. Since this medicine may be kept in a refrigerator, take special precautions to keep it away from children who also use the refrigerator.

This medicine is injected under the skin. Read the instructions and make sure that you or a caregiver understands how to prepare and use Onswik. If you have any questions about how to use Onswik, ask your health care provider.

Be careful if you are using more than one injectable medicine. To prevent mistakes, always double check the label and dialed units on the Onswik KwikPen to make sure you are using the right product and dose. Do not use a syringe to remove insulin from the pen, as this can lead to an overdose.

Do not use the same exact spot for each Onswik injection. Do not inject areas of your skin that are thickened, bruised, tender, hard, or damaged.

Do not drive or do other activities that require alertness or coordination until you know how Onswik affects you.

Talk with your health care provider about how to recognize and treat low blood sugar (hypoglycemia). Because Onswik is a long-acting insulin, low blood sugar may last longer and take more time to improve than with other insulin products.

Checking your blood sugar regularly can help you prevent and manage low blood sugar. If you are at higher risk of low blood sugar, or if you do not always feel symptoms, your health care provider may recommend checking your blood sugar more often.

If you need to change the day you use Onswik, you can do this as long as it has been at least 4 days since your last dose. Ask your health care provider if you have questions about when to use Onswik.

What should I tell my health care provider before using Onswik?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if Onswik is right for you.

In particular, make sure that you discuss any of the following.

Type 1 Diabetes. Onswik should not be used by people with type 1 diabetes due to an increased risk of severe low blood sugar (hypoglycemia). 

Heart Failure. Onswik may increase your risk of heart failure when used with other diabetes medicines, such as pioglitazone (Actos). If you already have heart failure, it may get worse if you take these medicines while using Onswik. Tell your health care provider right away if you have any of the following new or worse symptoms of heart failure.

  • Shortness of breath or trouble breathing, especially while lying down
  • Swelling in your feet, ankles, or legs
  • Unusually fast weight gain
  • Unusual tiredness

Other Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Diet and Lifestyle Changes. Tell your health care provider if you have any changes in your diet, timing of meals, level of physical activity, illnesses, weight, or stress. Such changes may affect the amount of Onswik you need.

Other Medicines and Supplements. Onswik may interact with other medicines and supplements. Before using Onswik, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section below for more details.

Pregnancy. Onswik may cause harm to a fetus and is not recommended for use during pregnancy. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if Onswik passes into breast milk and is not recommended for use while breastfeeding. Tell your health care provider if you are breastfeeding or plan to breastfeed.

How can I get more information about Onswik?

For more information about Onswik, you can visit the drugmaker’s website at www.onswik.lilly.com or call them at 800-545-5979.

Interactions

Does Onswik interact with foods or drinks?

There are no known interactions between Onswik and foods.

Alcohol may affect blood sugar levels in people with diabetes. This may interfere with the effect of Onswik. Do not drink alcohol or use any medicines that have alcohol in them while using Onswik.

Does Onswik interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using Onswik.

  • Any other medicine for diabetes, including pioglitazone (Actos)
  • A glucagon-like peptide-1 (GLP-1) receptor agonist, such as semaglutide (Ozempic, Wegovy), which is a medicine commonly used for diabetes or weight loss
  • A salicylate, such as diflunisal or salsalate, which is a medicine used for arthritis
  • An angiotensin-converting enzyme (ACE) inhibitor, such as enalapril or lisinopril, which is a medicine for high blood pressure, heart failure, and certain kidney problems
  • An angiotensin II receptor blocker (ARB), such as losartan or valsartan, which is a medicine for high blood pressure, heart failure, and other heart conditions
  • A selective serotonin re-uptake inhibitor (SSRI), such as fluoxetine (Prozac), which is commonly used for depression and anxiety
  • A sulfonamide antibiotic, such as sulfamethoxazole, which is used for certain infections
  • A corticosteroid, such as dexamethasone, methylprednisolone, or prednisone, which is a medicine for certain inflammatory conditions
  • A diuretic, also called a water pill, which is a medicine used to reduce fluid retention or blood pressure
  • A birth control pill or other medicine that contains estrogen
  • A beta-blocker, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol XL, and others), or propranolol (Inderal LA, Innopran XL), which is a medicine that may be used for certain heart conditions or to lower blood pressure
  • Clonidine (Catapres-TTS and others), which is a medicine used for high blood pressure or attention deficit hyperactivity disorder (ADHD)
  • A thyroid hormone, such as levothyroxine (Synthroid and others), which is used to treat low thyroid hormone levels
  • An FcRn inhibitor, such as efgartigimod (Vyvgart), nipocalimab (Imaavy), or rozanolixizumab (Rystiggo), which is used to treat certain immune system conditions

Many other medicines may affect your blood sugar levels, which may alter the effect of Onswik on your blood sugar. Talk to your pharmacist or other health care provider before starting or stopping other medicines while using Onswik. You may need to check your blood sugar levels more closely during these times.

This may not be a complete list of medicines that can interact with Onswik. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Onswik?

If you or someone else has used too much Onswik, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Onswik?

If you miss a dose of Onswik, use it as soon as possible if it has been 4 days or less. Then use your next dose on your usual scheduled day. If more than 4 days have passed, you can skip the missed dose and use your next dose on your usual day. Or, you can use the missed dose and then use your next dose 1 week later, which will become your new weekly scheduled day.

Check your blood sugar more often if you miss a dose, and call your health care provider if you have any questions.

If you accidentally use more than one dose in the same week, skip your next weekly dose. Check your blood sugar more often and watch for low blood sugar that is severe or keeps happening.