Afrezza is a brand-name prescription drug. It’s FDA-approved to help manage blood sugar levels in adults with type 1 or type 2 diabetes.

Afrezza contains the active drug insulin human. It belongs to a class of drugs called fast-acting insulins. (A drug class is a group of medications that work in a similar way).

Afrezza comes as a powder that you breathe in through your mouth with an inhaler. Afrezza is a mealtime (fast-acting) insulin. This means it works quickly to help manage any spikes in your blood sugar after you eat a meal.

Afrezza comes in cartridges that deliver four units, eight units, or 12 units of the drug. The number of units you inhale depends on the amount of carbohydrates in the meal, your physical activity level before and after dosing, and your current blood sugar level.

Effectiveness

To learn about Afrezza’s effectiveness, see the “Afrezza for type 2 diabetes” and “Afrezza for type 1 diabetes” sections.

Afrezza is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Afrezza contains the active drug insulin human.

The Afrezza dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Afrezza to treat
  • your age
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Afrezza comes as a powder that you breathe in through your mouth with an inhaler. You take it at the beginning of a meal.

Afrezza comes in cartridges that deliver four units, eight units, or 12 units of the drug. You can combine the cartridges to get the exact number of insulin units you need.

The number of units you inhale will depend on the amount of carbohydrates in the meal, your physical activity level, and your current blood sugar level.

Dosage for type 1 diabetes

Your dosage of Afrezza will depend on whether you’ve taken insulin in the past.

If you haven’t taken insulin in the past, your starting dosage will be four units of Afrezza at the start of each meal.

If you’ve used mealtime insulin in the past, your Afrezza dosage will depend on your typical dosage of mealtime insulin:

  • for up to four units of mealtime insulin, use the four-unit Afrezza cartridge
  • for five to eight units of mealtime insulin, use the eight-unit Afrezza cartridge
  • for nine to 12 units of mealtime insulin, use 12 units of Afrezza (either use a 12-unit cartridge or combine a four-unit cartridge and an eight-unit cartridge)
  • for 13 to 16 units of mealtime insulin, use two eight-unit cartridges for a total of 16 units
  • for 17 to 20 units of mealtime insulin, use 20 units (combine an eight-unit cartridge and a 12-unit cartridge)
  • for 21 to 24 units of mealtime insulin, use 24 units (use two 12-unit cartridges)

If you’ve used a pre-mixed insulin (Humalog Mix, Novolog Mix) in the past and are switching to Afrezza, your doctor will determine how much mealtime insulin you need based on your pre-mixed insulin dose.

Your Afrezza dosage may need to be adjusted depending on several factors. These include the amount of carbohydrates in the meal, your physical activity level, and your current blood sugar level.

Dosage for type 2 diabetes

Your dosage of Afrezza will depend on whether you’ve taken insulin in the past.

If you haven’t taken insulin in the past, your starting dosage will be four units of Afrezza at the start of each meal.

If you’ve used mealtime insulin in the past, your Afrezza dosage will depend on your typical dosage of mealtime insulin:

  • for up to four units of mealtime insulin, use the four-unit Afrezza cartridge
  • for five to eight units of mealtime insulin, use the eight-unit Afrezza cartridge
  • for nine to 12 units of mealtime insulin, use 12 units of Afrezza (either use a 12-unit cartridge or combine a four-unit cartridge and an eight-unit cartridge)
  • for 13 to 16 units of mealtime insulin, use two eight-unit cartridges for a total of 16 units
  • for 17 to 20 units of mealtime insulin, use 20 units (combine an eight-unit cartridge and a 12-unit cartridge)
  • for 21 to 24 units of mealtime insulin, use 24 units (use two 12-unit cartridges)

If you’ve used a pre-mixed insulin (Humalog Mix, Novolog Mix) in the past and are switching to Afrezza, your doctor will determine how much mealtime insulin you need based on your pre-mixed insulin dose.

Your Afrezza dosage may need to be adjusted depending on several factors. These include the amount of carbohydrates in the meal, your physical activity level, and your current blood sugar level.

What if I miss a dose?

If you forget to take Afrezza at the beginning of your meal, your blood sugar may rise in response to the food you eat. Make sure to take the dose of Afrezza as soon as you remember. The dose of Afrezza you take will depend on your blood sugar reading.

To help make sure you don’t miss a dose, try setting a reminder in your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Afrezza is meant to be used as a long-term treatment. It helps manage blood sugar levels in people with diabetes, which is a chronic (long-term) condition. If you and your doctor determine that Afrezza is safe and effective for you, you’ll likely take it long term.

Afrezza can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Afrezza. These lists do not include all possible side effects.

For more information on the possible side effects of Afrezza, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you’ve had with Afrezza, you can do so through MedWatch.

Mild side effects

Mild side effects* of Afrezza can include:

  • sore throat
  • headache
  • diarrhea
  • fatigue (lack of energy)
  • nausea
  • bronchitis (swelling in the tubes that carry air to and from your lungs)
  • cough — See “Side effect details” below
  • hypoglycemia (low blood sugar) — See “Side effect details” below

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Afrezza. To learn about other mild side effects, talk with your doctor or pharmacist or view Afrezza’s Medication Guide.

Serious side effects

Serious side effects from Afrezza aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency phone number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Reduced lung function. Symptoms can include:
    • wheezing
    • trouble breathing
    • cough that doesn’t go away or keeps coming back
  • Hypokalemia (low potassium level). Symptoms can include:
    • heart skipping a beat
    • abnormal heart rhythm
    • muscle pain or cramping
    • feeling short of breath

Other serious side effects, explained in more detail below in “Side effect details,” include:

* Afrezza has a boxed warning for acute bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD). See the “FDA warning” section at the beginning of the article to learn more.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Afrezza. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

It’s not known how many people had an allergic reaction to Afrezza during clinical studies. Call your doctor right away if you have a severe allergic reaction to Afrezza. Call 911 or your local emergency phone number if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Cough

Some people may experience coughing when using Afrezza. In clinical studies:

  • 25.6% to 29.4% of people taking Afrezza experienced coughing
  • 19.7% of people taking a placebo inhaler (containing no active drug) experienced coughing
  • 4.9% to 5.4% of people using either injectable insulin or a diabetes medicine that’s taken by mouth experienced coughing

In the studies, coughing was the most common reason people stopped taking Afrezza (2.8% of patients treated with Afrezza).

Acute bronchospasm

Afrezza has a boxed warning for acute bronchospasm in people with asthma or COPD. A boxed warning is the most serious warning from the FDA. It alerts doctors and patients about a drug’s effects that may be dangerous.

Afrezza has caused acute bronchospasm (severe tightening of the muscles in your airways) in some people with asthma or COPD. If you have one of these conditions, you shouldn’t take Afrezza.

Symptoms of acute bronchospasm can include coughing uncontrollably, trouble breathing, or wheezing.

In a clinical study of people taking Afrezza, 29% of people with asthma who took the drug experienced wheezing. In comparison, no one taking Afrezza who didn’t have asthma experienced wheezing. In the same study, the people with asthma had a decline in their lung capacity 15 minutes after a single dose of Afrezza.

In a study of people with COPD, people had a decline in lung capacity 18 minutes after a single dose of Afrezza.

If you have asthma or COPD as well as diabetes, talk with your doctor about treatment options for managing your blood sugar levels.

Hypoglycemia

Hypoglycemia (low blood sugar) can occur when taking any form of insulin, including Afrezza. Symptoms of hypoglycemia can include sweating, shakiness, headache, blurry vision, fast heart rate, and feeling dizzy or lightheaded.

Your risk for hypoglycemia will depend on your Afrezza dosage, blood sugar level, activity level, and the type and amount of food you’ve eaten.

In clinical studies:

  • 67% of people with type 2 diabetes who took Afrezza experienced non-severe hypoglycemia
  • 30% of people with type 2 diabetes who took a placebo experienced non-severe hypoglycemia

In the clinical studies, people were considered to have severe hypoglycemia (very low blood sugar) if they needed another person’s help to raise their blood sugar level.

Symptoms of severe hypoglycemia may include confusion, poor coordination, seizures, or loss of consciousness (not being able to respond to sound or touch).

In the studies:

  • 5.1% of people with type 2 diabetes who took Afrezza experienced severe hypoglycemia
  • 1.7% of people with type 2 diabetes who took a placebo (a treatment with no active drug) experienced severe hypoglycemia

It’s not known how often non-severe or severe hypoglycemia occurred in people with type 1 diabetes in clinical studies.

Severe hypoglycemia is a medical emergency and should be treated right away. You or someone else should call 911 or your local emergency phone number if you experience this condition.

Talk with your doctor about how to treat and help prevent episodes of hypoglycemia or severe hypoglycemia.

Diabetic ketoacidosis

Diabetic ketoacidosis is a condition that occurs when your blood sugar level is very high, but your insulin level is low. It results in an unhealthy level of acid in your blood, which can be life threatening.

When you have too little insulin to break down glucose for energy, your blood sugar level can rise to unhealthy levels. If it’s too high for too long, your body starts to break down fat instead of sugar for energy. Your liver processes the fat into an energy source called ketones.

A buildup of ketones in your blood leads to an increased level of acid in your blood. Too much acid in your blood can be dangerous to your health.

In clinical studies of people with type 1 diabetes:

  • 0.43% of people taking Afrezza experienced diabetic ketoacidosis
  • 0.14% of people taking a drug other than Afrezza experienced diabetic ketoacidosis

Your risk for diabetic ketoacidosis may be higher if you have an infection or an illness like the flu.

Symptoms of diabetic ketoacidosis may include nausea or vomiting, fruity-smelling breath, confusion, extreme thirst, and urinating more often than usual.

Call 911 right away if you experience any of these symptoms, as they may be a sign of diabetic ketoacidosis. This condition is a medical emergency and should be treated right away.

You should take Afrezza according to your doctor or healthcare provider’s instructions.

Afrezza comes as a powder that you breathe in through your mouth with an inhaler. Your doctor or pharmacist should show you how to use Afrezza before you take your first dose. MannKind Corporation, the manufacturer of Afrezza, also has a video to show you how to take it.

Always make sure you have the right number of Afrezza cartridges for your dose before you start your meal. Before you place the Afrezza cartridge into the inhaler, make sure it has been at room temperature for at least 10 minutes.

When to take

You should take Afrezza at the beginning of your meal (usually three meals per day). If you forget to take Afrezza before you start eating, your blood sugar may rise in response to your food. Make sure to take Afrezza as soon as you remember. The dose of Afrezza you take will depend on your blood sugar reading.

To help make sure you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Taking Afrezza with food

Afrezza should be taken at the beginning of a meal (usually three times per day). If you skip a meal, you can skip your Afrezza dose. This is because you won’t need to manage a spike in blood sugar after eating.

Afrezza is a mealtime (fast-acting) insulin and should only be taken right before a meal.

When you get Afrezza from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

Each Afrezza inhaler should only be used for 15 days. After 15 days, throw away the inhaler and start using a new one.

Afrezza cartridges in their unopened foil package should be refrigerated at 36°F to 46°F (2°C to 8°C). Afrezza cartridges come in blister strips, with three Afrezza cartridges per blister strip.

When stored in the refrigerator, the cartridges are safe to use until the expiration date on the box. Afrezza cartridges stored at room temperature (77°F or 25°C) should be used within 10 days, even if they’re sealed. Do not put blister strips back into the refrigerator after being stored at room temperature.

Once the foil package is opened but the cartridges are still sealed in the blister strips, store them in the refrigerator at 36°F to 46°F (2°C to 8°C). The cartridges must be used within 1 month of opening the foil package.

Once you open the blister strips, you can keep them at room temperature (77°F or 25°C). You should use them within 3 days.

The Afrezza inhaler should be stored in a cool, dry place with the mouthpiece cover on it until it’s time for your next dose. You can store it in the refrigerator if you want, but it should be at room temperature when you use it.

Disposal

If you no longer need to take Afrezza and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

After removing a used cartridge from the Afrezza inhaler, throw away the cartridge in your regular household trash.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist about the best way to dispose of your medication.

Other drugs are available that can treat type 1 or type 2 diabetes. Some may be a better fit for you than others. If you’re interested in finding an alternative to Afrezza, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternative fast-acting insulins for diabetes

Examples of other fast-acting insulin drugs that may be used to treat diabetes include:

  • Apidra (insulin glulisine)
  • Humalog (insulin lispro)
  • Novolog (insulin aspart)
  • Fiasp (faster-acting insulin aspart)

You may wonder how Afrezza compares with other medications that are prescribed for similar uses. Here we look at how Afrezza and Humalog are alike and different.

Ingredients

Afrezza contains the active drug insulin human. Humalog contains a human insulin analog (copy) called insulin lispro.

Uses

Both Afrezza and Humalog are FDA-approved to help manage blood sugar levels in adults with type 1 or type 2 diabetes. Humalog is also FDA-approved to help manage blood sugar levels in children ages 3 years and older who have type 1 diabetes.

Drug forms and administration

Afrezza comes as a powder that you breathe in through your mouth with an inhaler. Humalog comes as a liquid solution. It’s given as an injection, either from a vial with a syringe or with the Humalog KwikPen, Junior KwikPen, or Tempo Pen.

Side effects and risks

Afrezza and Humalog have some similar side effects and others that differ. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Afrezza, with Humalog, or with both drugs (when taken individually).

  • Can occur with Afrezza:
    • cough
    • sore throat
    • headache
    • diarrhea
    • nausea
    • bronchitis (swelling in the tubes that carry air to and from your lungs)
  • Can occur with Humalog:
    • injection site reactions
    • lipodystrophy (a depression or thickening of the skin) at the injection site
    • weight gain
    • swelling of your hands or feet
    • itching
    • rash
  • Can occur with both Afrezza and Humalog:

Serious side effects

These lists contain examples of serious side effects that can occur with Afrezza or with both drugs (when taken individually).

* Afrezza has a boxed warning for acute bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD). A boxed warning is the most serious warning from the Food and Drug Administration (FDA). See the “FDA warning” section at the beginning of this article to learn more.

Effectiveness

Afrezza and Humalog haven’t been directly compared in clinical studies. However, studies have found both drugs to be effective in helping manage blood sugar in adults with type 1 or type 2 diabetes.

Costs

Afrezza and Humalog are both brand-name drugs. Brand-name medications usually cost more than generics. There’s currently no generic form of Afrezza.

Eli Lilly and Company, the manufacturer of Humalog, offers a generic form of Humalog. It’s called Lilly’s Insulin Lispro Injection U-100. If you’re interested, ask your doctor if this drug is available in your area and whether it’s right for you.

According to estimates on GoodRx.com, Afrezza generally costs more than Humalog. However, insulin lispro, the generic form of Humalog, costs less than either of the brand-name drugs. The actual price you’ll pay for any of these drugs depends on your insurance plan, your location, and the pharmacy you use.

Afrezza and Apidra are prescribed for similar uses. Here’s a look at how these drugs are alike and different.

Ingredients

Afrezza contains the active drug insulin human. Apidra contains a human insulin analog (copy) called insulin glulisine.

Uses

Afrezza and Apidra are both FDA-approved to help manage blood sugar levels in adults with type 1 or type 2 diabetes. Apidra is also FDA-approved to help manage blood sugar levels in children with type 1 diabetes who are ages 4 years or older.

Drug forms and administration

Afrezza comes as a powder that you breathe in through your mouth with an inhaler. Apidra comes as liquid insulin. You inject Apidra under your skin using either a vial and syringe or a pre-filled SoloStar insulin pen.

Side effects and risks

Afrezza and Apidra have some similar side effects and others that differ. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Afrezza, with Apidra, or with both drugs (when taken individually).

  • Can occur with Afrezza:
    • cough
    • sore throat
    • headache
    • diarrhea
    • nausea
  • Can occur with Apidra:
    • weight gain
    • itching
    • rash
    • swelling
    • injection site reactions
    • lipodystrophy (a depression or thickening of the skin) at the injection site
  • Can occur with both Afrezza and Apidra:

Serious side effects

These lists contain examples of serious side effects that can occur with Afrezza, or with both drugs (when taken individually).

* Afrezza has a boxed warning for acute bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD). A boxed warning is the most serious warning from the Food and Drug Administration (FDA). See the “FDA warning” section at the beginning of this article to learn more.

Effectiveness

Afrezza and Apidra haven’t been directly compared in clinical studies. However, studies have found both drugs to be effective in helping manage blood sugar in adults with type 1 or type 2 diabetes.

Costs

Afrezza and Apidra are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Afrezza generally costs more than Apidra. The actual price you’ll pay for either drug will depend on your insurance plan, your location, and the pharmacy you use.

The Food and Drug Administration (FDA) approves prescription drugs such as Afrezza to treat certain conditions. Afrezza is FDA-approved for use in people with type 2 diabetes.

(Afrezza is also approved for use in people with type 1 diabetes. For more information, see the “Afrezza for type 1 diabetes” section below.)

With type 2 diabetes, your body doesn’t respond to insulin the way it should. This causes high blood sugar, which can damage your eyes, kidneys, nerves, and other organs.

Afrezza is a mealtime (fast-acting) insulin. It works quickly to help manage any spikes in your blood sugar after you eat a meal.

Effectiveness for type 2 diabetes

A clinical study compared Afrezza with a placebo (treatment with no active drug) in adults with type 2 diabetes. People received either Afrezza or a placebo inhaler in addition to their diabetes medications that are taken by mouth, such as metformin (Glucophage).

The people in the study had hemoglobin A1c (HbA1c) tests done. This test measures your average blood sugar levels over the past 3 months.

At the end of the 24-week study:

  • people who took Afrezza had their HbA1c lowered by an average of 0.82%
  • people who took a placebo had their HbA1c lowered by an average of 0.42%

The study also looked at people’s fasting blood sugar levels. (This is your blood sugar level after not eating for 8 hours.) After 24 weeks:

  • people who took Afrezza had their fasting blood sugar level lowered by an average of 11.2 milligrams per deciliter (mg/dL)
  • people who took a placebo had their fasting blood sugar level lowered by an average of 3.8 mg/dL

The Food and Drug Administration (FDA) approves prescription drugs such as Afrezza to treat certain conditions. Afrezza is FDA-approved for use in people with type 1 diabetes.

(Afrezza is also approved for use in people with type 2 diabetes. For more information about this use, see the “Afrezza for type 2 diabetes” section above.)

With type 1 diabetes, your pancreas doesn’t produce insulin on its own. Without insulin, your cells can’t absorb glucose (sugar) properly. This causes high blood sugar, which can damage your eyes, kidneys, nerves, and other organs.

People with type 1 diabetes need to take insulin to survive.

Afrezza is a mealtime (fast-acting) insulin. It works quickly to help manage any spikes in your blood sugar after you eat a meal.

Effectiveness for type 1 diabetes

In a clinical study of adults with type 1 diabetes, people either took Afrezza or insulin aspart (Novolog) in addition to a basal (long-acting) insulin.

The people in the study had hemoglobin A1c (HbA1c) tests done. This test measures your average blood sugar levels over the past 3 months.

After 24 weeks:

  • people who took Afrezza had their HbA1c lowered by an average of 0.21%
  • people who took insulin aspart (Novolog) had their HbA1c lowered by an average of 0.4%

The study also looked at people’s fasting blood sugar levels. (This is your blood sugar level after not eating for 8 hours.) After 24 weeks:

  • people who took Afrezza had their fasting blood sugar level lowered by an average of 25.3 milligrams per deciliter (mg/dL)
  • people who took insulin aspart (Novolog) had their fasting blood sugar level raised by an average of 10.2 mg/dL

Afrezza is a mealtime (fast-acting) insulin. This means it works quickly to help manage any spikes in your blood sugar after you eat a meal.

You’ll likely take other diabetes medications along with Afrezza to help manage your blood sugar levels.

If you have type 1 diabetes, you’ll likely also take a basal (long-acting) insulin. Examples of long-acting insulins include:

If you have type 2 diabetes, there are several types of diabetes drugs you may take with Afrezza. Examples of these drugs include:

  • diabetes drugs taken by mouth, such as:
    • metformin (Glucophage)
    • empagliflozin (Jardiance)
    • glipizide (Glucotrol)
    • glimepiride (Amaryl)
    • sitagliptin (Januvia)
  • injectable diabetes drugs, such as:
  • long-acting insulins, such as:
    • insulin glargine (Lantus, Basaglar, Toujeo)
    • insulin detemir (Levemir)
    • insulin degludec (Tresiba)

The medications you take with Afrezza will depend on how long you’ve had diabetes and how well your body responds to the different types of drugs.

Here are answers to some frequently asked questions about Afrezza.

How is Afrezza different from Exubera?

Afrezza and Exubera are both fast-acting insulins that help manage blood sugar levels in people with diabetes. Both drugs come in a powdered form that you breathe in through your mouth with an inhaler.

However, Exubera was discontinued in 2007, so it’s no longer available. If you’re interested in alternatives to Afrezza, talk with your doctor.

Will I need to have any tests done before I start using Afrezza?

Yes, your doctor will likely order standard blood tests before you start Afrezza. This may include the hemoglobin A1c (HbA1c) test, which measures your average blood sugar levels over the past 3 months.

You’ll also likely have a lung test to measure forced expiratory volume (FEV1).

FEV1 is a measurement of how much air you can force out of your lungs in one second. Higher FEV1 values show better airflow through your lungs. You’ll likely have this test done again after 6 months to make sure your lungs are healthy.

If your FEV1 values show you may have a lung disease such as asthma or chronic obstructive pulmonary disease (COPD), you may have to stop taking Afrezza.

If I see powder left in my Afrezza inhaler after taking the drug, did I get my full dose?

Most likely, yes. It’s normal to see a small amount of powder or residue in the inhaler mouthpiece or cartridge after you use Afrezza. This should not affect your dose.

If you see a lot of powder left in your inhaler after taking a dose, talk with your doctor. They can help make sure the inhaler is working properly and that you’re using it correctly.

Can I take Afrezza if I’m taking other drugs that are inhaled?

Do not take other inhaled drugs that are used to treat asthma or chronic obstructive pulmonary disease (COPD). Afrezza should not be used in people who have these conditions because of the risk of acute bronchospasm (severe tightening of your airways.)

To learn more, see the “FDA warning” section at the beginning of this article.

Is it safe to use Afrezza if I smoke?

No, it’s not recommended that you use Afrezza if you currently smoke or quit smoking less than 6 months ago. This is because there isn’t enough information to know if Afrezza is safe to use in people who smoke.

If you smoke or quit smoking within the past 6 months, talk with your doctor about treatment options for managing your blood sugar levels.

Will I need to wash my Afrezza inhaler after I use it?

No, you don’t need to wash your Afrezza inhaler. However, you can wipe down the mouthpiece with a clean, dry cloth to remove any moisture or residue.

Each Afrezza inhaler can be used for up to 15 days from the date you first use it. After that, you should throw it away and use a new inhaler.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist about the best way to dispose of your inhaler.

You should not drink alcohol when using Afrezza. This is because alcohol can have unpredictable effects on blood sugar. It can either raise or lower your blood sugar level.

This effect can be dangerous while you’re taking Afrezza, as it may lead to severe hypoglycemia (very low blood sugar).

Talk with your doctor if you’re concerned about avoiding alcohol during your Afrezza treatment.

Afrezza can interact with several other medications.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Afrezza and other medications

Below is a list of medications that can interact with Afrezza. This list does not contain all drugs that may interact with Afrezza.

Before taking Afrezza, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Afrezza and other diabetes drugs

Taking Afrezza with other diabetes medications may cause hypoglycemia (low blood sugar). To help prevent this, it’s important to monitor your blood sugar levels regularly, especially when taking a new drug.

Examples of other diabetes drugs include:

  • metformin (Glucophage)
  • glipizide (Glucotrol)
  • liraglutide injection (Victoza)
  • semaglutide injection (Ozempic)
  • dulaglutide injection (Trulicity)
  • pramlintide acetate (Symlin)

Talk with your doctor if you’re taking more than one diabetes drug and are concerned about hypoglycemia.

Afrezza and thiazolidinediones

You should not take insulin, including Afrezza, with a class of diabetes drugs called thiazolidinediones (TZDs). Taking these drugs together may raise your risk for developing heart failure. This is true even if you have no history of heart disease.

Examples of TZDs include:

  • rosiglitazone (Avandia)
  • pioglitazone (Actos)

If you currently take a TZD, talk with your doctor about your treatment options for fast-acting insulin.

Afrezza and certain antibiotics or antifungals

Taking Afrezza with sulfonamide antibiotics may make Afrezza lower your blood sugar more than it normally would. This could raise your risk for hypoglycemia (low blood sugar).

If you take any of the medications listed below, your doctor may lower your dose of Afrezza. Or, they may monitor your blood sugar levels more closely to make sure you can prevent or treat any episodes of hypoglycemia.

Examples of sulfonamide antibiotics include:

  • sulfamethoxazole and trimethoprim (Bactrim)
  • sulfadiazine

A type of antifungal drug called pentamidine (Pentam) may cause hypoglycemia at first, followed by hyperglycemia (high blood sugar). If you need to take pentamidine with Afrezza, your doctor may adjust your Afrezza dose based on your blood sugar changes.

Talk with your doctor if you need to take an antibiotic or antifungal drug during your Afrezza treatment.

Afrezza and certain blood pressure drugs

Taking Afrezza with certain blood pressure drugs called ACE inhibitors may make Afrezza lower your blood sugar more than it normally would. This could raise your risk for hypoglycemia.

If you take an ACE inhibitor, your doctor may lower your dose of Afrezza. Or, they may monitor your blood sugar levels more closely to make sure you can prevent or treat any episodes of hypoglycemia.

Examples of ACE inhibitors include:

  • lisinopril (Zestoretic)
  • enalapril (Vasotec)
  • benazepril (Lotensin)

Some blood pressure drugs may have an unpredictable effect on blood sugar. They can either raise or lower your blood sugar level. They can also mask or reduce certain symptoms of hypoglycemia, such as fast heartbeat or feeling shaky.

If you have to take these drugs with Afrezza, talk with your doctor about other symptoms of hypoglycemia to watch for. This can help you act quickly to treat episodes of hypoglycemia.

Examples of these blood pressure drugs include:

  • metoprolol (Toprol XL)
  • nadolol (Corgard)
  • atenolol (Tenormin)
  • clonidine (Catapres)

Taking Afrezza with certain blood pressure drugs called diuretics (water pills) may make Afrezza less effective at lowering your blood sugar level.

If you take a diuretic, your doctor may increase your dose of Afrezza. Or, they may monitor your blood sugar levels more closely to make sure your blood sugar is not going too high.

Examples of these diuretics include;

  • hydrochlorothiazide (Microzide)
  • furosemide (Lasix)

If you need to take a blood pressure medication with Afrezza, talk with your doctor about your treatment options.

Afrezza and certain steroids

Taking Afrezza with certain steroids that are used to treat inflammation (swelling) or autoimmune disorders may make Afrezza less effective at lowering your blood sugar level.

If you take one of these steroids with Afrezza, your doctor may recommend increasing your dose of Afrezza. Or, they may do more frequent monitoring of your blood sugar to make sure your blood sugar is not getting too high.

Examples of these steroids include:

  • prednisone (Deltasone)
  • methylprednisolone (Medrol)

Talk with your doctor about your treatment options if you need to take a steroid while using Afrezza.

Afrezza and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Afrezza. However, you should still check with your doctor or pharmacist before using any of these products while taking Afrezza.

Afrezza and foods

There aren’t any foods that have been specifically reported to interact with Afrezza. If you have any questions about eating certain foods with Afrezza, talk with your doctor.

As with all medications, the cost of Afrezza can vary.

The actual price you’ll pay will depend on your insurance plan, your location, and the pharmacy you use.

It’s important to note that you’ll have to get Afrezza at a specialty pharmacy. This type of pharmacy is authorized to carry specialty medications. These are drugs that may be expensive or may require help from healthcare professionals to be used safely and effectively.

Your insurance plan may require you to get prior authorization before they approve coverage for Afrezza. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Afrezza, contact your insurance plan.

Financial and insurance assistance

If you need financial support to pay for Afrezza, help is available.

MannKind Corp., the manufacturer of Afrezza, offers a savings card that may help to lower the cost of your prescription. For more information and to find out if you’re eligible for support, visit the program website.

Afrezza is FDA-approved to help manage blood sugar levels in adults with type 1 or type 2 diabetes.

How insulin affects blood sugar

Usually, after you eat, the food gets broken down in your stomach. Glucose (sugar) from the food travels into your bloodstream. In response to this, your body releases insulin.

Insulin is a hormone that helps move glucose out of your bloodstream and into your body’s cells. Once inside your cells, the glucose can be turned into energy.

Insulin is usually made by your pancreas. But in people with type 1 diabetes, their pancreas isn’t able to make insulin.

In those with type 2 diabetes, their body may still make insulin, but their cells are resistant to the hormone. (With insulin resistance, your body stops responding to insulin the way it normally should.) Over time, it’s possible that people with type 2 diabetes might not be able to make their own insulin.

If your body is either not making insulin or not responding to it properly, your blood sugar level can get too high. This is called hyperglycemia. Typically with hyperglycemia, blood sugar isn’t going from your bloodstream to your cells to be used for energy. Over time, high blood sugar levels can damage your organs.

What Afrezza does

Afrezza is a mealtime (fast-acting) insulin. This means it works quickly to help manage any spikes in your blood sugar after you eat a meal.

When you eat, your body absorbs sugar from carbohydrates in your food through your digestive tract. This causes a spike in blood sugar levels after meals and snacks.

Because Afrezza is inhaled, it enters your bloodstream quickly and allows your cells to take in sugar from your blood and use it for energy. This results in blood sugar levels lowering, while also allowing your body to use sugar for energy for everyday functions.

How long does it take to work?

Afrezza enters your bloodstream in less than 1 minute after you inhale your dose. It starts working in about 12 minutes to lower your blood sugar level. Afrezza is most effective 35 to 45 minutes after you take a dose.

It’s not known whether Afrezza is safe to use during pregnancy.

Some studies have been done in pregnant rats and rabbits. The results showed that when the pregnant animals were given high doses of Afrezza by injection, there were negative effects to the mother and the offspring. However, animal studies don’t always predict what will happen in humans.

If you’re pregnant or planning to become pregnant, talk with your doctor about the risks and benefits of using Afrezza.

It’s not known if Afrezza is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Afrezza.

It’s not known if Afrezza if safe to take while breastfeeding. Animal studies have shown that a high amount of Afrezza was present in the milk of nursing rats. Although animal studies don’t always predict what will happen in humans, these results mean it’s highly likely that Afrezza would pass into human breast milk.

If you’re currently breastfeeding or plan to breastfeed during your treatment, talk with your doctor about the risks and benefits of using Afrezza.

This drug comes with several precautions.

FDA warning: Acute bronchospasm in people with asthma or COPD

Afrezza has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

You shouldn’t take Afrezza if you have asthma or chronic obstructive pulmonary disease (COPD). This is because you may have a high risk of acute bronchospasm (severe tightening of your airways) after using Afrezza. This side effect makes it very hard to breathe. Your doctor may test your lung health before you start Afrezza to see if it’s safe for you to take.

Other precautions

Before taking Afrezza, talk with your doctor about your health history. Afrezza may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Lung cancer. You shouldn’t take Afrezza if you have lung cancer or a history of lung cancer. In rare cases, Afrezza may raise your risk for lung cancer. In clinical studies, two people developed lung cancer while taking Afrezza. No one who took other treatments had lung cancer. However, it’s not known if Afrezza was the cause of lung cancer in these studies. If you have lung cancer or have had it in the past, talk with your doctor about other treatment options for managing your blood sugar.
  • Heart failure. If you have a history of heart failure and you take any insulin, including Afrezza, you may be at risk for worsening your heart failure. If you are short of breath, retaining water, or getting tired too easily, call your doctor. These may be symptoms of heart failure getting worse. Taking Afrezza (or any insulin) with thiazolidinediones may raise your risk for developing heart failure.
  • Pregnancy. It’s not known if Afrezza is safe to take during pregnancy. For more information, see the “Afrezza and pregnancy” section above.
  • Breastfeeding. It’s not known whether Afrezza is safe to take while breastfeeding. For more information, see the “Afrezza and breastfeeding” section above.

Note: For more information about the potential negative effects of Afrezza, see the “Afrezza side effects” section above.

Using more than the recommended dosage of Afrezza can lead to serious side effects. These include severe hypoglycemia (very low blood sugar). Severe hypoglycemia caused by Afrezza can result in coma, loss of consciousness (not being able to respond to sound or touch), or even death.

Do not use more Afrezza than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

  • coma
  • seizures
  • feeling dizzy or lightheaded
  • sweating
  • confusion
  • headache
  • blurry vision
  • slurred speech
  • fast heartbeat
  • shakiness
  • loss of consciousness (not being able to respond to sound or touch)

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

The following information is provided for clinicians and other healthcare professionals.

Indications

Afrezza is a rapid acting insulin indicated to improve glycemic control in adults with type 1 or type 2 diabetes mellitus.

Mechanism of action

Afrezza contains human insulin in powder form. Insulin works to reduce blood glucose levels by increasing cellular uptake of glucose by fat and skeletal muscle.

Pharmacokinetics and metabolism

After inhalation, Afrezza appears in the bloodstream in less than 1 minute. Time to peak serum insulin concentration (onset) is 10 to 20 minutes after oral inhalation of 4 to 48 units. The duration of action appears to be within 60 to 240 minutes. The time to peak effect is approximately 35 to 55 minutes.

The terminal half-life of Afrezza is 120 to 206 minutes following 4 to 48 units orally inhaled.

Afrezza metabolism and elimination is the same as regular human insulin.

Contraindications

Afrezza is contraindicated during episodes of hypoglycemia. It’s also contraindicated in people with chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD). Patients with a history of hypersensitivity to human insulin or any of the Afrezza excipients should also not take Afrezza.

Storage

When Afrezza cartridges are still in the unopened foil package, they should be stored in the refrigerator at 36°F to 46°F (2°C to 8°C). The cartridges will be effective until the expiration date printed on the box. If stored at a room temperature of 77°F (25°C), they should be used within 10 days (even if still sealed).

Once the foil package is opened, but the Afrezza cartridges are still sealed in the blister card strips, they should be stored in the refrigerator at 36°F to 46°F (2°C to 8°C). They must be used within 1 month of opening the foil package.

Once the blister card strips are opened, they can be kept at a room temperature of 77°F (25°C). They should be used within 3 days.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.