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This safety and warning information provides essential guidance on the use of Levemir (insulin detemir). Please read carefully and discuss any concerns with your healthcare provider.

• Infection Risk: Never share Levemir pens, syringes, or needles, as this can lead to serious infections.

• Low Blood Sugar (Hypoglycemia): Insulin, including Levemir, can cause low blood sugar, which may be life-threatening. Symptoms include shakiness, anxiety, confusion, and hunger. Always have glucose tablets or fast-acting sugars available. Use the "15-15 Rule" to manage low blood sugar levels. Consult your doctor if frequent episodes occur, as your insulin dosage may need adjustment. Factors increasing risk include dietary changes, alcohol consumption, use of other blood sugar medications, age over 65, and liver or kidney issues.

• Severe Allergic Reactions: Rarely, severe allergic reactions can occur, which are life-threatening. Seek emergency help if you experience breathing difficulties, a rapid heartbeat, or swelling of the face, mouth, or throat.

• Low Potassium Levels: Levemir may lower blood potassium levels, which can be dangerous. Symptoms include muscle weakness, fatigue, a fast heartbeat, and tingling sensations. This risk is heightened if you're on medications that also lower potassium. Regular monitoring of potassium levels by your doctor is recommended.

• Fluid Retention and Heart Failure Risk: If you are using thiazolidinediones (TZDs) for blood sugar management, inform your healthcare provider before starting Levemir. Combining these can cause fluid retention leading to heart failure. Symptoms to watch for include sudden weight gain, breathing difficulty, and fatigue. Your medication regimen may need adjustment.

Contraindications:

• Untreated Low Blood Sugar: Do not use Levemir if you have untreated low blood sugar conditions, as it can pose serious health risks.

For any of these concerns, please consult your healthcare provider for personalized advice.

When using this medication, some common side effects may occur, usually mild and manageable. These include shakiness, hunger, and symptoms associated with low blood sugar, which may affect many depending on other medications taken. Cold symptoms such as those affecting the nose, throat, and lungs, headaches, throat irritation, back pain, and flu-like symptoms such as fever and chills may also occur. Stomach pain is another possible side effect. If any of these persist or become bothersome, it's advisable to consult a healthcare provider.

Other reported side effects include weight gain and swelling in the hands or feet due to fluid retention. Injection site reactions, such as redness, pain, or itching, may also be experienced. These are generally mild but should be monitored.

Rare but serious side effects require immediate medical attention. These include dangerously low blood sugar levels, which can present as shakiness, nervousness, fast heartbeat, sweating, confusion, drowsiness, weakness, or excessive hunger. Severe allergic reactions, identifiable by hives, itching, swelling of the face or tongue, and difficulty breathing, are also critical to address urgently. Additionally, dangerously low potassium levels may lead to muscle twitches, cramps, abnormal heart rhythms, and fatigue. If you notice these severe symptoms, seek medical care immediately. Always keep in touch with your healthcare provider if you experience any side effects or have concerns about your medication.

When using Levemir (insulin detemir), be aware that it might interact with various medications and supplements. It's crucial to inform your doctor and pharmacist about all the medications and supplements you are taking, including prescriptions, over-the-counter drugs, vitamins, and herbal products. The following interactions are important to note:

1. Interactions Requiring Caution: Some medications should generally be avoided with Levemir unless absolutely necessary. If your doctor prescribes both, they might adjust the dosages or usage frequency. These medications include antibiotics like Ciprofloxacin and Levofloxacin, diabetes treatments like Pioglitazone, and others such as Chloroquine and Octreotide.

2. Risk of Enhanced Side Effects: Combining Levemir with certain drugs might increase the risk of side effects, but this combination can sometimes be the best treatment option. In such cases, your doctor may adjust how you use these medications together. This list includes beta-blockers such as Metoprolol and Propranolol, as well as other drugs like Exenatide and Saxagliptin.

Beta-blockers, including Metoprolol and Propranolol, can mask signs of low blood sugar, like a rapid heartbeat, which might make it harder to recognize hypoglycemia. However, other symptoms like dizziness and sweating are not affected. Monitoring your blood sugar regularly and discussing any changes or symptoms with your doctor is crucial. Your healthcare provider might need to adjust your diabetes medications, exercise, or diet based on these interactions. Always consult your doctor before starting, stopping, or changing any medication.