glucagon intranasal (Rx)

Brand and Other Names:Baqsimi
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intranasal powder

  • 3mg/actuation

Hypoglycemia

Indicated for severe hypoglycemic reactions in patients with diabetes

3 mg administered as 1 actuation using the intranasal device into 1 nostril

If no response after 15 minutes, administer an additional 3-mg dose from a new device while waiting for emergency assistance

Dosage Forms & Strengths

intranasal powder

  • 3mg/actuation

Hypoglycemia

Indicated for severe hypoglycemic reactions in children aged ≥4 years with diabetes

<4 years: Safety and efficacy not established

≥4 years: 3 mg administered as 1 actuation using the intranasal device into 1 nostril

If no response after 15 minutes, administer an additional 3-mg dose from a new device while waiting for emergency assistance

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Interactions

Interaction Checker

and glucagon intranasal

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    Contraindicated

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            Adverse Effects

            >10%

            Adults

            • Watery eyes (58.8%)
            • Nasal congestion (42.5%)
            • Nasal itching (39.2%)
            • Nausea (26.1%)
            • Eye redness (24.8%)
            • Itchy eyes (21.6%)
            • Sneezing (19.6%)
            • Headache (18.3%)
            • Vomiting (15%)
            • Upper respiratory tract irritation (12.4%)
            • Throat itching (12.4%)

            Children

            • Watery eyes (47.2%)
            • Nasal congestion (41.7%)
            • Vomiting (30.6%)
            • Nasal itching (27.8%)
            • Headache (25%)
            • Runny nose (25%)
            • Sneezing (19.4%)
            • Upper respiratory tract irritation (16.7%)
            • Itchy eyes (16.7%)
            • Eye redness (13.9%)

            1-10%

            Children

            • Throat itching (2.8%)
            • Ears itching (2.8%)

            Adults

            • Ears itching (3.3%)

            Frequency Not Defined

            Adults and children

            • Dysgeusia
            • Pruritus
            • Tachycardia
            • Hypertension
            • Additional upper respiratory tract irritation (nasal pruritus, throat irritation, parosmia)
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            Warnings

            Contraindications

            Pheochromocytoma

            Insulinoma

            Hypersensitivity to glucagon or to any excipients

            Cautions

            Allergic reactions reported including anaphylactic shock with breathing difficulties and hypotension

            Contraindicated with pheochromocytoma; glucagon may stimulate catecholamine release from the tumor; if blood pressure (BP) increases dramatically and undiagnosed pheochromocytoma is suspected, administer phentolamine 5-10 mg IV to lower BP

            Contraindicated with insulinoma; glucagon administration may produce initial increase in blood glucose; however, glucagon may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia; treat with glucose PO or IV

            Effective for hypoglycemia only if sufficient hepatic glycogen is present; patients in states of starvation, with adrenal insufficiency, or chronic hypoglycemia may not have adequate levels of hepatic glycogen for glucagon to be effective; treat these patients with glucose

            Drug interaction overview

            • Patients taking beta-blockers may have transiently increased pulse and BP when administered glucagon
            • In patients taking indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia
            • Glucagon may increase anticoagulant effect of warfarin
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            Pregnancy & Lactation

            Pregnancy

            Available data from case reports and a small number of observational studies with glucagon use in pregnant women over decades of use have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

            Multiple small studies have demonstrated a lack of transfer of pancreatic glucagon across the human placental barrier during early gestation

            Lactation

            There is no information available on the presence of glucagon in human or animal milk, the effects of the drug on the breastfed infant, or the effects of the drug on milk production

            However, glucagon is a peptide and would be expected to be broken down to its constituent amino acids in the infant's digestive tract and is therefore unlikely to cause harm to an exposed infant

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Insulin antagonist

            Activates hepatic glucagon receptors that stimulate cAMP synthesis; this accelerates hepatic glycogenolysis and gluconeogenesis, causing an increase in blood glucose levels

            Preexisting hepatic glycogen stores necessary to be effective in treating hypoglycemia

            Mean maximum glucose increase from baseline

            • Adults: 140 mg/dL
            • Children aged 4 yr to <8 yr: 138 mg/dL
            • Children aged 8 yr to <12 yr: 133 mg/dL
            • Children aged 12 yr to <17 yr: 102 mg/dL

            Absorption

            Peak plasma concentration: 6130 pg/mL

            Peak plasma time: 15 minutes (adults); 15-20 minutes (children)

            Distribution

            Vd: 885 L

            Metabolism

            Degraded in the liver, kidneys, and plasma

            Elimination

            Half-life: ~35 minutes (adults); 21-31 minutes (children)

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            Administration

            Intranasal Administration

            For intranasal use only

            Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia

            Severe hypoglycemia requires help of others to recover; instruct the patient to inform those around them about intranasal glucagon and how to use it

            Administer as soon as possible when severe hypoglycemia is recognized

            Emphasize the following instructions to the patient or caregiver

            • Do not push plunger or test the device before administering
            • Administer according to instructions on the shrink-wrapped tube label
            • Administer by inserting the tip into 1 nostril and pressing the device plunger all the way in until the green line is no longer showing; dose does not need to be inhaled
            • Call for emergency assistance immediately after administering
            • When patient responds to treatment, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia
            • Do not attempt to reuse the glucagon intranasal device; each device contains 1 dose of glucagon and cannot be reused

            Storage

            May store up to 86ºF (30ºC) in the shrink-wrapped tube provided

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.