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Baqsimi: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Oct 13, 2020.

1. How it works

  • Baqsimi is a dry nasal spray that contains glucagon that may be used to treat hypoglycemic emergencies (severely low blood sugar levels).
  • Glucagon helps stimulate the conversion of stored glycogen in the liver into glucose. This is then released into the bloodstream. It also stimulates the liver to produce more glucose from amino acid molecules and reduces how much glucose the liver needs to function so that as much glucose as possible can be released into the bloodstream. Glucagon also slows down digestion.
  • Glucagon also acts on adipose (fat) tissue to increase the breakdown of fat stores into the bloodstream.
  • Glucagon is produced naturally in the body by the alpha cells, found in the islet cells of the pancreas.
  • Baqsimi will help increase blood sugar (glucose) levels in those with severe low blood sugar levels (also called a hypoglycemic emergency). It is designed for use in the nose only.
  • Baqsimi belongs to the class of medicines called glucose elevating agents.

2. Upsides

  • May be used to treat severe hypoglycemia (extremely low blood sugar levels) in adults and children aged four or older with diabetes.
  • It contains a fixed dose of 3mg of glucagon. This dose can be administered to adults and children over the age of 4.
  • Baqsimi is easy-to-use and is sprayed directly into the nose. The person receiving Baqsimi does not need to be able to inhale the nasal spray, it just needs to be sprayed up into one nostril where it will be quickly absorbed.
  • Baqsimi can be administered to people with suspected severe hypoglycemia who are unconscious or having a seizure.
  • There does not appear to be a risk associated with using Baqsimi during pregnancy; however, studies have indicated that there is a lack of transfer of pancreatic glucagon across the placenta during early gestation. In breastfeeding infants, Baqsimi is likely to be broken down in an infant's digestive tract and is unlikely to cause harm.
  • Available in a one-pack or two-pack carton.
  • Baqsimi will work even if the person needing it has a cold or is taking cold medicine.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Nausea, headache, vomiting, upper respiratory tract irritation, nasal and ocular symptoms are the most common side effects reported with Baqsimi. Vomiting was the most common side effect reported in children, followed by a headache. Allergic reactions have also been reported with glucagon preparations, including anaphylactic shock and a generalized rash.
  • Nasal side effects from Baqsimi include nasal congestion, nasal itching, runny nose, and sneezing. Ocular side effects include watery eyes, eye redness, and itching. Throat itching, taste disturbances, a fast heartbeat, high blood pressure, and ear itching have also been reported.
  • Each Baqsimi device is single-use only.
  • If there is no response to Baqsimi within 15 minutes, administer a second dose using a new Baqsimi device. After Baqsimi has been administered, call for emergency help right away. Turn the person on their side and put in the recovery position if they are unconscious.
  • Baqsimi is only effective in treating hypoglycemia if sufficient liver glycogen is present. Baqsimi may not be effective in people who are malnourished, with adrenal insufficiency or with longstanding hypoglycemia.
  • Baqsimi should not be given to people with pheochromocytoma because glucagon may stimulate the release of catecholamines (hormones such as dopamine; norepinephrine and epinephrine) from the tumor. If a person has a sudden increase in blood pressure after Baqsimi administration, consider the possibility of previously undiagnosed pheochromocytoma and administer 5 to 10 mg of phentolamine mesylate.
  • Do not use in patients with insulinoma. In people with insulinoma, although Baqsimi may produce an initial increase in blood glucose, it may then directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia. If a person develops symptoms of hypoglycemia after a dose of Baqsimi, give oral or intravenous glucose.
  • Baqsimi is not available as a generic.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Baqsimi is a dry-powder nasal spray that contains glucagon which can be used to treat symptoms of severe low blood sugar levels in adults and children over the age of 4. It may be used when people are unconscious or having a seizure and works within 7 to 8 minutes. Trials report that 100% of people respond within 30 minutes.

5. Tips

  • Each Baqsimi device contains 1 dose of glucagon nasal powder and cannot be reused.
  • Baqsimi should be administered as soon as severe hypoglycemia (low blood sugar levels) are recognized.
  • To use Baqsimi, remove the plastic wrap around the device by pulling on the red stripe. Open the lid and remove the device from the tube. Do not push the plunger or test the device until you are ready to give a dose.
  • Hold the device between two fingers and your thumb. Insert the tip of the device gently into one nostril until your fingers touch the outside of your nose. Push the plunger all the way in. The dose is complete when the green line marked on the plunger disappears.
  • After you have administered a dose of Baqsimi, you should call for emergency help right away. Turn the person on their side and put in the recovery position if they are unconscious.
  • If the person does not respond within 15 minutes give them another dose if available. Each baqsimi device only delivers one-dose, so a new Baqsimi device is needed.
  • Encourage the person to eat as soon as they can and can swallow safely. Initially give them a fast-acting source of sugar, such as juice, then a snack such as cheese and crackers or peanut butter.
  • Throw away the used Baqsimi device and tube. Arrange for a replacement Baqsimi device as soon as possible.
  • Always store unused Baqsimi in the shrink-wrapped tube at room temperature (no higher than 86°F [30°C]).
  • Signs and symptoms of hypoglycemia come on quickly and may include shaking, dizziness, anxiety or nervousness, confusion, irritability or impatience, sweating, chills and clamminess, fast heartbeat, hunger, headache, seizures, or unconsciousness.
  • Tell your family, friends, and work colleagues that you have diabetes and explain what they should do if you develop severe hypoglycemia. Show them where you keep your Baqsimi and how to use it. Explain to them that hypoglycemia needs to be treated as quickly as possible because having low blood sugar levels for too long can cause seizures, coma, or death.

6. Response and Effectiveness

  • One dose of Baqsimi lasts for at least 90 minutes.
  • Baqsimi starts working within 7 to 8 minutes of administration, with peak levels being reached 30 minutes after administration.
  • In clinical trials, 100% of people with severe hypoglycemia (low blood sugar levels) treated with Baqsimi responded within 30 minutes.
  • In trials, 100% of people given Baqsimi achieved treatment success, which was defined as an increase in blood glucose levels within 30 minutes to ≥70 mg/dL or an increase of ≥20 mg/dL from the lowest glucose level reported at the time of severe hypoglycemia.
  • A dose of Baqsimi should always be followed up with a fast-acting source of sugar (eg fruit juice, glucose gel) and a snack or small meal such as crackers with cheese or peanut butter, because the effects of Baqsimi will start to wear off after at least 90 minutes.

7. Interactions

Medicines that interact with Baqsimi may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Baqsimi. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Baqsimi include:

  • beta-blockers, such as atenolol, propranolol, sotalol, or timolol (may cause a short-term increase in blood pressure and pulse)
  • indomethacin (may interfere with Baqsimi's ability to raise blood sugar levels and may cause hypoglycemia)
  • warfarin (may increase the anticoagulant effect).

Note that this list is not all-inclusive and includes only common medications that may interact with Baqsimi. You should refer to the prescribing information for Baqsimi for a complete list of interactions.

References

Baqsimi (glucagon). Eli Lilly and Company. 08/2019 https://www.drugs.com/pro/baqsimi.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Baqsimi only for the indication prescribed.

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