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Medication Spotlight [Baqsimi]

What is Baqsimi?

Baqsimi is an intranasal glucagon powder formulation for treating severe hypoglycemic emergencies in diabetic patients > 4 years old using insulin and who cannot take oral carbohydrates. When consciousness is impaired, a caregiver can use Baqsimi to raise their blood glucose levels within 15 minutes. Glucagon is a hormone that increases glucose levels by promoting stored glycogen breakdown.

Role in Therapy

Previously, there were two injectable formulations of glucagon: Glucagon for Injection (Eli Lilly) and Glucagen Hypokit (Novo Nordisk). With Baqsimi (Eli Lilly), it is a novel route of administration which avoids needles and bypasses the difficulty in administration (injectable versions need to be constituted, then drawn up with syringe and administered). Also, it is a one standard dose, compared to the injectable version which has 0.5 mg dosing for young children and 1 mg for older children and adults. Nasal formulations may be more user-friendly and faster to administer (think nasal naloxone!).

Dosing and Administration

For patients ages 4 years and up, the dose is 3 mg (= 1 spray) intranasally in ONE nostril (only one dose). If there is no improvement within 15 minutes (compared to 10 minutes for glucagon IM), it is recommended to administer intravenous glucose (hopefully 911 arrives within that time frame). The common cold or use of decongestants does not affect the efficacy of Baqsimi (contrast this with FluMist where patients should not have nasal congestion or runny nose).

How to Use

Remove the foil from the device and it is ready for use. Do not test the spray because it only has one dose. Insert the tip into one nostril, until your fingers touch the nostril. Push the plunger all the way until the green line disappears. After administration, patients may feel an increase in heart rate and blood pressure.

Adverse Effects

The most common adverse effects include nausea, vomiting, headache, cough and nasal symptoms (specific to nasal formulation - runny nose, discomfort, congestion, dry nose).

Drug Interactions

In patients taking beta blockers, they may experience greater changes in heart rate and blood pressure due to their blunted hypoglycemic response.

Other Important Info

Do not remove the shrink wrap until ready to use because it is sensitive to moisture.

Store at room temperature (compared to Glucagen Hypokit in the fridge)

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