Glucagon for Intranasal Application Newly Available Also in the Czech Republic
Intramuscular administration of glucagon was until recently the only option for acute treatment of hypoglycemia with impaired consciousness at home. However, since July this year, the Baqsimi product – glucagon for intranasal application – is newly available in the Czech Republic.
Indications, Dosage, and Method of Administration
The product Baqsimi is indicated for the treatment of severe hypoglycemia (the patient is unable to eat or drink due to impaired consciousness and needs assistance from another person) in adults, adolescents, and children aged from 4 years with diabetes mellitus. It is available on prescription.
It is a nasal powder in a single-dose package containing 3 mg of glucagon. Dose adjustment is not necessary for older patients or diabetics with renal or hepatic insufficiency. It is administered into one nostril similarly to regular nasal spray for rhinitis. Since it is passively absorbed by the nasal mucosa, there is no need to take a deep breath or breathe deeply, and it can be administered even to a patient with impaired consciousness. Its absorption is not even disrupted in the case of rhinitis with nasal mucosa congestion.
If the patient responds to the treatment, they should eat food or drink a high-sugar beverage, such as sweets or fruit juice, as soon as possible to prevent the relapse of hypoglycemia.
Mechanism of Action
Glucagon acts through glucagon receptors in the liver, stimulates glycogenolysis, and thus increases blood glucose levels. It is effective only in the presence of a sufficient amount of glycogen in the liver. It is therefore ineffective or minimally effective in cases of starvation, adrenal insufficiency, chronic alcohol abuse, or chronic hypoglycemia. These conditions should be treated by administering glucose.
Contraindications and Side Effects
An obvious contraindication to the administration of Baqsimi is hypersensitivity to the active substance or any of the excipients. An allergic reaction usually manifests as a generalized rash, in some cases as anaphylactic shock with respiratory difficulties and hypotension.
Furthermore, it should not be used by diabetics with adrenal medullary pheochromocytoma, where glucagon can stimulate the release of catecholamines from the tumor and lead to a dramatic increase in blood pressure.
Its administration is also not suitable for patients with pancreatic insulinoma. This is because it can cause an initial increase in blood glucose, which, however, soon stimulates the secretion of hypoglycemic insulin from the tumor.
Since glucagon does not cross the placental barrier, it can be administered during pregnancy. Given its rapid elimination from the bloodstream, the amount excreted into the milk of breastfeeding mothers is presumed to be extremely small, and it can therefore be used during breastfeeding.
The most frequently reported adverse events include increased tearing, upper respiratory tract irritation, nausea, headache, and vomiting.
Practical and Simple
All diabetics (not only those with type 1 diabetes) treated with insulin or insulin secretagogues are at risk of hypoglycemia. In the therapy of insulin-induced hypoglycemia, intranasally administered glucagon has proven to be practically as effective as glucagon intended for intramuscular administration. Since it can be stored at temperatures up to 30°C for up to 2 years from the date of manufacture, diabetics can carry it in a handbag or other bag and always have it available for severe hypoglycemia with impaired consciousness. Another advantage is its simple use. Besides removing it from the protective package, no preparation is required (unlike the preparation of an intramuscular injection). It is important for people around the patient (family, friends, colleagues) to be able to recognize the symptoms of severe hypoglycemia and apply glucagon promptly and correctly.
(mafi)
Sources:
1. SPC Baqsimi. Available at: www.ema.europa.eu/en/documents/product-information/baqsimi-epar-product-information.cs.pdf
2. Baqsimi. Available at: www.baqsimi.com
3. Baqsimi. Educational material for physicians. Version 1, approved by SÚKL: 05/2020. Available at: www.sukl.cz/file/93357_1_1
4. Krollová P. Intranasal glucagon. Cukrovka.cz, 16. 7. 2020. Available at: www.cukrovka.cz/intranazalni-glukagon
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