Baqsimi is used to treat very low blood sugar (severe hypoglycemia) in adults and children aged 1 year and older with diabetes. It is a nasal powder that is administered into the nose, making it easier to administer than traditional injectable glucagon. After giving Baqsimi, the caregiver should call for emergency help.

Baqsimi (glucagon) works by activating liver glucagon receptors, stimulating glycogen breakdown, and releasing glucose from the liver, increasing blood glucose levels. Liver stores of glycogen are necessary for glucagon to produce an antihypoglycemic effect.

Baqsimi gained FDA approval on July 24, 2019. There is no generic.

Side effects

The most common side effects of Baqsimi include:

• nausea
• discomfort in your nose
• watery eyes
• vomiting
• stuffy nose
• redness in your eyes
• headache
• cough
• itchy nose, throat, and eyes
• runny nose
• nose bleed.

Serious side effects and warnings

Baqsimi may cause the following serious side effects:

• High blood pressure. Baqsimi can cause high blood pressure in certain people with tumors in their adrenal glands. Call your doctor at once if you have symptoms of high blood pressure, such as severe headache, blurred vision, and pounding in your neck or ears
• Low blood sugar. Baqsimi can cause certain people with tumors in their pancreas, called insulinomas, to have low blood sugar
• Serious allergic reactions. Call your healthcare provider or get medical help right away if you have a serious allergic reaction, including:
  • rash
  • difficulty breathing
  • low blood pressure
  • hives
  • trouble swallowing
  • feeling dizzy or faint
  • cough
  • swelling of the face, lips, or tongue
  • fast heartbeat.

It is not known if Baqsimi is safe and effective in children under 1 year of age.

These are not all the possible side effects of Baqsimi. For more information, ask your healthcare provider. Call your healthcare provider for medical advice about side effects.

Before taking

You should not use Baqsimi if you are allergic to glucagon, or if you have:

• a tumor of the pancreas (insulinoma); or
• a tumor of the adrenal gland (pheochromocytoma).

Before taking, tell your healthcare provider about all your medical conditions, including if you:

• have adrenal gland problems
• have a tumor in your pancreas
• have not had food or water for a long time (prolonged fasting or starvation)
• have low blood sugar that does not go away (chronic hypoglycemia)
• are pregnant or plan to become pregnant. It is not known if Baqsimi will harm your unborn baby
• are breastfeeding or plan to breastfeed. It is not known if Baqsimi passes into your breast milk. You and your healthcare provider should decide if you can use Baqsimi while breastfeeding.

How should I use Baqsimi?

Read the detailed Instructions for Use that comes with Baqsimi. Use Baqsimi exactly how your healthcare provider tells you to use it.

Make sure your caregiver and those around you know where you keep your Baqsimi and how to use Baqsimi the right way before you need their help.

• Baqsimi contains only 1 dose of medicine and cannot be reused.
• Baqsimi should be given in one side of your nose (nostril), but does not need to be inhaled.
• Baqsimi will work even if you have a cold or are taking cold medicine.
• Act quickly. Having very low blood sugar for a period of time may be harmful.
• After giving Baqsimi, the caregiver should call for emergency medical help right away.

When you can safely swallow food or drink, your caregiver should give you a fast-acting source of sugar (such as a regular soft drink or fruit juice) and a long-acting source of sugar (such as crackers with cheese or peanut butter).

If the person does not respond after 15 minutes, another dose of Baqsimi from a new device may be given, if available, while waiting for emergency services.

Tell your healthcare provider each time you use Baqsimi.

What happens if I miss a dose?

Since Baqsimi is used as needed, it does not have a daily dosing schedule.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include nausea, vomiting, constipation, rapid pulse, or increased blood pressure (severe headache, blurred vision, pounding in your neck or ears).

What should I avoid while using Baqsimi?

Do not take by mouth. Nasal medicine is for use only in the nose.

Avoid drinking alcohol. It can lower your blood sugar.

What other drugs will affect Baqsimi?

Many other medicines can affect your blood sugar, and some medicines can increase or decrease the effects of medicines used to treat diabetes. Some drugs can also cause you to have fewer symptoms of hypoglycemia, making it harder to tell when your blood sugar is low. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all medicines you start or stop using.

What is glucagon?

Glucagon is a hormone that increases blood sugar levels. It also slows involuntary muscle movements of the stomach and intestines that aid in digestion.

Glucagon injection is a prescription medicine used to treat very low blood sugar (hypoglycemia).

Glucagon is also used to stop stomach movement during radiologic (x-ray) examinations undertaken to diagnose certain disorders of the stomach or intestines.

Glucagon is available as an auto-injector, prefilled syringe, or injection vial.

Warnings

Glucagon should be used to treat hypoglycemia only if the person cannot eat, passes out, or is having a seizure. Be sure you know how to give a glucagon injection before you need to use it. Hypoglycemia should be treated as quickly as possible. Having low blood sugar for too long can cause seizure, coma, or death.

You should not use glucagon injection if you are allergic to glucagon or lactose, or if you have a tumor of the pancreas (insulinoma) or adrenal gland (pheochromocytoma).

Avoid driving and doing other tasks or actions that call for you to be alert until you have eaten sugar or a product that has sugar in it like a regular soft drink or fruit juice. Avoid these tasks or actions until you feel fully alert.

Low blood sugar can happen with this medicine (glucagon auto-injectors and prefilled syringes) in people who have certain types of pancreas tumors (glucagonoma, insulinoma). Very low blood sugar can lead to seizures, confusion, passing out, and sometimes death. If signs of low blood sugar happen after using this glucagon, get medical help right away.

Before taking this medicine

You should not use this medicine if you are allergic to glucagon or lactose, or if you have:

• a tumor of the pancreas (insulinoma); or
• a tumor of the adrenal gland (pheochromocytoma).

Glucagon should be used to treat hypoglycemia only if the person is unable to eat, or is unconscious or having a seizure.

Tell your doctor if:

• you have any tumor of the pancreas;
• you have not recently eaten on a regular basis; or
• you have chronic low blood sugar.

Do not give this medicine to a child without medical advice.

Glucagon is not expected to harm an unborn baby, but quickly treating hypoglycemia would outweigh any risks posed by using glucagon.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.

How should I use glucagon?

Use glucagon exactly as prescribed by your doctor. Hypoglycemia should be treated as quickly as possible. Having low blood sugar for too long can cause seizure, coma, or death.

Glucagon is injected under the skin, into a muscle, or into a vein. You will be shown how to use the emergency injections for severe hypoglycemia. Call your doctor after each time you use a glucagon injection.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don’t understand all instructions.

Be sure you know how to give a glucagon injection before you need to use it. The correct dose for a child is lower than an adult dose. A child’s dose may also be based on how much the child weighs. Follow your doctor’s dosing instructions very carefully.

You may need to mix glucagon with a liquid (diluent) before using it. When using injections by yourself, be sure you understand how to properly mix and store the medicine.

Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.

After the injection, you should eat a fast-acting source of sugar (fruit juice, glucose gel, hard candy, raisins, or non-diet soda) and then eat a snack or small meal such as cheese and crackers or a meat sandwich.

If you are a caregiver, get emergency medical help after giving a glucagon injection. If the patient does not improve within 15 minutes, you may need to mix a new dose and give a second injection.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

To keep from having severe hypoglycemia, follow your diet, medication, and exercise routines very closely.

Store glucagon and any diluent at room temperature, away from moisture, heat, and light. Do not refrigerate or freeze. Throw away any mixed medicine you have not used right away. Do not use this medicine after the expiration date on the label has passed.

Store the auto-injector or prefilled syringe in the foil pouch and use the medicine right away after opening.

What happens if I miss a dose?

Since glucagon is used as needed, it does not have a daily dosing schedule.

Call your doctor promptly if symptoms do not improve after using glucagon.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include nausea, vomiting, diarrhea, rapid pulse, or high blood pressure (severe headache, blurred vision, pounding in your neck or ears).

What should I avoid after using glucagon?

Avoid drinking alcohol. It can lower your blood sugar.

Glucagon side effects

Get emergency medical help if you have signs of an allergic reaction to glucagon: hives; difficulty breathing; fast or slow heartbeat; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of the following skin changes on your face, legs, groin, or genital area:

• redness;
• itching;
• blistering;
• crusting, scaling; or
• other skin sores or lesions.

Common glucagon side effects may include:

• nausea, vomiting; or
• swelling where an injection was given.