BAQSIMI
Clinical safety rating: caution
Comprehensive clinical and safety monograph for BAQSIMI (BAQSIMI).
BAQSIMI (glucagon) nasal powder is a hormone that increases blood glucose concentration by stimulating hepatic glycogenolysis and gluconeogenesis. It also relaxes smooth muscle of the gastrointestinal tract.
| Metabolism | Primarily hepatic degradation via proteolysis, with some renal metabolism. |
| Excretion | Primarily renal: metabolites and unchanged drug are excreted in urine. No significant biliary/fecal excretion data reported; glucagon is degraded in plasma, liver, and kidneys. |
| Half-life | Glucagon has a short plasma half-life of approximately 8–18 minutes after IV administration. For nasal glucagon (BAQSIMI), systemic half-life is similar; clinical effect is brief, and rapid clearance limits duration. |
| Protein binding | Minimal protein binding; specific binding proteins not well characterized (glucagon does not significantly bind to plasma proteins). |
| Volume of Distribution | Approximately 0.25 L/kg, indicating distribution primarily into extracellular fluid. Clinical meaning: rapid equilibration with interstitial space, consistent with peptide hormone. |
| Bioavailability | Nasal (BAQSIMI): approximately 30–40% relative to intramuscular injection. Bioavailability is sufficient to produce therapeutic glucose elevation. |
| Onset of Action | Nasal: 5–10 minutes for clinical response (elevation of blood glucose in hypoglycemia). |
| Duration of Action | Typically 30–60 minutes for glycemic effect. Clinical note: May require additional carbohydrate intake to prevent recurrence of hypoglycemia. |
3 mg intranasally as a single dose for severe hypoglycemia.
| Dosage form | POWDER |
| Renal impairment | No dose adjustment required for renal impairment. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | Approved for age 4 years and older: 3 mg intranasally as a single dose. No weight-based dosing; fixed dose. |
| Geriatric use | No specific dose adjustment; use standard adult dose of 3 mg intranasally. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for BAQSIMI (BAQSIMI).
| Breastfeeding | No human data; glucagon is a peptide with negligible oral bioavailability, unlikely to affect breastfed infant. M/P ratio unknown. |
| Teratogenic Risk | No evidence of teratogenicity in animal studies; no adequate human data. Glucagon does not cross the placenta in significant amounts. Considered low risk in all trimesters when used for severe hypoglycemia. |
| Fetal Monitoring |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to glucagon or any excipients","Known pheochromocytoma","Known insulinoma"]
| Precautions | ["Risk of hypoglycemia in patients with insulinoma or glucagonoma","May cause nausea, vomiting, and hypertension","Use caution in patients with pheochromocytoma"] |
| Food/Dietary | No specific food interactions. After successful treatment of severe hypoglycemia with BAQSIMI, consume fast-acting carbohydrates (e.g., fruit juice, regular soda, glucose tablets) as soon as patient is conscious and able to swallow to prevent recurrence. Avoid high-fat foods initially as they may delay glucose absorption. |
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| Monitor maternal blood glucose levels before and after administration. No specific fetal monitoring required. |
| Fertility Effects | No known effects on fertility in animal or human studies. |
| Clinical Pearls |
| BAQSIMI (glucagon nasal powder) is indicated for severe hypoglycemia in patients with diabetes aged ≥4 years. Administer as a single 3 mg dose intranasally; do not inhale. No needle required, making it ideal for non-medical bystanders. Onset of action is within 15 minutes; if no response after 15 minutes, a second dose may be given. Advise patient to seek emergency medical attention after administration. Adverse effects include nausea, vomiting, headache, and nasal irritation. Do not use in patients with pheochromocytoma or insulinoma. Efficacy may be reduced in patients with known adrenal insufficiency or chronic hypoglycemia. |
| Patient Advice | Use BAQSIMI only when the person with diabetes is unconscious, unable to eat, or having a seizure due to severe low blood sugar. · Do not attempt to give food or drink by mouth to an unconscious person; use BAQSIMI immediately. · Remove the device from the tube, peel off the tab, and gently insert the tip into one nostril; press the plunger firmly to deliver the full dose. · Do not need to inhale; the medication is absorbed through the nasal lining. · After giving BAQSIMI, call 911 or emergency services immediately, even if the person wakes up. · Turn the person on their side to prevent choking if they vomit. · Check blood glucose every 15 minutes and give fast-acting sugar (e.g., juice, glucose gel) if awake and able to swallow. · Store at room temperature; do not freeze. Keep in the original tube until use. Replace before expiration date. · Side effects may include nausea, vomiting, headache, runny or stuffy nose, and watery eyes. · Inform healthcare provider about all medications, especially beta-blockers (may mask hypoglycemia symptoms) and anticoagulants (increase risk of bleeding). |