Dasiglucagon is a subcutaneously administered glucagon analog used as an antihypoglycemic agent. It is indicated for the treatment of severe hypoglycemia in adult and pediatric patients 6 years of age and older with diabetes mellitus. The approval was based on efficacy results from three pivotal studies of dasiglucagon in children aged 6 to 17 years and in adults with type 1 diabetes. Blood glucose recovery from severe hypoglycemia was successfully achieved across all studies with a significantly faster median time to blood glucose recovery of only 10 minutes following dasiglucagon administration versus a recovery time of 30 to 45 minutes with placebo. In the main Phase 3 adult trial, 99% of patients recovered within 15 minutes. Patients with latex hypersensitivity should not handle or administer this product. The drug was FDA-approved in March 2021.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Injectable Administration
-Dasiglucagon is administered by subcutaneous injection only. Do not administer intramuscularly or intravenously.
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Subcutaneous Administration
-Dasiglucagon is available as an autoinjector or as a prefilled syringe. Keep dasiglucagon in the red protective case until ready for use.
-The inside of the gray cap of the autoinjector device and the inside of the gray needle cover of the prefilled syringe contain dry natural rubber, which may cause allergic reactions in people with latex allergy.
General Administration Instructions
-Inject dasiglucagon subcutaneously into the outer upper arm, front or back of the thigh, lower abdomen (at least 2 inches from the belly button), or buttocks.
-Roll back any clothing to expose bare skin; do not inject through clothes.
-After injection:-Roll the unconscious person on to their side to prevent choking.
-Call for emergency medical help right away. Even if the injection helps the person to wake up, still call for emergency medical help right away.
-If the person does not respond after 15 minutes, another dose may be given, if available.
-Once the person is able to safely consume food or drink, give the person a fast-acting source of sugar (e.g., fruit juice) and a long-acting source of sugar (e.g., crackers with cheese or peanut butter).
-Replace the used autoinjector or prefilled syringe right away so the patient will have a new one in case it is needed.
Subcutaneous autoinjector (Zegalogue Single-dose Autoinjector)
-Instruct the patient and/or caregiver to read the "Instructions For Use" at the time they receive a prescription for dasiglucagon.
-Choose injection site and expose the skin.
-Hold the red protective case upright with the gray lid on top and pull the gray cap straight off. Carefully remove the autoinjector from the red protective case without dropping it.
-Pull the gray cap straight off the autoinjector device. Do not put hand or fingers anywhere near the yellow needle guard.
-Push the autoinjector straight down on the patient's skin until the yellow needle guard is fully pressed down; you may hear the first 'click'. Keep holding the injector down and slowly count to 10 seconds; during this time the medicine window will turn red and you may hear a second 'click'. Check that the medicine window is red to ensure that the full dose has been given.
-Remove the autoinjector from the skin by lifting it straight up. The yellow needle guard will cover the needle and lock, preventing an accidental needle stick injury.
-Place the used autoinjector in an FDA-cleared sharps disposal container right away; do not dispose of injectors in household trash.
Subcutaneous prefilled syringe (Zegalogue Single-Use Prefilled Syringe)
-Instruct the patient and/or caregiver to read the "Instructions For Use" at the time they receive a prescription for dasiglucagon.
-Choose injection site and expose the skin.
-Hold the red protective case upright with the gray lid on top and pull the gray cap straight off. Carefully remove the prefilled syringe from the red protective case without dropping it.
-Gently pinch the skin and insert the entire needle into the skin at a 45-degree angle.
-After inserting the needle, release the pinched skin and slowly press the plunger rod all the way down until the syringe is empty and the plunger rod stops.
-After the plunger rod stops and the injection is complete, carefully remove the needle from the injection site.
-Place the used syringe in an FDA-cleared sharps disposal container right away; do not dispose of loose needles or syringes in household trash.
Adverse reactions reported in adult patients treated with dasiglucagon within 12 hours of treatment and at greater incidences than with placebo in 2 placebo-controlled trials included: diarrhea (5% vs. 0%), headache (11% vs. 4%), nausea (57% vs. 4%), and vomiting (25% vs. 2%). Adverse reactions reported in pediatric patients treated with dasiglucagon within 12 hours of treatment in the 2 placebo-controlled trials include: headache (10%), nausea (65%), and vomiting (50%); these adverse reactions were not reported in the placebo group.
Other adverse reactions in patients treated with dasiglucagon occurring within 12 hours of treatment during the 2 placebo-controlled trials included: hypertension, hypotension, bradycardia, presyncope, palpitations, and orthostatic intolerance (e.g., feeling lightheaded or dizziness on standing).
Allergic reactions to glucagon products have been reported and may occur with dasiglucagon. Allergic reactions may include generalized rash, and in some cases anaphylactic shock with breathing difficulties and hypotension. Advise patients to seek immediate medical attention if they experience any symptoms of serious hypersensitivity reactions.
Injection site reaction (pain) was reported in 2% of adults and 5% of children receiving dasiglucagon.
As with all therapeutic proteins, there is a potential for immunogenicity. In clinical trials, 4 out of 498 patients (less than 1%) had treatment-emergent anti-drug antibody formation. Two patients receiving a single dose of dasiglucagon had detectable anti-drug antibodies (ADA) to dasiglucagon for at least 14 months after dosing. One ADA-positive patient receiving multiple doses of dasiglucagon had ADAs with transient neutralizing activity and with cross-reactivity against native glucagon. Although no safety or efficacy concerns were noted for these ADA-positive subjects, it is unknown whether ADAs may affect pharmacokinetics, pharmacodynamics, safety, and/or effectiveness of the drug.
Do not use dasiglucagon in patients with a known hypersensitivity to glucagon, dasiglucagon, or any other constituent of the formulation. Allergic reactions may occur and include generalized rash, and in some cases anaphylactic shock with breathing difficulties, and hypotension. The inside of the gray cap on the auto injector and the inside of the gray needle cover on prefilled syringe contain dry natural rubber (a derivative of latex). Patients or caregivers with latex hypersensitivity should not handle or administer this product. Advise patients to seek immediate medical attention if they experience any symptoms of serious hypersensitivity reactions.
Dasiglucagon is contraindicated in patients who have been diagnosed with or suspected of having an insulinoma. In patients with insulinoma, glucagon products may produce an initial increase in blood glucose; however, glucagon administration may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from the insulinoma. Any patient developing symptoms of hypoglycemia after a dose of dasiglucagon should be given glucose orally or intravenously, whichever is most appropriate.
Dasiglucagon is contraindicated in patients with pheochromocytoma because the drug may stimulate the release of catecholamines from the tumor. Stimulation of catecholamine release by dasiglucagon can cause a substantial increase in blood pressure. If the patient develops a dramatic increase in blood pressure, 5 to 10 mg of phentolamine mesylate has been shown to be effective in lowering blood pressure for the short time that control would be needed.
Dasiglucagon is effective in treating hypoglycemia only if sufficient hepatic glycogen is present. Patients in states of starvation (e.g., anorexia nervosa), malnutrition, adrenal insufficiency, or chronic hypoglycemia may not have adequate levels of hepatic glycogen for glucagon administration to be effective. Patients with these conditions should be treated with glucose.
There are no available data on dasiglucagon use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes from use during pregnancy. Because appropriate care of pregnant women is essential, pregnant women suffering from severe hypoglycemia should be administered dasiglucagon when clinically indicated without concern for fetal safety; withholding therapy may place the fetus at greater risk than the minimal, if any, risk of dasiglucagon exposure. Animal studies have not revealed any teratogenic effects associated with dasiglucagon or glucagon.
There is no information on the presence of dasiglucagon in either human or animal milk, or the effects of the drug on the breastfed infant or milk production. Dasiglucagon is a peptide and would be expected to be broken down to its constituent amino acids in the infant's digestive tract and is therefore unlikely to cause harm to an exposed infant during breast-feeding. Further, dasiglucagon has a high molecular weight and a short plasma half-life thus likely limiting amounts excreted into human milk and available to the nursing infant.
Use in children and infants less than 6 years of age has not been established. The safety and effectiveness of dasiglucagon for the treatment of severe hypoglycemia in patients with diabetes have been established in pediatric patients 6 years of age and older. The use of dasiglucagon for this indication is supported by evidence from a study in 42 pediatric patients with type 1 diabetes. Dasiglucagon depletes glycogen stores, thus pediatric patients should be given supplemental carbohydrates as soon as possible after administration for hypoglycemia.
For the treatment of severe hypoglycemia in patients with diabetes mellitus:
Subcutaneous dosage:
Adults: 0.6 mg administered subcutaneously. Call for emergency assistance immediately after administering the dose. If there has been no response after 15 minutes, an additional dose may be administered while waiting for emergency assistance. IV dextrose must be administered if the patient fails to respond to glucagon. Once the patient has responded to treatment, give oral carbohydrates to prevent recurrence of hypoglycemia.
Children and Adolescents 6 years and older: 0.6 mg administered subcutaneously. Call for emergency assistance immediately after administering the dose. If there has been no response after 15 minutes, an additional dose may be administered while waiting for emergency assistance. IV dextrose must be administered if the patient fails to respond to glucagon. Once the patient has responded to treatment, give oral carbohydrates to prevent recurrence of hypoglycemia.
Maximum Dosage Limits:
-Adults
0.6 mg/dose subcutaneously; may repeat during an episode if needed based on clinical response.
-Geriatric
0.6 mg/dose subcutaneously; may repeat during an episode if needed based on clinical response.
-Adolescents
0.6 mg/dose subcutaneously; may repeat during an episode if needed based on clinical response.
-Children
6 to 12 years: 0.6 mg/dose subcutaneously; may repeat during an episode if needed based on clinical response.
5 years or less: Safety and efficacy have not been established.
-Infants
Safety and efficacy have not been established.
-Neonates
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
*non-FDA-approved indication
Acebutolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Anticholinergics: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Atenolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Atenolol; Chlorthalidone: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Atropine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Atropine; Difenoxin: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Belladonna; Opium: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Benztropine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Beta-blockers: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Betaxolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Bisoprolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Brimonidine; Timolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Budesonide; Glycopyrrolate; Formoterol: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Carteolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Carvedilol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Chlordiazepoxide; Clidinium: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Dicyclomine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Diphenoxylate; Atropine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Dorzolamide; Timolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Esmolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Flavoxate: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Glycopyrrolate: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Glycopyrrolate; Formoterol: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Homatropine; Hydrocodone: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Hyoscyamine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Indacaterol; Glycopyrrolate: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Indomethacin: (Moderate) When used with indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia. Therefore, caution should be exercised for patients taking indomethacin when glucagon will be administered.
Insulin Aspart: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Aspart; Insulin Aspart Protamine: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Degludec: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Degludec; Liraglutide: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Detemir: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Glargine: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Glargine; Lixisenatide: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Glulisine: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Lispro: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin Lispro; Insulin Lispro Protamine: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulin, Inhaled: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Insulins: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Isophane Insulin (NPH): (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Labetalol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Levobunolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Methscopolamine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Metoprolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Metoprolol; Hydrochlorothiazide, HCTZ: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Nadolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Nebivolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Nebivolol; Valsartan: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Neostigmine; Glycopyrrolate: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Oxybutynin: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Pindolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Propantheline: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Propranolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Regular Insulin: (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Regular Insulin; Isophane Insulin (NPH): (Minor) Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Scopolamine: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Sotalol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Timolol: (Minor) A temporary increase in both blood pressure and pulse rate may occur following the administration of glucagon. Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension in some patients. The increase in blood pressure and pulse rate may require therapy in some patients with coronary artery disease.
Trihexyphenidyl: (Major) The concomitant use of intravenous glucagon and anticholinergics increases the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. Concomitant use is not recommended.
Warfarin: (Moderate) Caution should be exercised for patients taking warfarin when glucagon will be administered. Monitor the INR as clinically indicated and monitor for evidence of bleeding. Glucagon has been reported to enhance the hypoprothrombinemic response in 8 out of 13 patients receiving warfarin. Clinical bleeding also was reported in 3 patients. These findings - based on data from only 13 patients - were published in 1970 and no subsequent reports have been identified. The mechanism of this interaction is uncertain.
Dasiglucagon is a glucagon receptor agonist that increases blood glucose concentration by activating hepatic glucagon receptors, thereby stimulating glycogen breakdown and release of glucose from the liver. Hepatic stores of glycogen are necessary for dasiglucagon to produce an antihypoglycemic effect.
Dasiglucagon is administered subcutaneously. Similar to other polypeptides, parenteral administration avoids rapid and complete degradation in the GI tract. Metabolism data indicated that dasiglucagon is cleared like native glucagon through proteolytic degradation pathways in blood, liver, and kidney. The mean apparent volume of distribution was 47 L to 57 L following subcutaneous administration. The half-life was approximately 30 minutes.
Affected cytochrome P450 isoenzymes and drug transporters: None
-Route-Specific Pharmacokinetics
Subcutaneous Route
Dasiglucagon absorption following subcutaneous injection of 0.6 mg resulted in a mean peak plasma concentration of 5,110 pg/mL (1510 pmol/L) at around 35 minutes. After administration in adult patients with type 1 diabetes mellitus, the mean glucose increase from baseline at 90 minutes was 168 mg/dL.
-Special Populations
Pediatrics
After administration of dasiglucagon in pediatric patients with type 1 diabetes mellitus, the mean peak plasma concentration of 3,920 pg/mL occurred at around 21 minutes. The mean glucose increase at 60 minutes after administration in pediatric patients (7 to 17 years) with type 1 diabetes mellitus was 162 mg/dL.