dasiglucagon (Rx)

Brand and Other Names:Zegalogue
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection, solution

  • 0.6mg/0.6mL single-dose autoinjector or prefilled syringe

Hypoglycemia

Ready-to-use, stable glucagon analog indicated for treatment of severe hypoglycemia in pediatric and adult patients with diabetes

0.6 mg SC; if no response after 15 minutes, an additional 0.6-mg dose from a new device may be administered

Dosage Modifications

Renal or hepatic impairment

  • No dosage adjustment recommended

Dosage Forms & Strengths

injection, solution

  • 0.6mg/0.6mL single-dose autoinjector or prefilled syringe

Hypoglycemia

Ready-to-use stable glucagon analog indicated for treatment of severe hypoglycemia in patients with diabetes aged ≥6 yr

<6 years: Safety and efficacy not established

≥6 years: 0.6 mg SC; if no response after 15 minutes, an additional 0.6 mg dose from a new device may be administered

Dosage Modifications

Renal or hepatic impairment

  • No dosage adjustment recommended
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Interactions

Interaction Checker

and dasiglucagon

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (16)

                • acebutolol

                  acebutolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • atenolol

                  atenolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • betaxolol

                  betaxolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • bisoprolol

                  bisoprolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • celiprolol

                  celiprolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • esmolol

                  esmolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • indomethacin

                  indomethacin decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor.

                • metoprolol

                  metoprolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • nadolol

                  nadolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • nebivolol

                  nebivolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • penbutolol

                  penbutolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • pindolol

                  pindolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • propranolol

                  propranolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • sotalol

                  sotalol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • timolol

                  timolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

                • warfarin

                  dasiglucagon increases effects of warfarin by unknown mechanism. Use Caution/Monitor. High doses of dasiglucagon may enhance anticoagulant effects of vitamin K antagonists.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Adults

                  • Nausea (57%)
                  • Vomiting (25%)
                  • Headache (11%)

                  Children aged 12-17 yr

                  • Nausea (92%)
                  • Vomiting (67%)
                  • Headache (17%)

                  Children aged 6-11 yr

                  • Nausea (25%)
                  • Vomiting (25%)

                  1-10%

                  Adults

                  • Diarrhea (5%)
                  • Injection site pain (2%)

                  Children aged 12-17 yr

                  • Injection site pain (8%)

                  Frequency Not Defined

                  Hypertension

                  Hypotension

                  Bradycardia

                  Presyncope

                  Palpitations

                  Orthostatic intolerance

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                  Warnings

                  Contraindications

                  Pheochromocytoma

                  Insulinoma

                  Cautions

                  Contraindicated with pheochromocytoma; glucagon may stimulate catecholamine release from the tumor; if substantial increase in blood pressure develops, phentolamine mesylate 5-10 mg IV has been shown to be effective in lowering blood pressure

                  Generalized allergic reactions, including urticaria, respiratory distress, hypotension, and in some cases anaphylactic shock, reported with glucagon products; if symptoms occur, discontinue and treat as indicated

                  Treatment for hypoglycemia only effective if sufficient hepatic glycogen present; patients in states of starvation, with adrenal insufficiency, or chronic hypoglycemia may not have adequate levels of hepatic glycogen for therapy to be effective; treat these conditions with glucose

                  Insulinoma

                  • Contraindicated with insulinoma
                  • Glucagon may initially produce increased glucose; however, administration may directly or indirectly (via initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia
                  • If hypoglycemia develops following administration, give PO or IV glucose

                  Drug interaction overview

                  • Beta-blockers
                    • Use with caution
                    • Beta-blockers may cause transient increases in pulse and blood pressure
                  • Indomethacin
                    • Use with caution
                    • When used with indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia
                  • Warfarin
                    • Use with caution
                    • Glucagon may increase anticoagulant effect of warfarin
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                  Pregnancy & Lactation

                  Pregnancy

                  There are no available data on use in pregnant females to evaluate for drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

                  Untreated hypoglycemia in pregnancy can cause complications and may be fatal

                  Animal data

                  • Daily SC administration to pregnant rabbits and rats during organogenesis did not cause adverse developmental effects at exposures 7 and 709 times the human dose of 0.6 mg based on AUC, respectively

                  Lactation

                  There is no information available on presence in human or animal milk, effects on breastfed children, or on milk production

                  Dasiglucagon is a peptide and would be expected to be broken down to its constituent amino acids in infant's digestive tract, and is therefore unlikely to cause harm to an exposed infant

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Glucagon receptor agonist; 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

                  Absorption

                  Peak plasma time

                  • Adults: ~35 minutes
                  • Children and adolescents: ~21 minutes

                  Peak plasma concentration

                  • Adults: 5,110 pg/mL
                  • Children and adolescents: 3,920 pg/mL

                  Distribution

                  Vd: 47-57 L

                  Metabolism

                  Cleared like native glucagon through proteolytic degradation pathways in blood, liver, and kidney

                  Elimination

                  Half-life: ~30 minutes

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                  Administration

                  SC Preparation

                  Visually inspect before administering; solution should appear clear, colorless, and free of particles; discard if discolored or contains particulate matter

                  SC Administration

                  For SC administration only

                  Inform patient and family members or caregivers on how to recognize signs and symptoms of severe hypoglycemia and risks of prolonged hypoglycemia

                  Do not inject through clothing; roll back clothing to expose bare skin

                  Inject in lower abdomen, buttocks, thigh, or outer upper arm

                  Call for emergency assistance immediately after administering

                  If no response after 15 minutes, administer additional dose while waiting for emergency assistance

                  When patient has responded to treatment, give oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia

                  Do not attempt to reuse autoinjector or prefilled syringe; each device contains 1 single dose

                  Storage

                  Store in red protective case it comes in; replace before expiration date

                  Protect from light

                  Gray cap on autoinjector and gray needle cover on prefilled syringe contain dry natural rubber (latex derivative)

                  Refrigerate at 2-8ºC (36-46ºF); do not freeze

                  Room temperature

                  • May store at room temperature of 20-25ºC (68-77ºF) for up to 12 months; discard if stored >12 months
                  • Mark package label with date when removed from refrigerator
                  • Do not return to refrigerator after storing at room temperature
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                  Images

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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
                  Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.