Version May 2024
Hypoglycemia, severe:
SUBQ: 0.6 mg; may repeat in 15 minutes as needed using a new device.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Dasiglucagon: Pediatric drug information")
Hypoglycemia, severe; treatment: Note: Glucagon products should be prescribed for all patients with type 1 diabetes and patients with type 2 diabetes at increased risk of level 2 (<54 mg/dL) or level 3 hypoglycemia; caregivers, school personnel, and family members of these patients should be trained on when and how to administer glucagon product (Ref). Patients with inadequate glycogen stores (eg, starvation, adrenal insufficiency, chronic hypoglycemia) may not respond to glucagon products and should be treated with glucose.
Children ≥6 years and Adolescents: SUBQ: 0.6 mg; if no response after 15 minutes, may give an additional 0.6 mg using a new device.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Hypersensitivity reactions, including anaphylaxis, anaphylactic shock, skin rash, erythema multiforme, urticaria, periorbital edema, dizziness, respiratory distress, and hypotension have been reported with administration of glucagon products; no cases specific to dasiglucagon have been identified (Ref).
Mechanism: Non–dose-related; immunologic. Glucagon is a protein and has the potential to cause hypersensitivity reactions (Ref).
Onset: Rapid; within 1 to 2 minutes to 4 hours after administration (Ref).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. As reported with adults, unless otherwise noted.
>10%:
Gastrointestinal: Nausea (57%), vomiting (25%)
Nervous system: Headache (11%)
1% to 10%:
Gastrointestinal: Diarrhea (5%)
Local: Pain at injection site (2%)
<1%: Immunologic: Antibody development
Frequency not defined: Cardiovascular: Bradycardia, hypertension, hypotension, orthostatic hypotension, palpitations, presyncope
Pheochromocytoma; insulinoma.
Concerns related to adverse effects:
• Hypersensitivity reactions: Allergic reactions, including skin rash and anaphylactic shock (with hypotension and respiratory difficulties), have been reported.
Disease-related concerns:
• Adrenal insufficiency: Use with caution in patients with adrenal insufficiency; hepatic glycogen levels may be inadequate for dasiglucagon to effectively increase blood glucose.
• Chronic hypoglycemia: Use with caution in patients with chronic hypoglycemia; hepatic glycogen levels may be inadequate for dasiglucagon to effectively increase blood glucose.
• Starvation: Use caution with starvation; hepatic glycogen levels may be inadequate for dasiglucagon to effectively increase blood glucose.
Dasiglucagon is only effective if sufficient glycogen stores are present; patients with inadequate storage (eg, starvation, adrenal insufficiency, chronic hypoglycemia) should be treated with glucose.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Auto-injector, Subcutaneous, as hydrochloride:
Zegalogue: 0.6 mg/0.6 mL (0.6 mL [DSC])
Solution Auto-injector, Subcutaneous, as hydrochloride [preservative free]:
Zegalogue: 0.6 mg/0.6 mL (0.6 mL)
Solution Prefilled Syringe, Subcutaneous, as hydrochloride:
Zegalogue: 0.6 mg/0.6 mL (0.6 mL [DSC])
Solution Prefilled Syringe, Subcutaneous, as hydrochloride [preservative free]:
Zegalogue: 0.6 mg/0.6 mL (0.6 mL)
No
Solution Auto-injector (Zegalogue Subcutaneous)
0.6 mg/0.6 mL (per 0.6 mL): $370.80
Solution Prefilled Syringe (Zegalogue Subcutaneous)
0.6 mg/0.6 mL (per 0.6 mL): $370.80
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
SUBQ: May administer as a SUBQ injection in the outer upper arms, lower abdomen, thighs, or buttocks; do not inject through clothes. If patient is unconscious, place in lateral recumbent position after injecting to prevent choking when consciousness returns. Administer fast-acting and long-acting oral carbohydrates to patient as soon as possible after response to treatment.
Autoinjector: Push the device straight down onto the skin until the needle guard is fully pressed down; hold the needle in the skin for 10 seconds (until the medicine window is red) before removing to ensure the full dose has been administered.
Prefilled syringe: Pinch skin and insert needle at a 45-degree angle. After inserting needle, release pinched skin and slowly depress plunger until fully depressed and syringe is empty before removing.
Parenteral: SUBQ: For SUBQ use only. Administer SUBQ in the lower abdomen (≥2 inches from belly button), buttocks, thigh, or outer upper arm; do not inject through clothing. Do not reuse the device after administration; a new device should be used for each dose. If patient is unconscious, place patient on side after injecting to prevent choking. Administer fast-acting (eg, fruit juice) and long-acting oral carbohydrates (eg, crackers with cheese or peanut butter) to patient as soon as possible after response to treatment to restore glycogen stores and prevent hypoglycemia.
Autoinjector: Remove gray lid and remove autoinjector from protective case, then remove gray cap from needle end of autoinjector. Push the device straight down onto the skin until the needle guard is fully pressed down (may hear click); continue holding the device down against the skin for 10 seconds (until the medicine window is red) before removing to ensure the full dose has been administered.
Prefilled syringe: Remove gray cap and remove prefilled syringe from protective case, then remove gray needle cover.Pinch skin and insert entire needle at a 45-degree angle. After inserting needle, release pinched skin and slowly depress plunger until fully depressed and syringe is empty before removing.
Hypoglycemia, severe: Treatment of severe hypoglycemia in adult and pediatric patients ≥6 years of age with diabetes.
Dasiglucagon may be confused with glucagon.
Zegalogue may be confused with Zegerid.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy
Indomethacin: May diminish the therapeutic effect of Glucagon and Glucagon Analogs. Risk C: Monitor therapy
Vitamin K Antagonists (eg, warfarin): Glucagon and Glucagon Analogs may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Adverse events were not observed in animal reproduction studies.
Untreated hypoglycemia may lead to adverse pregnancy outcomes. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant patients if there is a clear indication for use and should not be withheld because of concerns of teratogenicity (Bailey 2003).
It is not known if dasiglucagon is present in breast milk.
Maternal use of dasiglucagon is not expected to harm a breastfed infant.
Administer oral carbohydrates to patient as soon as possible after response to treatment.
BP, blood glucose, mentation; signs or symptoms of a hypersensitivity reaction.
Classification of hypoglycemia (ADA 2023 ):
Level 1: Glucose 54 to 70 mg/dL (SI: 3 to 3.9 mmol/L); hypoglycemia alert value; initiate fast-acting carbohydrate (eg, glucose) treatment.
Level 2: Glucose <54 mg/dL (SI: <3 mmol/L); threshold for neuroglycopenic symptoms; requires immediate action.
Level 3: Hypoglycemia associated with a severe event characterized by altered mental and/or physical status requiring assistance.
Dasiglucagon is a glucagon receptor agonist, which stimulates glycogenolysis and hepatic gluconeogenesis, causing an increase in blood glucose levels; antihypoglycemic effect requires preexisting hepatic glycogen stores.
Onset of action: Median time to plasma glucose recovery: 10 minutes.
Distribution: Vd: 47 to 57 L.
Metabolism: Cleared through proteolytic degradation pathways in blood, liver, and kidney.
Half-life elimination: ~30 minutes.
Time to peak, plasma: Pediatric patients: 7 to 17 years of age: ~21 minutes; Adults: ~35 minutes.
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