Baqsimi ® (glukagon näspulver)

För fullständig produktresumé för Baqsimi® se FASS.

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Baqsimi® (glukagon näspulver): Läkemedelsinteraktioner

Försiktighet ska iakttas när glukagon näspulver administreras till patienter som tar betablockerare, indometacin eller warfarin.

Summary

No interaction studies have been performed.1

Participants with daily use of systemic beta-blockers, indometacin, warfarin, or anticholinergic drugs were excluded from adult pivotal studies.2

Glucagon Drug Interactions

Beta Blockers

Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure, an increase of which will be transient because of glucagon's short half-life.1

Glucagon treatment results in catecholamine release from the adrenal glands, and concomitant use of beta-blockers could result in unopposed alpha-adrenergic stimulation and consequently, a greater increase in blood pressure.1

A review evaluated the hemodynamic effects of injectable glucagon in 24 studies in humans.3 

The studies evaluated had some limitations in that they 

  • were not randomized

  • were not blinded

  • lacked a control group, and 

  • were primarily in patients with pre-existing cardiovascular conditions.3

In the review, it was determined that if effects of glucagon on BP were seen, they were immediate and short-lasting with a maximum effect at 2 to 5 minutes and lasting less than 25 minutes.3

Blood pressure changes in response to a glucagon bolus were reported in 18 studies. In 11 studies, the observed mean arterial pressure increase was between 5% to 18% after receiving a glucagon bolus. Other studies reported no effects on BP after a glucagon bolus.3

Indometacin

When used with indometacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycaemia.1

The mechanism for interaction between glucagon and indometacin is not well understood.1

Indometacin is an inhibitor of prostaglandin synthesis and has been shown to potentiate glucose-stimulated insulin release. In addition, indometacin may blunt the glycemic response to glucagon.4

Warfarin

Glucagon may increase the anticoagulant effect of warfarin.1

Twenty-four patients on warfarin therapy were treated for myocardial contractile failure with daily doses of 2 to 96 mg of glucagon. Eight patients with a glucagon treatment duration of 3 or more days and with total glucagon doses of 62 to 362 mg demonstrated exaggerated hypoprothrombinemic effects of warfarin. Possible mechanisms are

  • an increase in the affinity of warfarin for its receptor sites, or

  • high doses of glucagon acting synergistically with the anticoagulant to depress hepatic synthesis of vitamin-K clotting factors.5

In patients not receiving warfarin, glucagon does not significantly prolong prothrombin time.5

References

1. Baqsimi [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

2. Data on file, Eli Lilly and Company and/or one of its subsidiaries.

3. Petersen KM, Bogevig S, Holst JJ, et al. Hemodynamic effects of glucagon: a literature review. J Clin Endocrinol Metab. 2018;103(5):1804-1812. http://dx.doi.org/10.1210/jc.2018-00050

4. Miller JD, Ganguli S, Sperling MA. Prostaglandin synthesis inhibitors impair hepatic glucose production in response to glucagon and epinephrine stimulation. Diabetes. 1983;32(5):439-444. https://doi.org/10.2337/diab.32.5.439

5. Koch-Weser J. Potentiation by glucagon of the hypoprothrombinemic action of warfarin. Ann Intern Med. 1970;72(3):331-335. https://doi.org/10.7326/0003-4819-72-3-331

Glossary

BP = blood pressure

NG = nasal glucagon (glucagon nasal powder)

Datum fӧr senaste ӧversyn 2019 M08 30


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