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Overview
Glucagon is a gastrointestinal agent that is FDA approved for the treatment of severe hypoglycemia, and as a diagnostic acid. Common adverse reactions include nausea and vomiting, temporary increase in blood pressure and pulse may occur after administration.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
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Condition4
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Off-Label Use and Dosage (Adult)
Guideline-Supported Use
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Developed by:
Class of Recommendation:
Strength of Evidence:
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Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Glucagon in adult patients.
Non–Guideline-Supported Use
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Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Glucagon in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Condition1
Dosing Information
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Condition2
There is limited information regarding FDA-Labeled Use of Glucagon in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
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Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Glucagon in pediatric patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
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Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Glucagon in pediatric patients.
Contraindications
GlucaGen is contraindicated in patients with:
Known hypersensitivity to glucagon, lactose or any other constituent in GlucaGen
Pheochromocytoma
Insulinoma
Warnings
Pheochromocytoma
Glucagon is contraindicated in patients with pheochromocytoma because Glucagon may stimulate the release of catecholamines from the tumor. 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.
Insulinoma and Glucagonoma
GlucaGen should be administered cautiously to patients suspected of having insulinoma or glucagonoma. In patients with insulinoma, intravenous administration of glucagon 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 an insulinoma. A patient developing symptoms of hypoglycemia after a dose of glucagon should be given glucose orally or intravenously, whichever is most appropriate. Caution should also be observed in administering GlucaGen to patients with glucagonoma.
Hypersensitivity and Allergic Reactions
Allergic reactions may occur and include generalized rash, and in some cases anaphylactic shock with breathing difficulties, and hypotension. The anaphylactic reactions have generally occurred in association with endoscopic examination during which patients often received other agents including contrast media and local anesthetics. The patients should be given standard treatment for anaphylaxis including an injection of epinephrine if they encounter respiratory difficulties after GlucaGen injection.
Glycogen Stores and Hypoglycemia
In order for GlucaGen treatment to reverse hypoglycemia, adequate amounts of glucose must be stored in the liver (as glycogen). Therefore, GlucaGen should be used with caution in patients with conditions such as prolonged fasting, starvation, adrenal insufficiency or chronic hypoglycemia because these conditions result in low levels of releasable glucose in the liver and an inadequate reversal of hypoglycemia by GlucaGen treatment.
Cardiac Disease
Caution should be observed when glucagon is used as an adjunct in endoscopic or radiographic procedures to inhibit gastrointestinal motility in patients with known cardiac disease.
Laboratory Tests
Blood glucose measurements may be considered to monitor the patient’s response.
Adverse Reactions
Clinical Trials Experience
Side effects may include nausea and vomiting at doses above 1 mg or with rapid injection. Hypotension has been reported up to 2 hours after administration in patients receiving GlucaGen as premedication for upper GI endoscopy procedures. Glucagon exerts positive inotropic and chronotropic effects and may, therefore, cause tachycardia and hypertension. Adverse reactions indicating toxicity of GlucaGen have not been reported. 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, an increase of which will be temporary because of glucagon’s short half-life [see Drug Interactions (7.1)]. The increase in blood pressure and pulse rate may require therapy in patients with pheochromocytoma or coronary artery disease [see Warnings and Precautions (5.1)]. Anaphylactic reactions may occur in some cases [see Warnings and Precautions (5.3)].
The following adverse reactions have been identified during postapproval use of GlucaGen. Because these adverse reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency.
Postmarketing Experience
There is limited information regarding Glucagon Postmarketing Experience in the drug label.
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 temporary because of glucagon’s short half-life. The increase in blood pressure and pulse rate may require therapy in patients with pheochromocytoma or coronary artery disease.
Indomethacin
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.
Anticholinergic Drugs
Coadministration with an anticholinergic drug is not recommended due to increased gastrointestinal side effects.
Warfarin
Glucagon may increase the anticoagulant effect of warfarin. Therefore, caution should be exercised for patients taking warfarin when glucagon will be administered.
Insulin
Insulin reacts antagonistically towards glucagon. Therefore, caution should be exercised when glucagon is used as a diagnostic aid in diabetes patients.
Australian Drug Evaluation Committee (ADEC) Pregnancy Category
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Glucagon in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Glucagon during labor and delivery.
Nursing Mothers
There is no FDA guidance on the use of Glucagon with respect to nursing mothers.
Pediatric Use
There is no FDA guidance on the use of Glucagon with respect to pediatric patients.
Geriatic Use
There is no FDA guidance on the use of Glucagon with respect to geriatric patients.
Gender
There is no FDA guidance on the use of Glucagon with respect to specific gender populations.
Race
There is no FDA guidance on the use of Glucagon with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Glucagon in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Glucagon in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Glucagon in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Glucagon in patients who are immunocompromised.
Administration and Monitoring
Administration
For GlucaGenHypoKit:
Treatment of severe hypoglycemia
Using the supplied prefilled syringe, carefully insert the needle through the rubber stopper of the vial containing GlucaGen powder and inject all the liquid from the syringe into the vial.
Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid. The reconstituted fluid should be clear and of water-like consistency.
The reconstituted GlucaGen gives a concentration of approximately 1 mg/mL glucagon.
The reconstituted GlucaGen should be used immediately after reconstitution.
Inject 1 mL (adults and children, weighing more than 55 lbs (25 kg)) or 0.5 mL (children weighing less than 55 lbs (25 kg)) subcutaneously, intramuscularly, or intravenously. If the weight is not known: children younger than 6 years should be given a 0.5 mL and children 6 years and older should be given 1 mL.
Discard any unused portion.
Emergency assistance should be sought immediately after subcutaneous or intramuscular injection of glucagon.
The glucagon injection may be repeated using a new kit while waiting for emergency assistance.
Intravenous glucose MUST be administered if the patient fails to respond to glucagon.
When the patient has responded to the treatment, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia.
For GlucaGen Diagnostic Kit and the GlucaGen 10-pack:
Use as a diagnostic aid
GlucaGen should be reconstituted with 1 mL of Sterile Water for Reconstitution (if supplied) or 1 mL of Sterile Water for Injection, USP. Using a syringe, withdraw all of the Sterile Water for Reconstitution (if supplied) or 1 mL Sterile Water for Injection, USP and inject into the GlucaGen vial.
Shake the vial gently until the powder is completely dissolved and no particles remain in the fluid. The reconstituted fluid should be clear and of water-like consistency.
The reconstituted GlucaGen gives a concentration of approximately 1 mg/mL glucagon.
The reconstituted GlucaGen should be used immediately after reconstitution.
GlucaGen must be administered by medical personnel.
Discard any unused portion.
Onset of action after an injection will depend on the organ under examination and route of administration.
The usual diagnostic dose for relaxation of the stomach, duodenal bulb, duodenum, and small bowel is 0.2 mg to 0.5 mg given intravenously or 1 mg given intramuscularly; the usual dose to relax the colon is 0.5 mg to 0.75 mg intravenously and 1 mg to 2 mg intramuscularly.
After the end of the diagnostic procedure, give oral carbohydrates to patients who have been fasting, if this is compatible with the diagnostic procedure applied.
The GlucaGen Diagnostic Kit and the GlucaGen 10-pack presentations are intended only for use by healthcare providers as a diagnostic aid. The GlucaGen Diagnostic Kit and the GlucaGen 10-pack presentations are not intended for use by patients to treat severe hypoglycemia because they are not packaged with a syringe and diluent necessary for rapid preparation and administration during an emergency outside of a healthcare facility.
Dosage forms and strengths
GlucaGen is supplied in a vial, alone, or accompanied by Sterile Water for Reconstitution (1 mL) also in a vial (10 pack or diagnostic kit). It is also supplied as GlucaGen HypoKit®, a presentation with a disposable prefilled syringe containing 1 mL Sterile Water for Reconstitution. When the glucagon powder is reconstituted with Sterile Water for Reconstitution (if supplied) or with Sterile Water for Injection, USP, it forms a solution of 1 mg/mL (1 unit/mL) glucagon for subcutaneous, intramuscular, or intravenous injection.
Monitoring
There is limited information regarding Monitoring of Glucagon in the drug label.
Description
IV Compatibility
There is limited information regarding IV Compatibility of Glucagon in the drug label.
Overdosage
Acute Overdose
Signs and Symptoms
Description
Management
Description
Chronic Overdose
There is limited information regarding Chronic Overdose of Glucagon in the drug label.
Pharmacology
There is limited information regarding Glucagon Pharmacology in the drug label.
Mechanism of Action
Structure
File:Glucagon01.pngThis image is provided by the National Library of Medicine.
Pharmacodynamics
There is limited information regarding Pharmacodynamics of Glucagon in the drug label.
Pharmacokinetics
There is limited information regarding Pharmacokinetics of Glucagon in the drug label.
Nonclinical Toxicology
There is limited information regarding Nonclinical Toxicology of Glucagon in the drug label.
Clinical Studies
There is limited information regarding Clinical Studies of Glucagon in the drug label.
How Supplied
Storage
There is limited information regarding Glucagon Storage in the drug label.
Images
Drug Images
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