Medically reviewed by Drugs.com. Last updated on Jun 23, 2019.

• Overview
• Side Effects
• Dosage
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Pronunciation

(GLOO ka gon)

Index Terms

• Glucagon HCl
• Glucagon Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Kit, Injection:

Glucagon Emergency: 1 mg [contains lactose]

Powder, Nasal [preservative free]:

Baqsimi One Pack: 3 mg/dose (1 ea)

Baqsimi Two Pack: 3 mg/dose (1 ea)

Solution Prefilled Syringe, Subcutaneous [preservative free]:

Gvoke PFS: 0.5 mg/0.1 mL (0.1 mL); 1 mg/0.2 mL (0.2 mL)

Solution Reconstituted, Injection:

GlucaGen Diagnostic: 1 mg (1 ea)

GlucaGen HypoKit: 1 mg (1 ea)

Generic: 1 mg (1 ea)

Brand Names: U.S.

• Baqsimi One Pack
• Baqsimi Two Pack
• GlucaGen Diagnostic
• GlucaGen HypoKit
• Glucagon Emergency
• Gvoke PFS

Pharmacologic Category

• Antidote
• Antidote, Hypoglycemia
• Diagnostic Agent

Pharmacology

Stimulates adenylate cyclase to produce increased cyclic AMP, which promotes hepatic glycogenolysis and gluconeogenesis, causing a raise in blood glucose levels; antihypoglycemic effect requires preexisting hepatic glycogen stores. Extra hepatic effects of glucagon include relaxation of the smooth muscle of the stomach, duodenum, small bowel, and colon.

Distribution

V_d: ~0.25 L/kg

Metabolism

Primarily hepatic; some inactivation occurring renally and in plasma

Onset of Action

Blood glucose levels:

IV: Peak effect: 5 to 20 minutes

IM: Onset: 10 minutes; peak effect: 30 minutes

Intranasal: Compared to IM administration, median response times were slightly longer for intranasal administration, but clinical outcomes at 30 minutes did not differ.

SubQ: Peak effect: 30 to 45 minutes

GI relaxation: IV: 45 seconds; IM: 4 to 10 minutes

Time to Peak

IM: ~10 to 12.5 minutes; Intranasal: ~15 minutes; SubQ: 20 minutes

Duration of Action

Glucose elevation: IV, IM, SubQ: 60 to 90 minutes

GI relaxation: IV: 9 to 25 minutes; IM: 12 to 32 minutes

Half-Life Elimination

Plasma: IV: 8 to 18 minutes; IM (apparent): 26 to 45 minutes; Intranasal (apparent): ~35 minutes

Use: Labeled Indications

Diagnostic aid (injection): As a diagnostic aid during radiologic examinations to temporarily inhibit movement of the GI tract in adults.

Hypoglycemia: Note: The American Diabetes Association (ADA) recommends that glucagon be prescribed for all diabetic patients at increased risk of level 2 hypoglycemia (<54 mg/dL); caregivers, school personnel, or family members of these patients should be trained on when and how to administer glucagon (ADA 2019).

Injection: Treatment of severe hypoglycemia in pediatric and adult patients.

Limitations of use: Products not packaged with a syringe and diluent necessary for rapid preparation and administration during an emergency outside of a health care facility are not indicated for the emergency treatment of hypoglycemia.

Intranasal: Treatment of severe hypoglycemia in adult and pediatric patients ≥4 years of age.

Off Label Uses

Anaphylaxis

Based on the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allergy, Asthma & Immunology (ACAAI), and the Joint Council of Allergy, Asthma, and Immunology (JCAAI) guidelines for management of anaphylaxis, glucagon is recommended for the treatment of anaphylaxis in patients on beta-blocker therapy who are refractory to epinephrine.

Beta-blocker overdose

Based on the American Heart Association (AHA) guideline for cardiopulmonary resuscitation and emergency cardiovascular care and the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay, glucagon given for beta-blocker toxicity is a recommended treatment option in patients with cardiovascular instability refractory to standard measures.

Calcium channel blocker overdose

Based on the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay, glucagon given for calcium channel blocker toxicity is a recommended treatment option in patients with cardiovascular instability refractory to standard measures.

Contraindications

Known hypersensitivity to glucagon or any component of the formulation (injection contains lactose); pheochromocytoma; insulinoma; use of injection as a diagnostic aid in patients with glucagonoma.

Dosing: Adult

Anaphylaxis (refractory to epinephrine) in patients on beta-blocker therapy (off-label use): IV: Initial: 1 to 5 mg bolus; followed by an infusion of 5 to 15 mcg/minute; titrate the infusion rate to achieve an adequate clinical response (Lieberman 2015).

Beta-blocker overdose (off-label use): IV: 3 to 10 mg bolus; if no clinical response may repeat bolus dose; if clinical response with bolus, start continuous infusion at 3 to 5 mg/hour; titrate infusion rate to achieve adequate hemodynamic response (ACC/AHA/HRS [Kusumoto 2018]; AHA [Vanden Hoek 2010]; Barrueto 2019).

Calcium channel blocker overdose (off-label use): IV: 3 to 10 mg bolus; if no clinical response may repeat bolus dose; if clinical response with bolus, start continuous infusion at 3 to 5 mg/hour; titrate infusion rate to achieve adequate hemodynamic response (ACC/AHA/HRS [Kusumoto 2018]; Barrueto 2019).

Diagnostic aid:

Relaxation of stomach, duodenal bulb, duodenum, and small bowel:

IM: 1 mg.

IV: 0.2 to 0.5 mg

Relaxation of colon:

IM: 1 to 2 mg.

IV: 0.5 to 0.75 mg.

Hypoglycemia: Note: IV dextrose should be administered as soon as it is available; if patient fails to respond to glucagon, IV dextrose must be given.

IM, IV, SubQ: 1 mg; may repeat in 15 minutes as needed.

Intranasal: 3 mg (one actuation) into a single nostril; if no response, may repeat in 15 minutes using a new intranasal device.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Hypoglycemia, severe; treatment:

Weight-directed dosing:

Manufacturer's labeling: Infants, Children, or Adolescents weighing <20 kg: Glucagon: IM, IV, SubQ: 0.02-0.03 mg/kg; maximum dose: 0.5 mg

Alternate dosing: Infants, Children, and Adolescents:

AAP: IM, IV, SubQ: 0.03 mg/kg; maximum dose: 1 mg (Hegenbarth, 2008)

IDF-ISPAD: IM, SubQ: 0.01-0.03 mg/kg; maximum dose dependent on age: <12 years: 0.5 mg; ≥12 years: 1 mg (IDF-ISPAD, 2011)

Fixed dosing; age-directed:

Manufacturer's labeling: GlucaGen: IM, IV, SubQ:

Infants and Children <6 years: 0.5 mg

Children and Adolescents ≥6 years: 1 mg

Alternate dosing: IM, SubQ:

IDF-ISPAD (IDF-ISPAD, 2011):

Infants and Children <12 years: 0.5 mg

Children and Adolescents ≥12 years: 1 mg

CDA (Canadian Diabetes Association, 2013):

Infants and Children ≤5 years: 0.5 mg

Children and Adolescents >5 years: 1 mg

Fixed dosing; weight-directed: Infants, Children, and Adolescents: Manufacturer's labeling: IM, IV, SubQ:

Glucagon: Patient weight:

<20 kg: 0.5 mg

≥20 kg: 1 mg

GlucaGen: Patient weight:

<25 kg: 0.5 mg

≥25 kg: 1 mg

Hypoglycemia, prevention during illness (fixed dosing, mini-dose): Limited data available (Haymond, 2001; IDF-ISPAD, 2011): SubQ: Note: These doses are lower than hypoglycemia treatment doses and have been shown to prevent hypoglycemia for several hours during hypoglycemia-associated illness (eg, gastroenteritis, nausea/vomiting).

Infants and Children <2 years: 0.02 mg

Children and Adolescents 2-15 years: 0.01 mg per year of age

Adolescents >15 years: 0.15 mg

Beta-blocker or calcium channel blocker toxicity/overdose:

Infants and Children: Limited data available (Hegenbarth, 2008): IV:

Loading dose: 0.03-0.15 mg/kg

Continuous IV infusion: 0.07 mg/kg/hour; maximum rate: 5 mg/hour

Adolescents [Hegenbarth, 2008; PALS guidelines (Kleinman, 2010)]: IV:

Loading dose: 5-10 mg over several minutes

Continuous IV infusion: 1-5 mg/hour

Reconstitution

Reconstitute powder for injection by adding 1 mL of manufacturer-supplied sterile diluent or sterile water for injection to a vial containing 1 unit of the drug, to provide solutions containing 1 mg of glucagon/mL. Shake vial gently to dissolve. A solution for continuous infusion may be prepared by further dilution in D5W (Shepherd 2006); also refer to institution-specific policies and procedures.

Administration

Note: For the treatment of hypoglycemia, administer fast-acting and long-acting oral carbohydrates to patient as soon as possible after response to glucagon treatment.

IM: For treatment of hypoglycemia, may administer IM injection in the upper arms, thighs, or buttocks. For use as a diagnostic aid, may administer IM. After the diagnostic procedure, administer oral carbohydrates to patients who have been fasting, if this is compatible with the diagnostic procedure applied.

Intranasal: Insert the tip of the intranasal device into one nostril and fully depress plunger until the green line is no longer visible. Inhalation of the dose is not necessary. Do not reuse the device after administration.

IV: Rapid injection may be associated with increased nausea and vomiting; if patient is unconscious/obtunded, place patient in lateral recumbent position to protect airway and to prevent choking when consciousness returns (Lieberman 2015).

Anaphylaxis (refractory to epinephrine) in patients on beta-blocker therapy: Administer IV bolus over 5 minutes; continuous infusions may be used (Lieberman 2015).

Beta-blocker/calcium channel blocker toxicity: Administer IV bolus over 3 to 5 minutes; continuous infusions may be used. Ensure adequate supply available to continue therapy (AHA [Vanden Hoek 2010]).

Diagnostic aid: May administer IV over 1 minute. After the diagnostic procedure, administer oral carbohydrates to patients who have been fasting, if this is compatible with the diagnostic procedure applied. Bolus IV doses >1 mg are not recommended.

Hypoglycemia: May administer IV.

Subcutaneous: For treatment of hypoglycemia, may administer SubQ injection in the upper arms, thighs, or buttocks.

Dietary Considerations

Administer oral carbohydrates to patient as soon as possible after response to treatment.

Storage

Injection: Prior to reconstitution, store at 20°C to 25°C (69°F to 77°F) for up to 24 months. Do not freeze. Protect from light. Use reconstituted solution immediately; discard unused portion.

Intranasal: Store at ≤30°C (86°F). Do not remove intranasal device from the provided shrink-wrapped tube until ready to use. For single use only; discard after use.

Drug Interactions

Anticholinergic Agents: May enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

Indomethacin: May diminish the therapeutic effect of Glucagon. Monitor therapy

Vitamin K Antagonists (eg, warfarin): Glucagon may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy

Adverse Reactions

1% to 10%:

Gastrointestinal: Nausea (with rapid administration of high doses)

Frequency not defined.

Cardiovascular: Hypotension (up to 2 hours after GI procedures), increased blood pressure, increased pulse

Dermatologic: Skin rash

Gastrointestinal: Vomiting (with rapid administration of high doses)

Hypersensitivity: Anaphylactic shock, hypersensitivity reaction

Respiratory: Dyspnea

<1%, postmarketing, and/or case reports: Hypoglycemia, hypoglycemic coma, necrolytic migratory erythema, respiratory distress, urticaria

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Allergic reactions including skin rash and anaphylactic shock (with hypotension and respiratory difficulties) have been reported; reactions have generally been associated with endoscopic patients.

• Necrolytic migratory erythema: Necrolytic migratory erythema (NME), a skin rash associated with glucagonomas (glucagon-producing tumors) and characterized by scaly, pruritic, erythematous plaques, bullae, and erosions, has been reported (rarely) following continuous glucagon infusion. Rash may occur on face, groin, perineum, and legs or may be more widespread; rash generally resolves with discontinuation of treatment. Consider the risks versus benefits of continuing the glucagon infusion if NME occurs.

Disease-related concerns:

• Adrenal insufficiency: Use with caution in patients with adrenal insufficiency; levels of glucose stores in liver may be decreased.

• Cardiac disease: Use with caution in patients with cardiac disease.

• Chronic hypoglycemia: Use with caution in patients with chronic hypoglycemia; levels of glucose stores in liver may be decreased.

• Diabetes: Use caution if using as diagnostic aid in patients with diabetes on insulin; may cause hyperglycemia.

• Glucagonoma: Use with caution in patients with glucagonoma. The use of injectable glucagon as a diagnostic aid is contraindicated in patients with this condition.

• Insulinoma: Exogenous glucagon may cause an initial rise in blood glucose followed by rebound hypoglycemia. The use of glucagon is contraindicated in patients with this condition.

• Pheochromocytoma: Exogenous glucagon may cause the release of catecholamines, resulting in an increase in blood pressure. The use of glucagon is contraindicated in patients with this condition.

• Starvation/fasting: Use caution with prolonged fasting and/or starvation; levels of glycogen stores in liver may be decreased.

Dosage form specific issues:

• Lactose: May contain lactose; avoid administration in hereditary galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption.

Other warnings/precautions:

• Appropriate use: Insulin or sulfonylurea overdose: Patients with hypoglycemia should immediately be treated with dextrose. If IV access cannot be established or if dextrose is not available, glucagon may be considered as alternative acute treatment until dextrose can be administered.

• Secondary hypoglycemia: Supplemental carbohydrates should be given to patients who respond to glucagon for severe hypoglycemia to prevent secondary hypoglycemia.

Monitoring Parameters

Blood pressure, blood glucose, ECG, heart rate, mentation; signs or symptoms of a hypersensitivity reaction.

Pregnancy Considerations

Glucagon may be used for the treatment of severe hypoglycemia during pregnancy (Alexopoulos 2019). In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant females if there is a clear indication for use and should not be withheld because of concerns of teratogenicity (Bailey 2003a).

Patient Education

What is this drug used for?

• It is used to treat low blood sugar.

• It is used to quiet the GI (gastrointestinal) tract so it may be x-rayed.

• It may be given to you for other reasons. Talk with the doctor.

Frequently reported side effects of this drug

• Nausea

• Vomiting

• Common cold symptoms

• Nose irritation

• Sore throat

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Low blood sugar like dizziness, headache, fatigue, feeling weak, shaking, fast heartbeat, confusion, increased hunger, or sweating

• High blood sugar like confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit

• Skin blister

• Skin breakdown

• Painful skin

• Severe dizziness

• Passing out

• Severe headache

• Vision changes

• Fast heartbeat

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Further information

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