glucagon

Contraindicated in:

Hypersensitivity
Pheochromocytoma
Insulinoma.

Use Cautiously in:

Prolonged fasting, starvation, adrenal insufficiency, or chronic hypoglycemia (low levels of releasable glucose)
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
Lactation: Safety not established in breastfeeding
Pedi: Children <4 yr (safety and effectiveness of nasal powder not established).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: necrolytic migratory erythema.

EENT: epistaxis, eye redness, itchy eyes, itchy throat, nasal congestion, nasal discomfort, nasal itching, rhinorrhea, sneezing, watery eyes.

GI: nausea, vomiting.

Neuro: headache.

Resp: cough.
Misc: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS .

Interactions ⬆ ⬇

Drug-Drug:

Large doses may ↑ the effect of warfarin.
Negates the response to insulin or oral hypoglycemic agents.
Phenytoin inhibits the stimulant effect of glucagon on insulin release.
Hyperglycemic effect is intensified and prolonged by epinephrine.
Patients on concurrent beta blocker therapy may have a greater ↑ in heart rate and BP.

Availability ⬆ ⬇

(Generic available)

Nasal powder: 3 mg/device;
Powder for injection: 1-mg (equivalent to 1 unit) vials as an emergency kit for low blood glucose and as a diagnostic kit;
Solution for SUBQ injection (Gvoke) (prefilled syringes and prefilled autoinjectors): 0.5 mg/0.1 mL; 1 mg/0.2 mL;

Route/Dosage ⬆ ⬇

Hypoglycemia

IV, IM, SC (Adults and Children >25 kg): 1 mg; may be repeated in 15 min if necessary.
SC (Adults and Children ≥12 yr): Gvoke: 1 mg; may be repeated in 15 min if necessary.
IV, IM, SC (Children <25 kg): 0.5 mg or 0.02–0.03 mg/kg; may be repeated in 15 min if necessary.
IV, IM, SC (Children >6 yr and unknown weight): 1 mg; may be repeated in 15 min if necessary.
IV, IM, SC (Children <6 yr and unknown weight): 0.5 mg or 0.02–0.03 mg/kg; may be repeated in 15 min if necessary.
SC (Children 2–12 yr and ≥45 kg): Gvoke: 1 mg; may be repeated in 15 min if necessary.
SC (Children 2–12 yr and <45 kg): Gvoke: 0.5 mg; may be repeated in 15 min if necessary.
Intranasal (Adults and Children ≥4 yr): 3 mg (one actuation) in one nostril; may be repeated in 15 min if necessary.

Radiographic Examination of the GI Tract

IM, IV (Adults): 0.25–2 mg; depending on location and duration of examination (0.5 mg IV or 2 mg IM for relaxation of stomach; for examination of the colon 2 mg IM 10 min before procedure).

Beta Blocker or Calcium Channel Blocker Overdose

IV (Adults): Beta blocker overdose: 50–150 mcg (0.05–0.15 mg)/kg, followed by 1–5 mg/hr infusion. Calcium channel blocker overdose: 2 mg; additional doses determined by response.

US Brand Names ⬆ ⬇

Baqsimi, GlucaGen, Gvoke

Action ⬆ ⬇

Stimulates hepatic production of glucose from glycogen stores (glycogenolysis).
Relaxes the musculature of the GI tract (stomach, duodenum, small bowel, and colon), temporarily inhibiting movement.
Has positive inotropic and chronotropic effects.

Therapeutic Effects:

Increase in blood glucose.
Relaxation of GI musculature, facilitating radiographic examination.

Classifications ⬆ ⬇

Therapeutic Classification: hormones

Pharmacologic Classification: pancreatics

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following IM, intranasal, and SUBQ administration; IV administration results in complete bioavailability.

Distribution: Extensively distributed to tissues.

Metabolism/Excretion: Extensively metabolized by the liver, plasma, and kidneys.

Half-life: 8–18 min.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IM (hyperglycemic action)	within 10 min	30 min	12–27 min
IV (hyperglycemic action)	1 min	5 min	9–17 min
SUBQ (hyperglycemic action)	within 10 min	30–45 min	60–90 min
Intranasal (hyperglycemic action)	within 15 min	unknown	unknown
IV (effect on GI musculature)	45 sec (for 0.25–2-mg dose)	unknown	9–17 min (0.25–0.5-mg dose); 22–25 min (2-mg dose)
IM (effect on GI musculature)	8–10 min (1-mg dose); 4–7 min (2-mg dose)	unknown	9–27 min (1-mg dose); 21–32 min (2-mg dose)

Patient/Family Teaching ⬆ ⬇

Teach patient and family signs and symptoms of hypoglycemia. Instruct patient to take oral glucose as soon as symptoms of hypoglycemia occur; glucagon is reserved for episodes when patient is unable to swallow because of decreased level of consciousness.
Home Care Issues: Instruct family on correct technique to prepare, draw up, and administer injection. Health care professional must be contacted immediately after each dose for orders regarding further therapy or adjustment of insulin dose or diet.
Advise family that patient should receive oral glucose when alertness returns.
Instruct family to position patient on side until fully alert. Explain that glucagon may cause nausea and vomiting. Aspiration may occur if patient vomits while lying on back.
Instruct patient to check expiration date monthly and to replace outdated medication immediately.
Review hypoglycemic medication regimen, diet, and exercise programs.
Patients with diabetes mellitus should carry a source of sugar (such as a packet of sugar or candy) and identification describing disease process and treatment regimen at all times.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇