glucagon

GLOO-ka-gon

Therapeutic Classification: hormones

Pharmacologic Classification: pancreatics

REMS

Acute management of severe hypoglycemia.
Facilitation of radiographic examination of the GI tract.

Unlabeled Use:

Beta blocker overdose.
Calcium channel blocker overdose.

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

Therapeutic effects:

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

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.

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)

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 <1 yr (safety and effectiveness of nasal powder not established).

CV: hypotension

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: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

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 beta blocker therapy may have a greater ↑ in HR and BP.

Hypoglycemia

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

(Generic available)

Nasal powder: 3 mg/device
Lyophilized powder for injection: 1 mg/vial
Solution for SUBQ injection (Gvoke) (prefilled syringes and prefilled autoinjectors): 0.5 mg/0.1 mL; 1 mg/0.2 mL

Assess for signs of hypoglycemia (sweating, hunger, weakness, headache, dizziness, tremor, irritability, tachycardia, anxiety) before and periodically during therapy.
Assess for hypersensitivity reactions (anaphylaxis, rash, hives, itching, wheezing, trouble breathing) and implement supportive measures (epinephrine) as indicated.
Assess neurologic status during therapy. Institute safety precautions to protect patient from injury caused by seizures, falling, or aspiration. For insulin shock therapy, 0.5–1 mg is administered after 1 hr of coma; patient usually awakens in 10–25 min. If no response occurs, repeat the dose. Feed patient supplemental carbohydrates orally to replenish liver glycogen and prevent secondary hypoglycemia as soon as possible after awakening, especially in pediatric patients.
Assess nutritional status. Patients who lack liver glycogen stores (starvation, chronic hypoglycemia, adrenal insufficiency) will require glucose instead of glucagon.
Assess for nausea and vomiting after administration of dose. Protect patients with depressed level of consciousness from aspiration by positioning on side; ensure that a suction unit is available. Notify health care provider if vomiting occurs; patient will require parenteral glucose to prevent recurrent hypoglycemia.

Lab Test Considerations:

Monitor serum glucose levels throughout episode, during treatment, and for 3–4 hr after patient regains consciousness. Use of bedside fingerstick blood glucose determination methods is recommended for rapid results. Follow-up lab results may be ordered to validate fingerstick values, but do not delay treatment while awaiting lab results, as this could result in neurologic injury or death.
- Large doses of glucagon may ↓ potassium.

Administer supplemental carbohydrates IV or PO to ↑ serum glucose levels.
SUBQ: Gvoke solution is clear and colorless to pale yellow; do not administer if solution is discolored or contains particulate matter. Inject in lower abdomen, outer thigh, or outer upper arm.
Intranasal: Administer by inserting tip into one nostril and pressing device plunger all the way in until green line is no longer showing. Dose does not need to be inhaled. Call for emergency assistance immediately after administering dose. When patient responds to treatment, give oral carbohydrates.

IV Administration:

Continuous Infusion: Reconstitution: Reconstitute vials as per directions above (use sterile water for injection). Diluent: Further dilute 10 mg of glucagon in 100 mL of D5W. Concentration: 0.1 mg/mL.
Rate: See Route/Dosage section.
Y-Site Compatibility: naloxone.

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other Rx, OTC, or herbal products.
Educate patient and family/caregivers on 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 ↓ level of consciousness.
Home Care Issues: Instruct family/caregivers on correct technique to prepare, draw up, and administer injection. Health care provider must be contacted immediately after each dose for orders regarding further therapy or adjustment of insulin dose or diet.
Advise patient, family, and caregivers of hypersensitivity reactions and to seek immediate medical attention if any occur.
Instruct family/caregivers 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.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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

Baqsimi, ~~GlucaGen,~~ Gvoke

NDC Code

0378- Mylan Pharmaceuticals Inc.
- 0378-8067- Glucagon
  - 0378-8067-90- 1 KIT in 1 KIT (0378-8067-90) * 1 mL in 1 VIAL (0378-8065-32) * 1 mL in 1 SYRINGE (0378-8066-32)

0548- Amphastar Pharmaceuticals, Inc.
- 0548-5850- Glucagon
  - 0548-5850-00- 1 KIT in 1 KIT (0548-5850-00) * 1 mL in 1 VIAL (0548-5905-00) * 1 mL in 1 SYRINGE (0548-5831-00)

0548- Amphastar Pharmaceuticals, Inc.
- 0548-8351- Baqsimi
  - 0548-8351-01- 1 TUBE in 1 CARTON (0548-8351-01) / 1 BOTTLE, UNIT-DOSE in 1 TUBE / 1 POWDER in 1 BOTTLE, UNIT-DOSE

0548- Amphastar Pharmaceuticals, Inc.
- 0548-8352- Baqsimi
  - 0548-8352-02- 2 TUBE in 1 CARTON (0548-8352-02) / 1 BOTTLE, UNIT-DOSE in 1 TUBE / 1 POWDER in 1 BOTTLE, UNIT-DOSE

11014- Catalent Pharma Solutions LLC
- 11014-0687-
  - 11014-0687-3- 1 BOTTLE, UNIT-DOSE in 1 TUBE (11014-0687-3) / 9720 POWDER in 1 BOTTLE, UNIT-DOSE

41524- Ambiopharm, Inc.
- 41524-0005-
  - 41524-0005-1- 1 g in 1 BOTTLE (41524-0005-1)

50090- A-S Medication Solutions
- 50090-6550- Glucagon
  - 50090-6550-0- 1 KIT in 1 VIAL (50090-6550-0) / 1 KIT in 1 KIT * 1 mL in 1 VIAL (0548-5905-00) * 1 mL in 1 SYRINGE (0548-5831-00)

51662- HF Acquisition Co LLC, DBA HealthFirst
- 51662-1498- GLUCAGON
  - 51662-1498-1- 1 KIT in 1 KIT (51662-1498-1) * 1 mL in 1 VIAL, SINGLE-DOSE * 1 mL in 1 SYRINGE, GLASS

55463- Bachem AG
- 55463-0009-
  - 55463-0009-1- 200 g in 1 BOTTLE, GLASS (55463-0009-1)

63323- Fresenius Kabi USA, LLC
- 63323-582- Glucagon
  63323-582-82- 1 KIT in 1 KIT (63323-582-82) * 1 mL in 1 VIAL, SINGLE-DOSE (63323-583-13) * 1 mL in 1 SYRINGE, GLASS (63323-185-82)

63323- Fresenius Kabi USA, LLC
- 63323-593- Glucagon
  - 63323-593-03- 1 KIT in 1 CARTON (63323-593-03) * 1 mL in 1 VIAL, SINGLE-DOSE (63323-596-03) * 1 mL in 1 VIAL, SINGLE-DOSE (63323-185-03)

63323- Fresenius Kabi USA, LLC
- 63323-594- Glucagon
  - 63323-594-03- 1 KIT in 1 CARTON (63323-594-03) * 1 mL in 1 VIAL, SINGLE-DOSE (63323-596-06) * 1 mL in 1 VIAL, SINGLE-DOSE (63323-185-03)

63323- Fresenius Kabi USA, LLC
- 63323-596- Glucagon
  - 63323-596-13- 10 VIAL, SINGLE-DOSE in 1 TRAY (63323-596-13) / 1 mL in 1 VIAL, SINGLE-DOSE (63323-596-11)

63323- Fresenius Kabi USA, LLC
- 63323-596- Glucagon
  - 63323-596-16- 10 VIAL, SINGLE-DOSE in 1 TRAY (63323-596-16) / 1 mL in 1 VIAL, SINGLE-DOSE (63323-596-08)

66558- FRESENIUS KABI IPSUM SRL
- 66558-0195-
  - 66558-0195-1- 25 g in 1 JAR (66558-0195-1)

66558- FRESENIUS KABI IPSUM SRL
- 66558-0195-
  66558-0195-2- 50 g in 1 JAR (66558-0195-2)

66558- FRESENIUS KABI IPSUM SRL
- 66558-0195-
  66558-0195-3- 100 g in 1 JAR (66558-0195-3)

69097- Cipla USA Inc.
- 69097-027- Glucagon
  69097-027-50- 1 KIT in 1 CARTON (69097-027-50) * 1 mL in 1 VIAL, GLASS (69097-028-32) * 1 mL in 1 SYRINGE, GLASS (69097-029-31)

70748- Lupin Pharmaceuticals, Inc.
- 70748-311- GLUCAGON
  - 70748-311-01- 1 KIT in 1 CARTON (70748-311-01) * 1 mL in 1 VIAL (70748-309-01) * 1 mL in 1 SYRINGE (70748-310-01)

85766- Sportpharm, Inc. dba Sportpharm
- 85766-065- Glucagon
  - 85766-065-01- 1 KIT in 1 KIT (85766-065-01) * 1 mL in 1 VIAL (0378-8065-32) * 1 mL in 1 SYRINGE (0378-8066-32)

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Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

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