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

Unlabeled Use:

• Beta-blocker overdose.
• Calcium channel blocker overdose.

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).

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 concurrent beta blocker therapy may have a greater ↑ in heart rate and BP.

(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;

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.

Baqsimi, GlucaGen, Gvoke

• 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.

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

Therapeutic Classification: hormones

Pharmacologic Classification: pancreatics

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.

• 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.
• Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

GLOO-ka-gon

NDC Code^*

• 0002- Eli Lilly and Company
  • 0002-6145- Baqsimi
    • 0002-6145-11- 1 TUBE in 1 CARTON (0002-6145-11) > 1 BOTTLE, UNIT-DOSE in 1 TUBE (0002-6145-02) > 1 POWDER in 1 BOTTLE, UNIT-DOSE (0002-6145-01)

• 0002- Eli Lilly and Company
  • 0002-6145- Baqsimi
    • 0002-6145-27- 2 TUBE in 1 CARTON (0002-6145-27) > 1 BOTTLE, UNIT-DOSE in 1 TUBE (0002-6145-02) > 1 POWDER in 1 BOTTLE, UNIT-DOSE (0002-6145-01)

• 0002- Eli Lilly and Company
  • 0002-8031- Glucagon
    • 0002-8031-01- 1 KIT in 1 KIT (0002-8031-01) * 1 mL in 1 VIAL (0002-7529-01) * 1 mL in 1 SYRINGE (0002-7530-01)

• 0169- Novo Nordisk
  • 0169-7065- GlucaGen HypoKit
    • 0169-7065-15- 1 KIT in 1 KIT (0169-7065-15) * 1 mL in 1 VIAL, GLASS * 1 mL in 1 SYRINGE, GLASS

• 0597- Boehringer Ingelheim Pharmaceuticals, Inc.
  • 0597-0053- GlucaGen
    • 0597-0053-45- 10 VIAL in 1 CARTON (0597-0053-45) > 1 mL in 1 VIAL

• 0597- Boehringer Ingelheim Pharmaceuticals, Inc.
  • 0597-0260- GlucaGen
    • 0597-0260-10- 1 KIT in 1 KIT (0597-0260-10) * 1 mL in 1 VIAL, GLASS (0597-0053-01) * 1 mL in 1 VIAL, GLASS (0597-0265-94)

• 43742- Deseret Biologicals, Inc.
  • 43742-0252- Glucagon
    • 43742-0252-1- 30 mL in 1 PACKAGE (43742-0252-1)

• 43742- Deseret Biologicals, Inc.
  • 43742-0734- Glucagon
    • 43742-0734-1- 30 mL in 1 BOTTLE, DROPPER (43742-0734-1)

• 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-USE (63323-596-03) * 1 mL in 1 VIAL, SINGLE-USE (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-USE (63323-596-06) * 1 mL in 1 VIAL, SINGLE-USE (63323-185-03)

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

• 63323- Fresenius Kabi USA, LLC
  • 63323-596- Glucagon
    • 63323-596-13- 10 VIAL in 1 TRAY (63323-596-13) > 1 mL in 1 VIAL