Glucagon parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Injection of glucagon.
Drugs List
Therapeutic Indications
Uses
Control of gastro-intestinal motility for investigative procedures
Severe hypoglycaemia
Unlicensed Uses
Beta blocker poisoning
Diagnosis of growth hormone secretion
Endogenous hyperinsulinism
Dosage
Adults
Severe hypoglycaemia
1mg by subcutaneous or intramuscular injection.
Patients will normally respond to treatment within 10 minutes (vial) or 15 minutes (pen device).
Manufacturer of vial advises that intravenous glucose should be administered if patient does not respond within 10 minutes.
Manufacturer of pen advises that an additional dose may be administered if patient does not respond within 15 minutes.
Inhibition of motility for gastrointestinal examinations
To relax stomach, duodenal bulb, duodenum and small bowel: 0.2mg to 0.5mg intravenously or 1mg intramuscularly.
To relax the colon: 0.5mg to 0.75mg intravenously or 1mg to 2mg intramuscularly.
After intravenous injection, the onset of action occurs within one minute and the duration of action is 5 to 20 minutes, depending on the organ under examination.
After intramuscular injection, the onset of action occurs in 5 to 15 minutes and the duration of action is 10 to 40 minutes, depending on the organ under examination.
After the diagnostic procedure oral carbohydrate should be given, if this is compatible with the diagnostic procedure applied.
Beta-blocker poisoning (unlicensed)
5mg to 10mg by intravenous injection administered over 1 to 2 minutes. Follow with 50 to 150 micrograms/kg/hour of glucagon by intravenous infusion.
Children
Severe hypoglycaemia
Subcutaneous or intramuscular injection
Children aged 9 to 18 years or above 25kg: 1mg.
Children aged 1 month to 9 years or below 25kg: 0.5mg.
Subcutaneous injection by pre-filled pen device
Children aged 6 to 18 years: 1mg.
Children aged 2 to 5 years and above 25kg: 1mg.
Children aged 2 to 5 years and below 25kg: 0.5mg.
Patients will normally respond to treatment within 10 minutes (vial) or 15 minutes (pen device).
Manufacturer of vial advises that intravenous glucose should be administered if patient does not respond within 10 minutes.
Manufacturer of pen advises that an additional dose may be administered if patient does not respond within 15 minutes.
Beta-blocker poisoning (unlicensed)
50 to 150 micrograms/kg (up to a maximum of 10mg) by intravenous injection. Follow with 50 micrograms/kg/hour by intravenous infusion.
Diagnosis of growth hormone secretion (unlicensed)
Intramuscular injection
100 micrograms/kg (up to a maximum of 1mg) as a single dose.
Endogenous hyperinsulinism (unlicensed)
Intramuscular or intravenous injection
Children aged 1 month to 1 year: 1mg as a single dose.
Continuous intravenous infusion
Children aged 1 month to 1 year: 1 to 10 micrograms/kg/hour, increased if necessary.
Neonates
Hypoglycaemia associated with diabetes
20 micrograms/kg by subcutaneous or intramuscular injection.
Endogenous hyperinsulinism (unlicensed)
200 micrograms/kg (up to a maximum of 1mg) as a single dose by intramuscular or intravenous injection.
OR
1 to 18 micrograms/kg/hour, titrated to response (up to a maximum of 50 micrograms/kg/hour) by continuous intravenous infusion.
Administration
Administer by subcutaneous, intramuscular or intravenous injection.
Pre-filled pen device should only be administered subcutaneously in the lower abdomen, outer thigh, or outer upper arm.
When administered by intravenous infusion (unlicensed), infusion fluids containing calcium must not be added due to risk of precipitation.
Contraindications
Phaeochromocytoma
Precautions and Warnings
Children under 2 years
Prolonged fasting
Adrenal insufficiency
Cardiac disorder in the elderly
Diabetes mellitus - if used to inhibit GI motility for diagnostic procedure
Glucagonoma
Insulinoma
Not all available brands are licensed for all indications
Not all available brands are licensed for all routes of administration
Not all available products are licensed for all age groups
Oral carbohydrates should be given to restore liver glycogen post treatment
Pregnancy and Lactation
Pregnancy
Glucagon is considered safe for use during pregnancy.
The manufacturer states that use of glucagon has been reported in pregnant women with diabetes and no harmful effects are known and glucagon does not cross the human placenta barrier.
Briggs (2015) states that when glucagon is used for treatment of severe hypoglycaemic reactions in diabetic patients receiving insulin maternal treatment is paramount. In cases where intravenous glucose cannot be administered, glucagon should not be withheld because of concern for embryo/fetal safety. The maternal consequences of withholding treatment might place the pregnancy at a far greater risk than the undocumented risk from the drug.
Lactation
Glucagon is considered safe for use during breastfeeding.
The manufacturer states that glucagon is degraded in the gastrointestinal tract and is not absorbed in its intact form, therefore it will not exert any metabolic effects on the child. The amount of glucagon excreted in breast milk is extremely small as glucagon is cleared very quickly from the bloodstream with a half life of under 20 minutes. LactMed states that due to the high molecular weight of glucagon, it is unlikely that glucagon will be excreted into human milk.
Side Effects
Abdominal pain
Anaphylactic shock
Bruising at injection site
Diarrhoea
Erythema at injection site
Headache
Hyperglycaemia
Hypersensitivity reactions
Hypertension
Hypoglycaemia
Hypokalaemia
Hypotension
Nausea
Oedema (injection site)
Pain on injection
Tachycardia
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: September 2021
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: GlucaGen Hypokit 1 mg. Novo Nordisk Ltd. Revised May 2021.
Summary of Product Characteristics: Ogluo 0.5mg. Tetris Pharma Ltd. Revised October 2021.
Summary of Product Characteristics: Ogluo 1mg. Tetris Pharma Ltd. Revised October 2021.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 15 September 2021
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Glucagon Last revised: 19 April 2021
Last accessed: 15 September 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.