Intramuscular Diagnostic aid in the radiologic examination of the gastrointestinal tract
Adult: For relaxation of the stomach, duodenal bulb, duodenum, and small bowel: 1 mg. For relaxation of the colon: 1-2 mg. Doses are given via IM inj.
Intramuscular, Intravenous, Subcutaneous Severe hypoglycaemia
Adult: 1 mg via IV, IM, or SC inj. If a response does not occur within 15 minutes, an additional dose may be given while waiting for emergency assistance. Oral carbohydrates may be given once the patient has responded and is able to swallow. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Child: ≤8 years or patients weighing <25 kg: 0.5 mg; >8 years or patients weighing ≥25 kg: Same as adult dose. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Intravenous Diagnostic aid in the radiologic examination of the gastrointestinal tract
Adult: For relaxation of the stomach, duodenal bulb, duodenum, and small bowel: 0.2-0.5 mg. For relaxation of the colon: 0.5-0.75 mg. Doses are given via IV inj.
Nasal Severe hypoglycaemia
Adult: 3 mg (1 actuation of the nasal device) into one nostril. If a response does not occur within 15 minutes, an additional dose from a new device may be given while waiting for emergency assistance. Doses given do not need to be inhaled. Child: ≥4 years Same as adult dose.
Reconstitution
Solution for parenteral inj: Reconstitute with 1 mL of water for inj to provide a solution containing 1 mg/mL. Gently shake the vial to dissolve. Instructions for reconstitution may vary depending on the indication and/or between countries and individual products. Refer to country-specific product guidelines.
Incompatibility
Solution for IV infusion: Precipitation may occur with fluids containing Ca.
Contraindications
Phaeochromocytoma, insulinoma. Glucagonoma (use as a diagnostic aid).
Special Precautions
Patient with adrenal insufficiency, cardiac disease, chronic hypoglycaemia, alcohol induced hypoglycaemia. Patient subjected to starvation or fasting. Glucagonoma, diabetes mellitus (use as diagnostic aid). Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Anaphylactic shock, rash (accompanied by hypotension and respiratory difficulties); secondary hypoglycaemia (patient with glucagonoma); elevated blood glucose followed by rebound hypoglycaemia, hypertension; short-term hyperglycaemia. Rarely, necrolytic migratory erythema (continuous infusion). Gastrointestinal disorders: Abdominal pain, nausea, vomiting. General disorders and administration site conditions: Inj site reactions. Respiratory, thoracic and mediastinal disorders: Upper respiratory tract irritation (nasal). Potentially Fatal: Increased myocardial oxygen demand, blood pressure, and pulse rate (patient with cardiac disease in cases when used as a diagnostic aid).
This drug may cause infrequent hypoglycaemia particularly following diagnostic procedures, if affected, do not drive or operate machinery; or until oral carbohydrates have been consumed.
Monitoring Parameters
Monitor blood pressure, blood glucose, ECG, heart rate, and mentation. Assess for signs and symptoms of hypersensitivity reactions.
Overdosage
Symptoms: Nausea, vomiting, gastrointestinal tract motility inhibition, rise in blood pressure and pulse rate, hypokalaemia. Management: May give phentolamine to treat dramatic increases in blood pressure. Monitor and correct serum K levels.
Drug Interactions
Increased heart rate and blood pressure with β-blockers. May diminish the therapeutic effect or cause paradoxical hypoglycaemia with indometacin. May increase the risk of gastrointestinal adverse reactions with anticholinergic agents. Attenuated therapeutic effect with insulin. May enhance the anticoagulant effect of warfarin.
Action
Description: Mechanism of Action: Glucagon is an endogenous polypeptide hormone produced by the α cells of the pancreatic islets of Langerhans. It stimulates adenylate cyclase to produce cAMP, to activate hepatic glycogenolysis and gluconeogenesis, thus increasing serum glucose level. Onset: Blood glucose elevation: Approx 10 minutes (IM, SC). Gastrointestinal relaxation: 45 seconds (IV); 4-15 minutes (IM). Duration: Blood glucose elevation: 60-90 minutes. Gastrointestinal relaxation: 9-25 minutes (IV); 12-32 minutes (IM). Pharmacokinetics: Absorption: Time to peak plasma concentration: Approx 10-12.5 minutes (IM); 20 minutes (SC); 15 minutes (nasal). Distribution: Volume of distribution: Approx 0.25 L/kg. Metabolism: Metabolised in the liver; in small portions in the kidneys and plasma. Excretion: Elimination half-life: 8-18 minutes (IV); 26-45 minutes (IM); approx 35 minutes (nasal).
Chemical Structure
Glucagon Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 16132283, Glucagon. https://pubchem.ncbi.nlm.nih.gov/compound/Glucagon. Accessed Nov. 23, 2023.
Storage
Store between 20-25°C. Protect from light. Do not freeze.
H04AA01 - glucagon ; Belongs to the class of glycogenolytic hormones. Used in the treatment of hypoglycemia.
References
Anon. Glucagon (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/11/2023.Anon. Glucagon. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/06/2023.Baqsimi Powder (Eli and Lilly Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/10/2023.Buckingham R (ed). Glucagon. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/06/2023.GlucaGen 1 mg Powder and Solvent for Solution for Injection (Novo Nordisk A/S). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 05/06/2023.GlucaGen 1 mg Powder and Solvent for Solution for Injection; GlucaGen HypoKit 1 mg Powder and Solvent for Solution for Injection (Novo Nordisk A/S). MHRA. https://products.mhra.gov.uk. Accessed 05/06/2023.Glucagen Injection, Powder, for Solution (Boehringer Ingelheim Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/06/2023.Glucagon. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 06/11/2023.Gvoke Kit Vial, Kit, Pre-filled Syringe, Hypopen Auto-injector (Xeris Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/10/2023.Joint Formulary Committee. Glucagon. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/06/2023.Novo Nordisk Pharmaceuticals Ltd. GlucaGen HypoKit, Powder and Solvent for Solution for Injection data sheet 26 July 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 05/06/2023.Ogluo 0.5 mg Solution for Injection in Pre-filled Pen (Tetris Pharma). MHRA. https://products.mhra.gov.uk. Accessed 19/10/2023.Paediatric Formulary Committee. Glucagon. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 06/11/2023.
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