Convenient for use in emergency situations when dextrose cannot be administered IV; however, severe hypoglycemia initially should be treated with IV dextrose, if possible.
Do not substitute for IV dextrose in emergency situations in which hypoglycemia is suspected but not established.
Increase in blood glucose concentration produced by glucagon not as great in patients with type 1 diabetes mellitus as in those with type 2 diabetes mellitus; administer supplemental carbohydrate as soon as possible, especially to pediatric patients.
Little or no value for treatment of chronic hypoglycemia or hypoglycemia associated with starvation or adrenal insufficiency.
Radiographic Examination of GI Tract
Diagnostic aid in radiographic examination of the stomach, duodenum, small intestine, and colon when a hypotonic state would be advantageous; appears to be as effective as antimuscarinic agents and associated with fewer adverse effects.
β-Adrenergic or Calcium-Channel Blocking Agent Overdosage
Has been used with some success as a cardiac stimulant for management of cardiac manifestations (e.g., bradycardia, hypotension, myocardial depression, impaired conduction, cardiogenic shock, cardiac arrest) associated with severe β-adrenergic blocking agent overdosage† or calcium-channel blocking agent overdosage†; has successfully reversed such manifestations in patients unresponsive to other drugs (e.g., atropine, dobutamine, dopamine, epinephrine).
Administer early in the management of severe β-adrenergic blocking agent overdosage†.
Sensitivity Reactions
Has been used rarely in patients with anaphylaxis unresponsive to epinephrine†, particularly in patients receiving β-adrenergic blocking agents, who have an increased incidence and severity of anaphylaxis and may develop a paradoxical response to epinephrine. May prevent cardiopulmonary arrest.
Dosage and Administration
General
Monitor blood glucose concentrations in patients with hypoglycemia until patient is asymptomatic.
After clinical response is achieved or following completion of procedure, administer supplemental carbohydrate to restore liver glycogen and prevent secondary hypoglycemia.
Administration
IV, IM, or Sub-Q Administration
Administer by IV, IM, or sub-Q injection.
Reconstitution
Glucagon (Lilly): Reconstitute by adding 1 mL of sterile diluent to vial labeled as containing 1 mg of glucagon to provide a solution containing 1 mg of glucagon per mL. Do not use concentrations >1 mg/mL. Use only diluent provided by manufacturer; do not use diluent to reconstitute other drugs.
Glucagon hydrochloride (GlucaGen®): Reconstitute by adding 1 mL of sterile diluent (if supplied by manufacturer) or sterile water for injection to a vial labeled as containing 1 mg of glucagon to provide a solution containing 1 mg of glucagon per mL.
Use reconstituted solutions immediately; discard any unused portion.
Dilution
To prepare continuous IV infusion solution for treatment of β-adrenergic or calcium-channel blocking agent overdosage†, dilute reconstituted glucagon in 5% dextrose injection.
Dosage
Available as glucagon (rDNA origin, Lilly) and glucagon hydrochloride (rDNA origin, GlucaGen®); dosage expressed in terms of glucagon.
1 mg of glucagon is equivalent to 1 International Unit (IU, unit).
Pediatric Patients
Hypoglycemia
Glucagon (Lilly)
IV, IM, or Sub-Q
Children <20 kg: 0.5 mg. Alternatively, 20–30 mcg/kg may be administered.
Children ≥20 kg: 1 mg.
An additional dose may be administered if patient does not awaken within 15 minutes following administration of drug; however, seek emergency assistance so that IV dextrose may be administered because of potential serious adverse effects associated with prolonged cerebral hypoglycemia. If patient fails to respond to glucagon, IV dextrose must be given.
Glucagon Hydrochloride (GlucaGen®)
IV, IM, or Sub-Q
Children <25 kg: 0.5 mg.
Children ≥25 kg: 1 mg.
Alternatively, if weight is not known, usual dose in children <6–8 years of age is 0.5 mg and in children >6–8 years of age is 1 mg.
An additional dose may be administered if patient does not awaken within 15 minutes following administration of drug; however, seek emergency assistance so that IV dextrose may be administered because of potential serious adverse effects associated with prolonged cerebral hypoglycemia. If patient fails to respond to glucagon, IV dextrose must be given.
β-Adrenergic or Calcium-Channel Blocking Agent Overdosage
IV
In children, initially, 50–100 mcg/kg as a loading dose (i.e., bolus), followed by a continuous IV infusion of 100 mcg/kg per hour.†
Alternatively, in adolescents, some experts have suggested a dose of 5–10 mg administered over several minutes, followed by an IV infusion of 1–5 mg/hour for the treatment of β-adrenergic blocking agent overdosage†.†
Adults
Hypoglycemia
Glucagon (Lilly) and Glucagon Hydrochloride (GlucaGen®)
IV, IM, or Sub-Q
1 mg.
An additional dose may be administered if patient does not awaken within 15 minutes following administration of drug; however, seek emergency assistance so that IV dextrose may be administered because of potential serious adverse effects associated with prolonged cerebral hypoglycemia. If patient fails to respond to glucagon, IV dextrose must be given.
Radiographic Examination of GI Tract
IV
Stomach, duodenum, or small intestine: 0.25–2 mg, depending on onset of action and duration of effect required for specific examination. (See Absorption under Pharmacokinetics.)
For relaxation of the stomach, one manufacturer (Lilly) has recommended a dose of 0.5 mg since the stomach is less sensitive to effect of drug.
IM
Stomach, duodenum, or small intestine: 1–2 mg, depending on onset of action and duration of effect required for specific examination. (See Absorption under Pharmacokinetics.)
For relaxation of the stomach, one manufacturer (Lilly) has recommended a dose of 2 mg since the stomach is less sensitive to effect of drug.
Colon: One manufacturer (Lilly) has recommended a dose of 2 mg approximately 10 minutes prior to initiating examinations of colon; may facilitate a more satisfactory radiographic examination.
β-Adrenergic or Calcium-Channel Blocking Agent Overdosage
IV
Initially (as a loading dose), 50–150 mcg/kg (approximately 3–10 mg for a 70-kg patient) over 1–2 minutes; higher doses may be needed if ineffective. Loading dose has been repeated every 3–10 minutes, if needed; however, continuous IV infusion should follow loading dose administration because of drug’s short duration of action. (See Absorption under Pharmacokinetics.)†
Continuous IV infusion: 1–5 mg/hour; infusion rate may be reduced according to response. Alternatively, a continuous IV infusion of 50–100 mcg/kg per hour has been administered. Also, some experts suggest an IV infusion rate based on effective loading dose per hour (e.g., if initial effective cumulative loading dose is 10 mg, hourly infusion rate should be 10 mg/hour).†
Sensitivity Reactions
IV or IM
1–2 mg every 5 minutes has been administered in patients with anaphylaxis unresponsive to epinephrine†.†
Special Populations
Geriatric Patients
Select dosage with caution, usually initiating therapy at the low end of the dosage range, because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. (See Geriatric Use under Cautions.)
Drug Info Tools
