Glucagon

Registered South African indications:

• Hypoglycaemia
• Diagnostic procedures of the gastrointestinal tract

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Phaeochromocytoma

Cautions

• Elderly (with known cardiac disease)
• Patients whose liver glycogen is depleted
• Fasting for prolonged period
• Adrenal insufficiency
• Chronic hypoglycaemia
• Alcohol-induced hypoglycaemia
• Insulinoma
• Glucagonoma
• Cardiac disease  
• Diabetic patients  
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: inj 

Hypoglycaemia - Severe  

• SC/IM/IV: 1mg  

On regaining consciousness, give oral carbohydrate (e.g. dextrose, sweets, sweet biscuit) to restore the hepatic glycogen and prevent relapse of hypoglycaemia

If patient fails to respond within 10 minutes, IV glucose should be given ₁ 

Inhibition of gastrointestinal motility for diagnostic procedures of the stomach, duodenal bulb, duodenum and small bowel

• IV: 0.2-0.5mg  
• IM: 1mg

Inhibition of gastrointestinal motility for diagnostic procedures of the colon 

• IV: 0.5-0.75mg
• IM: 1-2mg

After end of the diagnostic procedure oral carbohydrate should be given, if this is compatible with the diagnostic procedure applied

Paed. forms avail. in SA and covered in this monograph: inj 

Severe hypoglycaemia

Younger than 6 years or <25kg

• SC/IM/IV: 0.5mg

Older than 6 years or >25kg

• SC/IM/IV: 1mg

When the patient has responded to the treatment, give oral carbohydrate to restore the liver glycogen and prevent relapse of hypoglycaemia

If patient fails to respond within 10 minutes, IV glucose should be given

Pregnancy 

• Safe; no evidence of risk in studies
• Glucagon does not cross the human placenta barrier. The use of glucagon has been reported in pregnant women with diabetes and no harmful effects are known with respect to the course of pregnancy and the health of the unborn and the neonate. Glucagon can be used during pregnancy

Breastfeeding 

• Compatible
• Glucagon is cleared from the bloodstream very fast (mainly by the liver) (t1/2= 3–6min.); thus the amount excreted in the milk of breastfeeding mothers following treatment of severe hypoglycaemic reactions is expected to be extremely small. As glucagon is degraded in the digestive tract and cannot be absorbed in its intact form, it will not exert any metabolic effect in the child. Glucagon can be used during breastfeeding

Fertility

• Animal reproduction studies have not been conducted with glucagon
• Studies in rats have shown that glucagon does not cause impaired fertility

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment 

• No dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended
  Caution should be observed when glucagon is used as an adjunct in endoscopic or radiographic procedures in elderly patients with known cardiac disease

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Cardiovascular Disorders

• Tachycardia
• Hypotension
• Hypertension

Gastrointestinal Disorders

• Nausea and vomiting
• Abdominal pain

Endocrine and Metabolic Disorders

• Hypoglycaemia
• Hypoglycaemic coma

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity reactions including anaphylactic reaction/ shock

• Insulin
• Indomethacin
• Warfarin
• Beta blockers

• Serum potassium
• Blood pressure
• Blood glucose
• Electrocardiogram
• Heart rate

Additional observations

• Mentation
• Signs or symptoms of a hypersensitivity reaction

Glucagon is a hyperglycaemic agent that mobilises hepatic glycogen, which is released into the blood as glucose. Glucagon inhibits the tone and motility of the smooth muscle in the gastrointestinal tract. 

Injection (per ml) 1mg

• GlucaGen Hypokit (Novo Nordisk) originator