Glucagon
GLUCAGEN
What it isGlucagon-receptor agonist raising hepatic glucose output; severe hypoglycemia and beta-blocker overdose.
Why this oneIt rescues hypoglycemia without oral or IV access and raises cAMP independently of beta receptors in beta-blocker overdose.
What limits itIt fails when hepatic glycogen is depleted, as in prolonged fasting or severe alcohol-related malnutrition; vomiting is common.
FDA-approved for
- severe hypoglycemia (~1960)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe hypoglycemia (SubQ) | Adults & peds ≥12 yr | 1 mg SubQ | 1 mg SubQ | |
| Severe hypoglycemia (SubQ) | Peds 2 to <12 yr | 0.5 mg (<45 kg) or 1 mg (≥45 kg) SubQ | ||
| Diagnostic aid — GI relaxation (IV, VialDx) | Adults | 0.2–0.5 mg (stomach/duodenum) or 0.5–0.75 mg (colon) IV | 0.75 mg IV |
Renal Undefined
Hepatic Undefined
May give one additional dose from a new device after 15 minutes if no response
Instructions
- Inject SubQ in lower abdomen, outer thigh, or outer upper arm
- Single-use device/vial; do not reuse
- Give oral carbohydrates once the patient responds
- GVOKE VialDx: intravenous use only under medical supervision
Contraindications
- Pheochromocytoma
- Insulinoma
- Glucagonoma (when used as a diagnostic aid)
Cautions
- Substantial BP increase in pheochromocytoma
- Hypoglycemia in insulinoma
- Serious hypersensitivity reactions/anaphylaxis
- Lack of efficacy with decreased hepatic glycogen (starvation, adrenal insufficiency)
- Necrolytic migratory erythema with continuous infusion
Adverse reactions
- Nausea
- Vomiting
- Injection site edema
- Headache
- Pediatric: hypoglycemia, abdominal pain, hyperglycemia, urticaria
Pregnancy Data over decades show no drug-associated risk; minimal placental transfer.
Lactation No data; as a peptide, unlikely to harm a breastfed infant (broken down in the infant's GI tract).
NO BOXED WARNINGS
Principal riskIt fails without hepatic glycogen
Cost, est. cash$300–$5,000/dose or month
Generic entry2020
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Glucagon ballicule
