Glucagon
GLUCAGEN
Pronunciation: GLOO-ka-gon
What it isGlucagon-receptor agonist raising hepatic glucose output; severe hypoglycemia and beta-blocker overdose.
Why this oneRescues hypoglycemia without oral or IV access and raises cAMP independently of beta receptors in beta-blocker overdose.
What limits itFails when hepatic glycogen is depleted, as in prolonged fasting or severe alcohol-related malnutrition; vomiting is common.
FDA-approved for
- severe hypoglycemia (~1960)
Principal riskIt fails without hepatic glycogen
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.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe hypoglycemia (emergency kit) | Adults & peds >25 kg (or unknown weight ≥6 yr) | 1 mg (1 mL) SC/IM (upper arm, thigh, buttocks) or IV, once | If no response after 15 min, may give an additional 1 mg from a new kit | Undefined |
| Diagnostic aid — GI relaxation during radiologic exam (stomach, duodenal bulb, duodenum, small bowel) | Adults | 0.2–0.5 mg IV or 1 mg IM, once | Undefined | |
| Diagnostic aid — GI relaxation during radiologic exam (colon) | Adults | 0.5–0.75 mg IV or 1–2 mg IM, once | Undefined | |
| Severe hypoglycemia (emergency kit) | Peds <25 kg (or unknown weight <6 yr) | 0.5 mg (0.5 mL) SC/IM (upper arm, thigh, buttocks) or IV, once | If no response after 15 min, may give an additional 0.5 mg from a new kit | Undefined |
Renal Undefined
Hepatic Undefined
Instructions
- Reconstitute: inject all diluent from supplied syringe (emergency kit) or 1 mL Sterile Water for Injection (diagnostic) into vial; shake gently until dissolved; solution = 1 mg/mL; do not use if cloudy or particulate
- Inject immediately after reconstitution; discard any unused portion
- IV only under medical supervision
- Hypoglycemia: call for emergency assistance right after dosing; give oral carbohydrates once patient responds and can swallow
- Diagnostic use: after the procedure give oral carbohydrates to fasting patients if compatible with the procedure
Available strengths
- powder 3 mg
- powder 1 mg/vial
- inj 1 mg
Contraindications
- Pheochromocytoma
- Insulinoma
- Glucagonoma (when used as a diagnostic aid)
Cautions
- Catecholamine release in pheochromocytoma
- Hypoglycemia in insulinoma
- Hypersensitivity and allergic reactions incl. anaphylactic shock
- Lack of efficacy with decreased hepatic glycogen (starvation, adrenal insufficiency, chronic hypoglycemia)
- Necrolytic migratory erythema with continuous infusion
- Hyperglycemia in diabetes when used as diagnostic aid
- BP and heart rate increase in cardiac disease when used as diagnostic aid
- Hypoglycemia in glucagonoma
Adverse reactions
- Injection site swelling
- Injection site erythema
- Vomiting
- Nausea
- Decreased blood pressure
- Asthenia
- Headache
- Dizziness
- Pallor
- Diarrhea
- Somnolence
Pregnancy Decades of case reports/small studies identify no drug-associated risk; pancreatic glucagon does not cross the placenta in early gestation
Lactation No data; as a peptide broken down in the infant's digestive tract, unlikely to harm an exposed infant
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 3 mg | powder | per unit | — | $293.01/ea | not offered |
| 1 mg/vial | powder | per unit | — | not offered |
Generic entry2020
Open Glucagon in the interactive console ↗
Self-check
- Why can glucagon work in beta-blocker overdose?
It raises cAMP independently of beta receptors. - When can glucagon fail to rescue hypoglycemia?
When hepatic glycogen is depleted.