Glucagon

Indications

Glucagon is used for: Indicated for, Severe hypoglycaemia, in patients with diabetes treated with insulin, Indicated as, diagnostic aid for decreased GI motility

Adult Dose

Parenteral Severe hypoglycaemia Adult: 1 mg given via SC, IM or IV inj. Administer oral carbohydrates once the patient has responded. If there is no response w/in 10 min, give IV glucose. Glucagon dose may be repeated if necessary. Intravenous As a diagnostic aid in the radiologic examination of the gastrointestinal tract Adult: For relaxation of stomach, duodenal bulb, duodenum, and small bowel: 0.2-0.5 mg. For relaxation of colon: 0.5-0.75 mg. Intramuscular As a diagnostic aid in the radiologic examination of the gastrointestinal tract Adult: For relaxation of stomach, duodenal bulb, duodenum, and small bowel: 1 mg. For relaxation of colon: 1-2 mg.

Child Dose

Parenteral Severe hypoglycaemia Child: <25 kg: 0.5 mg; ?25 kg: Same as adult dose.

Renal Dose

Administration

IV Preparation Reconstitute by adding 1 or 10 mL of sterile diluent to a vial containing 1 or 10 units of drug, respectively, to yield solutions containing 1 mg/mL If dose <2 mg, use only diluent provided by Mfr If >2 mg, use SWI Use immediately after reconstitution IV Administration Bolus may be associated with nausea and vomiting Continuous infusions may be used in beta-blocker overdose/toxicity

Contra Indications

Hypersensitivity Pheochromocytoma Insulinoma Glucagonoma

Precautions

Patient w/ adrenal insufficiency, DM (when used as diagnostic aid), cardiac disease, chronic hypoglycaemia, uraemia, hepatic disease. Childn. Pregnancy and lactation. Monitoring Parameters Monitor BP, serum glucose, ECG, heart rate, mentation; signs and symptoms of hypersensitivity reactions.

Pregnancy-Lactation

Pregnancy Available data from case reports and a small number of observational studies in pregnant women over decades of use have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes; multiple small studies have demonstrated a lack of transfer of pancreatic glucagon across human placental barrier during early gestation Animal data In rat and rabbit reproduction studies, no embryofetal toxicity was observed with glucagon administered by injection during period of organogenesis at doses representing up to 100 and 200 times the human dose, respectively, based on body surface area (mg/m2) Lactation There is no information available on presence of glucagon in human or animal milk, effects on breastfed child or on milk production; however, glucagon is a peptide and would be expected to be broken down to its constituent amino acids in infant's digestive tract and is therefore, unlikely to cause harm to an exposed infant

Interactions

Beta blockers may cause greater increase in heart rate and BP. Insulin antagonises the effect of glucagon. Indomethacin may produce hypoglycaemia. May enhance the anticoagulant effect of warfarin. Anticholinergic drugs may increase GI reactions.

Adverse Effects

Side effects of Glucagon : Frequency Not Defined Nausea and vomiting Rash Hypotension Tachycardia Increased blood pressure Increased pulse Respiratory distress Urticaria Hypoglycemic coma Hypoglycemia

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 cyclic AMP, to activate hepatic glycogenolysis and gluconeogenesis, thus increasing serum glucose level.