GENERIC NAME: glucagon
BRAND NAME: none
DRUG CLASS AND MECHANISM: Glucagon is a hormone produced by the pancreas that, along with insulin, controls the level of glucose in the blood. Glucagon has the opposite effect of insulin, that is, it increases the glucose level in blood. Glucagon, the drug, is a synthetic (man-made) version of human glucagon and is manufactured by genetic engineering using the bacteria Escherichia coli. Glucagon is used to increase the blood glucose level in severe hypoglycemia (low blood glucose). Glucagon is a glucose-elevating drug. Other glucose-elevating drugs are glucose itself and diazoxide (Proglycem). In diabetic patients, low blood glucose (hypoglycemia) may occur from an unintended excess of injected insulin or oral glucose-lowering medication, such as a sulfonylurea like glipizide (Glucotrol), that are being used to treat the diabetes. Hypoglycemia also may occur as a result of insufficient caloric intake or sudden, excessive physical exertion. Symptoms of hypoglycemia include nervousness, cool skin, headache, confusion, convulsions or coma. In any hypoglycemic situation, efforts should be made to raise the glucose level in the blood. Glucagon raises blood glucose levels by preventing the liver from storing glucose, increasing glucose formation in the liver from dietary proteins and fats, and increasing the release of glucose from the liver into blood. Glucagon transiently paralyzes the muscles of the intestines and occasionally is used during testing that requires the intestines to be flaccid, for example, endoscopic retrograde cholangiopancreatography and barium enema.
PREPARATIONS: Glucagon is available as an emergency kit. The kit contains freeze-dried glucagon as a powder for injection with 1 mg (1 unit) of drug and a 1 ml syringe of glycerin. The glycerin is mixed with the glucagon powder prior to injection.
STORAGE: The glucagon emergency kit should be stored at room temperature, 20-25°C (68-77°F) prior to mixing with glycerin. Once mixed with glycerin, the prepared drug should be used immediately.
PRESCRIBED FOR: Glucagon is used to treat severe hypoglycemia in diabetic patients.
DOSING: Adults and children weighing 44 pounds or more should receive 1mg (1 unit) of glucagon either subcutaneously or intramuscularly. Children weighing less than 44 pounds should receive 0.5mg (0.5 units) of glucagon or an amount equal to 20-30 micrograms per kilogram or 0.009-0.014 milligrams per pound. Before injecting, the mixture should appear clear and free of any floating particles. It should not be used if it is discolored. Once glucagon is administered, blood glucose measurements should be obtained until the patient is no longer experiencing hypoglycemic symptoms. A physician should be notified immediately after a hypoglycemic episode to consider a change in the dose of drug being used to treat the diabetes in order to prevent further episodes of hypoglycemia.
DRUG INTERACTIONS: Glucagon may increase the anticoagulant effect of warfarin (Coumadin) causing an increase in the slow clotting of blood and a greater risk of developing an episode of bleeding. Careful monitoring is necessary when the two drugs are used together.
PREGNANCY: There are no studies of the safety of glucagons in pregnant women.
NURSING MOTHERS: It is not known if glucagon is secreted in breast milk.
SIDE EFFECTS: Nausea and vomiting may occur occasionally after injection of glucagon, but this may be a symptom of the hypoglycemia for which glucagons is being given. Rare allergic-type reactions may occur with glucagon including itching, respiratory distress or low blood pressure. Glucagon should not be administered to hypoglycemic patients who are also experiencing starvation, adrenal insufficiency or are suffering from chronic hypoglycemia. These medical conditions may be associated with an inability of the liver to produce glucose sufficiently in response to glucagon. For these patients, oral glucose is more effective if the patient is conscious. If the patient is not conscious, intravenous glucose should be given.
Reference: FDA Prescribing Information
Last Editorial Review: 6/21/2001 7:27:00 PM
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