Your activity: 235 p.v.
your limit has been reached. plz Donate us to allow your ip full access, Email: sshnevis@outlook.com

Glucagon: Drug information

Glucagon: Drug information
(For additional information see "Glucagon: Patient drug information" and see "Glucagon: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Baqsimi One Pack;
  • Baqsimi Two Pack;
  • GlucaGen Diagnostic;
  • GlucaGen HypoKit;
  • Gvoke HypoPen 1-Pack;
  • Gvoke HypoPen 2-Pack;
  • Gvoke Kit;
  • Gvoke PFS
Brand Names: Canada
  • Baqsimi;
  • GlucaGen;
  • GlucaGen HypoKit
Pharmacologic Category
  • Antidote;
  • Antidote, Hypoglycemia;
  • Diagnostic Agent
Dosing: Adult
Anaphylaxis in patients on beta-blocker therapy

Anaphylaxis (refractory to epinephrine) in patients on beta-blocker therapy (off-label use): IV: Initial: 1 to 5 mg bolus; followed by an infusion of 5 to 15 mcg/minute; titrate the infusion rate to achieve an adequate clinical response (Lieberman 2015).

Beta-blocker overdose

Beta-blocker overdose (off-label use): IV: 3 to 10 mg bolus; if no clinical response may repeat bolus dose; if clinical response with bolus, start continuous infusion at 3 to 5 mg/hour; titrate infusion rate to achieve adequate hemodynamic response (ACC/AHA/HRS [Kusumoto 2018]; AHA [Vanden Hoek 2010]; Barrueto 2019).

Calcium channel blocker overdose

Calcium channel blocker overdose (off-label use): IV: 3 to 10 mg bolus; if no clinical response may repeat bolus dose; if clinical response with bolus, start continuous infusion at 3 to 5 mg/hour; titrate infusion rate to achieve adequate hemodynamic response (ACC/AHA/HRS [Kusumoto 2018]; Barrueto 2019).

Diagnostic aid, radiologic examinations

Diagnostic aid, radiologic examinations:

Relaxation of colon:

IM: 2 mg.

Relaxation of duodenal bulb, duodenum, and small bowel:

IM: Usual dose: 1 mg; may give up to 2 mg if needed.

IV: Usual dose: 0.25 to 0.5 mg; may give up to 2 mg if needed.

Relaxation of stomach:

IM: 2 mg.

IV: 0.5 mg; may give up to 2 mg if needed.

Growth hormone deficiency, alternative diagnostic test

Growth hormone deficiency, alternative diagnostic test (off-label use): Note: Correct other pituitary hormone deficiencies prior to administration (AACE/ACE [Yuen 2019]; Hamrahian 2016).

IM:

Weight ≤90 kg: 1 mg as a single dose.

Weight >90 kg: 1.5 mg as a single dose.

Hypoglycemia

Hypoglycemia: Note: IV dextrose should be administered as soon as it is available; if patient fails to respond to glucagon, IV dextrose must be given.

Injection:

GlucaGen HypoKit or Glucagon Emergency: IM, IV, SUBQ: 1 mg; may repeat in 15 minutes as needed.

Gvoke: SUBQ: 1 mg; may repeat in 15 minutes as needed using a new device.

Intranasal: 3 mg (one actuation) into a single nostril; if no response, may repeat in 15 minutes using a new intranasal device.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

(For additional information see "Glucagon: Pediatric drug information")

Hypoglycemia, severe; treatment

Hypoglycemia, severe; treatment: Note: Glucagon should be prescribed for all type 1 diabetic patients and type 2 diabetic patients at increased risk of level 2 (<54 mg/dL) or level 3 hypoglycemia; caregivers, school personnel, and family members of these patients should be trained on when and how to administer glucagon (ADA 2021; ADA [Chiang 2018]). Patients with inadequate glycogen stores (eg, starvation, adrenal insufficiency, chronic hypoglycemia) may not respond to glucagon and should be treated with glucose.

Parenteral:

Weight-based dosing: Infants, Children, and Adolescents: IM, IV, SubQ: 0.02 to 0.03 mg/kg/dose; may repeat every 15 minutes if needed for clinical effect for up to a total of 3 doses; maximum dose: 1 mg/dose (AAP [Shenoi 2020]; manufacturer labeling).

Product-specific dosing:

Glucagon: Infants, Children, and Adolescents: IM, IV, SubQ:

<20 kg: 0.5 mg; if no response in 15 minutes, may repeat dose.

≥20 kg: 1 mg; if no response in 15 minutes, may repeat dose.

GlucaGen: Infants, Children, and Adolescents: IM, IV, SubQ:

Weight-directed dosing:

<25 kg: 0.5 mg; may repeat once if needed.

≥25 kg: 1 mg; may repeat once if needed.

Age-directed dosing: Note: Use when weight is unknown.

Infants and Children <6 years: 0.5 mg; may repeat once if needed.

Children ≥6 years and Adolescents: 1 mg; may repeat once if needed.

Gvoke:

Children 2 to <12 years: SubQ:

<45 kg: 0.5 mg; if no response after 15 minutes, may administer an additional 0.5 mg dose.

≥45 kg: 1 mg; if no response after 15 minutes, may administer an additional 1 mg dose.

Children ≥12 years and Adolescents: SubQ: 1 mg; if no response after 15 minutes, may administer an additional 1 mg dose.

Intranasal (Baqsimi): Children ≥4 years and Adolescents: 3 mg (1 actuation) intranasally into a single nostril; if no response after 15 minutes, may repeat dose using a new device. Note: Inhalation not necessary.

Hypoglycemia, mild or impending hypoglycemia during illness

Hypoglycemia, mild (<70 mg/dL) or impending hypoglycemia during illness (mini-dose regimen): Limited data available (Chung 2015; Haymond 2001; ISPAD [Abraham 2018]; ISPAD [Laffel 2018]): Note: These doses are lower than hypoglycemia treatment doses and have been shown to prevent hypoglycemia for several hours during mild hypoglycemia or impending hypoglycemia-associated illness (eg, gastroenteritis, nausea/vomiting) and/or poor oral carbohydrate intake.

Initial dose:

Infants and Children ≤2 years: SubQ: 0.02 mg.

Children >2 years and Adolescents ≤15 years: SubQ: 0.01 mg per year of age.

Adolescents >15 years: SubQ: 0.15 mg.

Subsequent dose: SubQ: If initial dose fails to increase glucose after 30 minutes, may give an additional dose that is twice the initial dose.

Anaphylaxis in patients on beta-blocker therapy

Anaphylaxis (refractory to epinephrine) in patients on beta-blocker therapy: Limited data available (AAAAI/ACAAI [Campbell 2014]; AAP [Shenoi 2020]; Canadian Paediatric Society [Cheng 2011]):

Infants, Children, and Adolescents: IV:

Initial: 0.02 to 0.03 mg/kg slow IV; maximum dose: 1 mg/dose.

Continuous infusion: Follow initial dose with a continuous infusion of 5 to 15 mcg/minute; titrate to effect.

Beta-blocker or calcium channel blocker toxicity/overdose

Beta-blocker or calcium channel blocker toxicity/overdose: Limited data available:

Infants and Children:

Loading dose: IV: 0.05 mg/kg as a single dose (AAP [Shenoi 2020]; Arroyo 2009; Nelson 2019); if no response, may repeat dose (Nelson 2019).

Continuous IV infusion: 0.05 to 0.1 mg/kg/hour; titrate to effect (Arroyo 2009); usual adolescent dose: 1 to 5 mg/hour (PALS [Kleinman 2010]); some experts recommend initiating the infusion at the "response dose" (cumulative loading dose) per hour (Nelson 2019).

Adolescents:

Loading dose: IV: 5 to 10 mg (PALS [Kleinman 2010]).

Continuous IV infusion: 1 to 5 mg/hour (PALS [Kleinman 2010]); some experts recommend initiating the infusion at the "response dose" (cumulative loading dose) per hour (Nelson 2019).

Esophageal food impaction, esophageal relaxation

Esophageal food impaction, esophageal relaxation: Limited data available, efficacy results variable (ASGE 2011; Fung 2019):

Children and Adolescents: IV: 1 mg once prior to endoscopic intervention; may repeat once within 15 to 30 minutes if needed and no adverse effects observed with first dose. Note: Glucagon administration should not delay endoscopic removal of foreign body when necessary.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Kit, Injection:

Generic: 1 mg

Powder, Nasal [preservative free]:

Baqsimi One Pack: 3 mg/dose (1 ea)

Baqsimi Two Pack: 3 mg/dose (1 ea)

Solution, Subcutaneous [preservative free]:

Gvoke Kit: 1 mg/0.2 mL (0.2 mL)

Solution Auto-injector, Subcutaneous:

Gvoke HypoPen 1-Pack: 0.5 mg/0.1 mL (0.1 mL); 1 mg/0.2 mL (0.2 mL)

Gvoke HypoPen 2-Pack: 0.5 mg/0.1 mL (0.1 mL); 1 mg/0.2 mL (0.2 mL)

Solution Prefilled Syringe, Subcutaneous [preservative free]:

Gvoke PFS: 0.5 mg/0.1 mL (0.1 mL); 1 mg/0.2 mL (0.2 mL)

Solution Reconstituted, Injection:

GlucaGen Diagnostic: 1 mg (1 ea)

GlucaGen HypoKit: 1 mg (1 ea)

Generic: 1 mg (1 ea); 1 mg/mL (1 ea)

Generic Equivalent Available: US

May be product dependent

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Powder, Nasal:

Baqsimi: 3 mg/dose (1 ea)

Solution Reconstituted, Injection:

GlucaGen: 1 mg (1 ea)

GlucaGen HypoKit: 1 mg (1 ea)

Generic: 1 mg (1 mL)

Administration: Adult

Note: For the treatment of hypoglycemia, administer fast-acting and long-acting oral carbohydrates to patient as soon as possible after response to glucagon treatment. If patient is unconscious, place in lateral recumbent position to prevent choking when consciousness returns.

IM: For treatment of hypoglycemia, may administer reconstituted solution for injection as an IM injection in the upper arms, thighs, or buttocks. For use as a diagnostic aid for radiologic examinations, may administer IM; for examination of the colon, administer ~10 minutes prior to procedure. After the diagnostic procedure, administer oral carbohydrates to patients who have been fasting, if this is compatible with the diagnostic procedure applied.

Intranasal: Insert the tip of the intranasal device into one nostril and fully depress plunger until the green line is no longer visible. Inhalation of the dose is not necessary. Do not reuse the device after administration.

IV: Rapid injection may be associated with increased nausea and vomiting.

Anaphylaxis (refractory to epinephrine) in patients on beta-blocker therapy: Administer IV bolus over 5 minutes; continuous infusions may be used (Lieberman 2015).

Beta-blocker/calcium channel blocker toxicity: Administer IV bolus over 3 to 5 minutes; continuous infusions may be used. Ensure adequate supply available to continue therapy (AHA [Vanden Hoek 2010]).

Diagnostic aid for radiologic examinations: May administer IV over 1 minute. After the diagnostic procedure, administer oral carbohydrates to patients who have been fasting, if this is compatible with the diagnostic procedure applied. Bolus IV doses >1 mg are not recommended.

Hypoglycemia: May administer IV.

Subcutaneous:

Injection, powder for reconstitution: For treatment of hypoglycemia, may administer reconstituted solution in the upper arms, thighs, or buttocks.

Injection, solution (Gvoke): Administer in the lower abdomen, outer thigh, or outer upper arm; inject rapidly to reduce injection-site pain.

Administration: Pediatric

Hypoglycemia: Note: Administer fast-acting and long-acting oral carbohydrates to patient as soon as possible after response to treatment. If patient is unconscious, place patient on side to prevent choking if vomiting occurs.

Parenteral:

Vial: May administer IV or as IM or SUBQ injection in the upper arms, thighs, or buttocks.

Mini-dose regimen: Following reconstitution of 1 mg/mL solution, inject glucagon SUBQ using an insulin syringe (U-100); 1 unit on the syringe provides 0.01 mg of glucagon (Haymond 2001; ISPAD [Abraham 2018]).

Autoinjector/prefilled syringe (Gvoke): For SUBQ use only. Do not open foil package until ready to administer. Administer SUBQ in the lower abdomen, outer thigh, or outer upper arm. Do not reuse the device after administration; a new device should be used for each dose.

Intranasal: For intranasal use only. Insert the tip of the device into 1 nostril and fully depress plunger until the green line is no longer visible. Inhalation of the dose is not necessary. Do not reuse the device after administration.

Anaphylaxis: Initial dose should be administered over 5 minutes (AAAAI/ACAAI [Campbell 2014]; Canadian Paediatric Society [Cheng 2011]).

Beta-blocker/calcium channel blocker toxicity: Initial loading dose (bolus) should be administered over 1 to 5 minutes (Nelson 2019); may also administer as a continuous IV infusion; ensure adequate supply available to continue therapy (AHA [Vanden Hoek] 2010).

Usual Infusion Concentrations: Adult

IV infusion: 4 mg in 50 mL (concentration: 0.08 mg/mL); some centers may use a higher concentration (eg, 20 mg in 100 mL [concentration 0.2 mg/mL] of D5W) to meet the needs in some patients (eg, beta-blocker or calcium channel blocker overdose).

Use: Labeled Indications

Diagnostic aid: Radiologic examinations (injection): As a diagnostic aid during radiologic examinations to temporarily inhibit movement of the GI tract in adults.

Hypoglycemia: Note: The American Diabetes Association (ADA) recommends that glucagon be prescribed for all patients with diabetes at increased risk of level 2 hypoglycemia (<54 mg/dL); caregivers, school personnel, or family members of these patients should be trained on when and how to administer glucagon (ADA 2021).

Injection, powder for reconstitution (GlucaGen HypoKit or Glucagon Emergency): Treatment of severe hypoglycemia in pediatric and adult patients with diabetes.

Limitations of use: Products not packaged with a syringe and diluent necessary for rapid preparation and administration during an emergency outside of a health care facility are not indicated for the emergency treatment of hypoglycemia.

Injection, solution (Gvoke): Treatment of severe hypoglycemia in adult and pediatric patients (≥2 years of age) with diabetes.

Intranasal: Treatment of severe hypoglycemia in adult and pediatric patients (≥4 years of age) with diabetes.

Use: Off-Label: Adult

Anaphylaxis; Beta-blocker overdose; Calcium channel blocker overdose; Growth hormone deficiency (alternative diagnostic test)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse drug reactions reported for injection use unless otherwise noted.

>10%:

Gastrointestinal: Nausea (intranasal, IV: 26% to 30%), vomiting (intranasal, IV: 15% to 16%)

Nervous system: Headache (intranasal, IV: 5% to 18%)

Respiratory: Upper respiratory system symptoms (intranasal: including cough, epistaxis, nasal congestion, nasal discomfort, sneezing, throat irritation: 12%)

1% to 10%:

Immunologic: Antibody development (2%)

Local: Pain at injection site (1%), swelling at injection site (7%)

Frequency not defined (any route of administration):

Cardiovascular: Hypertension, hypotension (up to 2 hours after GI procedures), tachycardia

Dermatologic: Pallor, pruritus (including ears), pruritus of nose, urticaria

Endocrine & metabolic: Hyperglycemia

Gastrointestinal: Abdominal pain, diarrhea, dysgeusia

Hypersensitivity: Anaphylactic shock, hypersensitivity reaction

Local: Discomfort at injection site, erythema at injection site, injection site reaction

Nervous system: Altered sense of smell (intranasal), dizziness, drowsiness

Neuromuscular & skeletal: Asthenia

Ophthalmic: Eye pruritus, eye redness, watery eyes

Respiratory: Rhinorrhea

Postmarketing (any indication): Dermatologic: Necrolytic migratory erythema

Contraindications

Known hypersensitivity to glucagon or any component of the formulation (injection contains lactose); pheochromocytoma; insulinoma; use of injection as a diagnostic aid in patients with glucagonoma.

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Allergic reactions including skin rash and anaphylactic shock (with hypotension and respiratory difficulties) have been reported; reactions have generally been associated with endoscopic patients.

• Necrolytic migratory erythema: Necrolytic migratory erythema (NME), a skin rash associated with glucagonomas (glucagon-producing tumors) and characterized by scaly, pruritic, erythematous plaques, bullae, and erosions, has been reported (rarely) following continuous glucagon infusion. Rash may occur on face, groin, perineum, and legs or may be more widespread; rash generally resolves with discontinuation of treatment. Consider the risks versus benefits of continuing the glucagon infusion if NME occurs.

Disease-related concerns:

• Adrenal insufficiency: Use with caution in patients with adrenal insufficiency; hepatic glycogen levels may be inadequate for glucagon to effectively increase blood glucose.

• Cardiac disease: Use with caution in patients with cardiac disease.

• Chronic hypoglycemia: Use with caution in patients with chronic hypoglycemia; hepatic glycogen levels may be inadequate for glucagon to effectively increase blood glucose.

• Diabetes: Use caution if using as diagnostic aid in patients with diabetes on insulin; may cause hyperglycemia.

• Glucagonoma: Use with caution in patients with glucagonoma; may cause secondary hypoglycemia. The use of injectable glucagon as a diagnostic aid is contraindicated in patients with this condition.

• Insulinoma: Exogenous glucagon may cause an initial rise in blood glucose followed by rebound hypoglycemia. The use of glucagon is contraindicated in patients with this condition.

• Pheochromocytoma: Exogenous glucagon may cause the release of catecholamines, resulting in an increase in blood pressure. The use of glucagon is contraindicated in patients with this condition.

• Starvation/fasting: Use caution with prolonged fasting and/or starvation; hepatic glycogen levels may be inadequate for glucagon to effectively increase blood glucose.

Dosage form specific issues:

• Lactose: May contain lactose; avoid administration in hereditary galactose intolerance, congenital lactase deficiency, or glucose-galactose malabsorption.

Other warnings/precautions:

• Appropriate use: Insulin or sulfonylurea overdose: Patients with hypoglycemia should immediately be treated with dextrose. If IV access cannot be established or if dextrose is not available, glucagon may be considered as alternative acute treatment until dextrose can be administered.

• Secondary hypoglycemia: Supplemental carbohydrates should be given to patients who respond to glucagon for severe hypoglycemia to prevent secondary hypoglycemia.

Warnings: Additional Pediatric Considerations

Glucagon is only effective if sufficient glycogen stores are present; patients with inadequate storage (eg, starvation, adrenal insufficiency, chronic hypoglycemia) should be treated with glucose.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Anticholinergic Agents: May enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Indomethacin: May diminish the therapeutic effect of Glucagon and Glucagon Analogs. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Glucagon and Glucagon Analogs may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Food Interactions

Glucagon depletes glycogen stores.

Pregnancy Considerations

Glucagon may be used for the treatment of severe hypoglycemia during pregnancy (Alexopoulos 2019). In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant females if there is a clear indication for use and should not be withheld because of concerns of teratogenicity (Bailey 2003a).

Breastfeeding Considerations

Glucagon is not absorbed from the GI tract and therefore, it is unlikely adverse effects would occur in a breastfeeding infant.

Dietary Considerations

Administer oral carbohydrates to patient as soon as possible after response to treatment.

Monitoring Parameters

BP, blood glucose, ECG, heart rate, mentation; signs or symptoms of a hypersensitivity reaction.

Growth hormone (GH) deficiency: Serum GH levels at baseline (prior to glucagon injection) and every 30 minutes for 4 hours following administration (AACE/ACE [Yuen 2019]; Hamrahian 2016).

Reference Range

Classification of hypoglycemia (ADA 2021):

Level 1: Glucose ≥54 to ≤70 mg/dL; hypoglycemia alert value; initiate fast-acting carbohydrate (eg, glucose) treatment.

Level 2: Glucose <54 mg/dL; threshold for neuroglycopenic symptoms; requires immediate action.

Level 3: Hypoglycemia associated with a severe event characterized by altered mental and/or physical status requiring assistance.

Diagnosis of adult growth hormone deficiency (AACE/ACE [Yuen 2019]): Note: Use caution when interpreting growth hormone (GH) levels in patients with hyperglycemia and in patients >70 years of age; diagnostic accuracy of glucagon stimulation in these populations is unknown.

Patients with BMI <25 kg/m2, or with BMI 25 to 30 kg/m2 and high pretest probability: Peak GH levels <3 mcg/L (assay dependent) within 4 hours following glucagon administration confirm the presence of adult growth hormone deficiency.

Patients with BMI >30 kg/m2, or with BMI 25 to 30 kg/m2 and low pretest probability: Peak GH levels <1 mcg/L (assay dependent) within 4 hours following glucagon administration confirm the presence of adult growth hormone deficiency.

Mechanism of Action

Stimulates adenylate cyclase to produce increased cyclic AMP, which promotes hepatic glycogenolysis and gluconeogenesis, causing a raise in blood glucose levels; antihypoglycemic effect requires preexisting hepatic glycogen stores. Extra hepatic effects of glucagon include relaxation of the smooth muscle of the stomach, duodenum, small bowel, and colon.

In the setting of beta-blocker and calcium channel blocker toxicity, the glucagon-mediated increase in cyclic AMP increases automaticity at the sinoatrial and atrioventricular nodes. In addition, glucagon improves myocardial contractility and produces peripheral vasodilation (Bailey 2003b).

Pharmacokinetics

Onset of action:

Blood glucose concentrations: Note: In general, when used for the treatment of hypoglycemia, the time required to correct hypoglycemia (eg, increase blood glucose concentrations by 20 mg/dL) is similar between formulations and routes of administration (~10 to 15 minutes); clinicians should note that the durability of response may result in blood glucose concentrations that continue to rise for >90 minutes (Baqsimi prescribing information 2019; Gvoke prescribing information; Rickels 2016).

IV: Peak effect: 5 to 20 minutes (GlucaGen prescribing information 2018).

IM:

Onset: 10 minutes.

Peak effect: 30 minutes when used as a diagnostic aid (GlucaGen prescribing information 2018); in patients with type 1 diabetes and insulin-induced hypoglycemia, the peak glucose response was not yet reached during the 90-minute observation window following glucagon administration (Rickels 2016).

Intranasal:

Onset: Slightly delayed compared to IM administration; for example, median response time to reach glucose target in adults was 13 minutes (IM) versus 16 minutes (intranasal), but clinical outcomes/resolution of hypoglycemia at 30 minutes did not differ (Rickels 2016).

Peak effect: Patients with type 1 diabetes:

Children ≥4 years of age: ~60 minutes (Baqsimi prescribing information 2019).

Adults: A peak glucose response was not yet reached during the 90-minute observation window following glucagon administration (Baqsimi prescribing information 2019; Rickels 2016).

SUBQ:

Onset: ~10 minutes; Gvoke onset is delayed a few minutes compared to Glucagon Emergency, but clinical outcomes/resolution of hypoglycemia at 30 minutes did not differ between SUBQ formulations (Gvoke prescribing information).

Peak effect: 30 to 45 minutes in healthy patients (GlucaGen prescribing information 2018; Glucagon Emergency prescribing information 2018); in patients with type 1 diabetes and insulin-induced hypoglycemia, the peak glucose response was not yet reached during the 90-minute observation window following glucagon administration (Gvoke prescribing information).

GI relaxation: IV: 45 seconds; IM: 4 to 10 minutes.

Duration:

Blood glucose concentrations: 60 to 90 minutes (GlucaGen prescribing information 2018); other data suggest glucose elevation may persist >90 minutes following intranasal, IM, or SUBQ administration in patients with type 1 diabetes (Gvoke prescribing information; Rickels 2016).

GI relaxation: IV: 9 to 25 minutes; IM: 12 to 32 minutes.

Distribution: Vd: Reported values vary significantly: ~0.25 L/kg (Glucagon Emergency); 137 to 2,425 L (Gvoke); 885 L (Baqsimi).

Metabolism: Primarily hepatic; some inactivation occurring renally and in plasma.

Half-life elimination, plasma:

IV: 8 to 18 minutes.

IM (apparent): 26 to 45 minutes.

Intranasal (apparent): Median:

Pediatric patients 4 to <17 years: 21 to 31 minutes.

Adults: ~35 minutes.

SUBQ: 32 minutes (Gvoke prescribing information; not reported for other formulations).

Time to peak, plasma:

IM: ~10 to 12.5 minutes.

Intranasal:

Pediatric patients 4 to <17 years: 15 to 20 minutes.

Adults: 15 minutes.

SUBQ:

Glucagon Emergency: 20 minutes.

Gvoke:

Pediatric patients:

2 to <6 years: 41 minutes.

6 to <12 years: 34 minutes.

12 to <18 years: 51 minutes.

Adults: 50 minutes.

Pricing: US

Kit (Glucagon Emergency Injection)

1 mg (per each): $336.00 - $336.96

Powder (Baqsimi One Pack Nasal)

3 mg/dose (per each): $336.96

Powder (Baqsimi Two Pack Nasal)

3 mg/dose (per each): $336.96

Solution (Gvoke Kit Subcutaneous)

1 mg/0.2 mL (per 0.2 mL): $357.48

Solution (reconstituted) (GlucaGen Diagnostic Injection)

1 mg (per each): $205.92

Solution (reconstituted) (GlucaGen HypoKit Injection)

1 mg (per each): $351.66

Solution (reconstituted) (Glucagon HCl (Diagnostic) Injection)

1 mg (per each): $194.40 - $204.60

Solution Auto-injector (Gvoke HypoPen 1-Pack Subcutaneous)

0.5MG/0.1ML (per 0.1 mL): $357.48

1 mg/0.2 mL (per 0.2 mL): $357.48

Solution Auto-injector (Gvoke HypoPen 2-Pack Subcutaneous)

0.5MG/0.1ML (per 0.1 mL): $357.48

1 mg/0.2 mL (per 0.2 mL): $357.48

Solution Prefilled Syringe (Gvoke PFS Subcutaneous)

0.5MG/0.1ML (per 0.1 mL): $357.48

1 mg/0.2 mL (per 0.2 mL): $357.48

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Baqsimi (AT, CZ, EE, HR, LT, NL, RO, SK);
  • Garcon (KR);
  • Glucagen (AE, AR, AU, BB, BE, BH, BR, CH, CL, CO, CU, CY, DE, DK, EC, ES, FR, GR, HK, IE, IN, IT, JO, LB, LK, MY, NZ, PL, PY, SA, TH, UY, ZA);
  • GlucaGen (AT, EG, FI, GB, HR, HU, IE, IL, IS, LT, LU, LV, MT, NL, PT, QA, SG, SI, SK, TR, VN);
  • Glucagen G (JP);
  • Glucagen Novo (HK);
  • Glucagon Novo Nordisk (SE)


For country code abbreviations (show table)
  1. Abraham MB, Jones TW, Naranjo D, et al. ISPAD clinical practice consensus guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2018;19(suppl 27):178-192. [PubMed 29869358]
  2. Alexopoulos AS, Blair R, Peters AL. Management of preexisting diabetes in pregnancy: a review. JAMA. 2019;321(18):1811-1819. doi:10.1001/jama.2019.4981 [PubMed 31087027]
  3. American Diabetes Association (ADA). Standards of medical care in diabetes–2021. Diabetes Care. 2021;44(suppl 1):S1-S232. https://care.diabetesjournals.org/content/44/Supplement_1. Accessed January 13, 2021.
  4. Arroyo AM, Kao LW. Calcium channel blocker toxicity. Pediatr Emerg Care. 2009;25(8):532-540. [PubMed 19687715]
  5. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085‐1091. [PubMed 21628009]
  6. Aynsley-Green A, Hussain K, Hall J, et al. Practical Management of Hyperinsulinism in Infancy. Arch Dis Child Fetal Neonatal Ed. 2000;82(2):98-107. [PubMed 10685981]
  7. Bailey B. Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women? Birth Defects Res A Clin Mol Teratol. 2003a;67(2):133-140. doi:10.1002/bdra.10007 [PubMed 12769509]
  8. Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003b;41(5):595-602. doi:10.1081/clt-120023761 [PubMed 14514004]
  9. Baqsimi (glucagon) [prescribing information]. Indianapolis, IN: Lilly USA LLC; August 2021.
  10. Barrueto F. Calcium channel blocker poisoning. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 28, 2019.
  11. Campbell RL, Li JT, Nicklas RA, Sadosty AT; Members of the Joint Task Force; Practice Parameter Workgroup. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;113(6):599-608. [PubMed 25466802]
  12. Carter PE, Lloyd DJ, Duffty P. Glucagon for hypoglycaemia in infants small for gestational age. Arch Dis Child. 1988;63(10):1264-1266. [PubMed 3196055]
  13. Charsha DS, McKinley PS, Whitfield JM. Glucagon infusion for treatment of hypoglycemia: efficacy and safety in sick, preterm infants. Pediatrics. 2003;111(1):220-221. [PubMed 12509583]
  14. Cheng A. Emergency treatment of anaphylaxis in infants and children. Paediatr Child Health. 2011;16(1):35-40. [PubMed 22211074]
  15. Chiang JL, Maahs DM, Garvey KC, et al. Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care. 2018;41(9):2026-2044. [PubMed 30093549]
  16. Chung ST, Haymond MW. Minimizing morbidity of hypoglycemia in diabetes: a review of mini-dose glucagon. J Diabetes Sci Technol. 2015;9(1):44-51. [PubMed 25160667]
  17. Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018;71(3):314-325.e1. doi:10.1016/j.annemergmed.2017.05.021 [PubMed 28669553]
  18. Dichtel LE, Yuen KC, Bredella MA, et al. Overweight/Obese adults with pituitary disorders require lower peak growth hormone cutoff values on glucagon stimulation testing to avoid overdiagnosis of growth hormone deficiency. J Clin Endocrinol Metab. 2014;99(12):4712-4719. doi:10.1210/jc.2014-2830 [PubMed 25210883]
  19. Diri H, Karaca Z, Simsek Y, et al. Can a glucagon stimulation test characterized by lower GH cut-off value be used for the diagnosis of growth hormone deficiency in adults? Pituitary. 2015;18(6):884-892. doi:10.1007/s11102-015-0666-1 [PubMed 26129876]
  20. Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18)(suppl 3):S640-S656. [PubMed 20956217]
  21. Fung BM, Sweetser S, Wong Kee Song LM, Tabibian JH. Foreign object ingestion and esophageal food impaction: An update and review on endoscopic management. World J Gastrointest Endosc. 2019;11(3):174‐192. [PubMed 30918584]
  22. Galcheva S, Al-Khawaga S, Hussain K. Diagnosis and management of hyperinsulinaemic hypoglycaemia. Best Pract Res Clin Endocrinol Metab. 2018;32(4):551-573. [PubMed 30086874]
  23. GlucaGen (glucagon) [prescribing information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals Inc; July 2021.
  24. GlucaGen HypoKit and Diagnostic Kit (glucagon) [prescribing information]. Plainsboro, NJ: Novo Nordisk; March 2021.
  25. Glucagon Emergency Kit [prescribing information]. Lake Zurich, IL: Fresenius Kabi; August 2020.
  26. Glucagon for injection [prescribing information]. Lake Zurich, IL: Fresenius Kabi; July 2022.
  27. Glucagon injection [prescribing information]. Lake Zurich, IL: Fresenius Kabi; January 2016.
  28. Glucagon injection [prescribing information]. Lake Zurich, IL: Fresenius Kabi; August 2020.
  29. Gvoke (glucagon) [prescribing information]. Chicago, IL: Xeris Pharmaceuticals Inc; August 2021.
  30. Hamrahian AH, Yuen KC, Gordon MB, Pulaski-Liebert KJ, Bena J, Biller BM. Revised GH and cortisol cut-points for the glucagon stimulation test in the evaluation of GH and hypothalamic-pituitary-adrenal axes in adults: results from a prospective randomized multicenter study. Pituitary. 2016;19(3):332-341. doi:10.1007/s11102-016-0712-7 [PubMed 26897383]
  31. Hawdon JM, Aynsley-Green A, Ward Platt MP. Neonatal Blood Glucose Concentrations: Metabolic Effects of Intravenous Glucagon and Intragastric Medium Chain Triglyceride. Arch Dis Child. 1993;68(3 Spec No):255-261. [PubMed 8466259]
  32. Haymond MW, Schreiner B. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes. Diabetes Care. 2001;24(4):643-645. [PubMed 11315823]
  33. Holger JS, Engebretsen KM, Obetz CL, et al. A Comparison of Vasopressin and Glucagon in Beta-Blocker Induced Toxicity. Clin Toxicol (Phila). 2006;44(1):45-51.
  34. Hussain K, Aynsley-Green A. Hyperinsulinaemic Hypoglycaemia in Preterm Neonates. Arch Dis Child Fetal Neonatal Ed. 2004;89(1):65-67. [PubMed 14711860]
  35. Kapoor RR, Flanagan SE, James C, et al. Hyperinsulinaemic Hypoglycaemia. Arch Dis Child. 2009;94(6):450-457. [PubMed 19193661]
  36. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18)(suppl 3):S876-S908. [PubMed 20956230]
  37. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018. pii: S0735-1097(18)38985-X. doi:10.1016/j.jacc.2018.10.044 [PubMed 30412709]
  38. Laffel LM, Limbert C, Phelan H, Virmani A, Wood J, Hofer SE. ISPAD clinical practice consensus guidelines 2018: sick day management in children and adolescents with diabetes. Pediatr Diabetes. 2018;19(suppl 27):193-204. [PubMed 30079506]
  39. Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi:10.1016/j.anai.2015.07.019 [PubMed 26505932]
  40. Love JN, Sachdeva DK, Bessman ES, et al. A Potential Role for Glucagon in the Treatment of Drug-Induced Symptomatic Bradycardia. Chest. 1998;114(1):323-326. [PubMed 9674488]
  41. Mehta A, Wootton R, Cheng KN, et al. Effect of Diazoxide or Glucagon on Hepatic Glucose Production Rate During Extreme Neonatal Hypoglycaemia. Arch Dis Child. 1987;62(9):924-930. [PubMed 3314727]
  42. Miralles RE, Lodha A, Perlman M, et al. Experience With Intravenous Glucagon Infusions as a Treatment for Resistant Neonatal Hypoglycemia. Arch Pediatr Adolesc Med. 2002;156(10):999-1004. [PubMed 12361445]
  43. Mokhlesi B, Leikin JB, Murray P, et al. Adult Toxicology in Critical Care: Part II: Specific Poisonings. Chest. 2003;123(3):897-922. [PubMed 12628894]
  44. Nelson LS, Howland, MA, Lewin NA, et al, eds. Goldfrank's Toxicologic Emergencies. 11th ed. McGraw-Hill Education; 2019.
  45. Rickels MR, Ruedy KJ, Foster NC, et al; T1D Exchange Intranasal Glucagon Investigators. Intranasal glucagon for treatment of insulin-induced hypoglycemia in adults with type 1 diabetes: a randomized crossover noninferiority study. Diabetes Care. 2016;39(2):264-270. doi: 10.2337/dc15-1498. [PubMed 26681725]
  46. Shah P, Rahman SA, Demirbilek H, Güemes M, Hussain K. Hyperinsulinaemic hypoglycaemia in children and adults. Lancet Diabetes Endocrinol. 2017;5(9):729-742. [PubMed 27915035]
  47. Shenoi RP, Timm N; Committee on Drugs; Committee on Pediatric Emergency Medicine. Drugs Used to Treat Pediatric Emergencies. Pediatrics. 2020;145(1):e20193450. [PubMed 31871244]
  48. Shepherd G. Treatment of poisoning caused by beta-adrenergic and calcium-channel blockers [published correction appears in J Health Syst Pharm. 2008;65(17):1592]. Am J Health Syst Pharm. 2006;63(19):1828-1835. doi:10.2146/ajhp060041 [PubMed 16990629]
  49. Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr. 2015;167(2):238-245. [PubMed 25957977]
  50. Trujillo MH, Guerrero J, Fragachan C, et al. Pharmacologic Antidotes in Critical Care Medicine: A Practical Guide for Drug Administration. Crit Care Med. 1998;26(2):377-391.
  51. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care [published corrections appear in Circulation. 2011;123(6):e239; Circulation. 2011;124(15):e405]. Circulation. 2010;122(18)(suppl 3):S829-S861. doi:10.1161/CIRCULATIONAHA.110.971069 [PubMed 20956228]
  52. Wax PM, Erdman AR, Chyka PA, et al. Beta-Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management. Clin Toxicol (Phila). 2005;43(3):131-146.
  53. Yorifuji T, Horikawa R, Hasegawa T, et al. Clinical practice guidelines for congenital hyperinsulinism. Clin Pediatr Endocrinol. 2017;26(3):127-152. [PubMed 28804205]
  54. Yuen KC, Biller BM, Katznelson L, et al. Clinical characteristics, timing of peak responses and safety aspects of two dosing regimens of the glucagon stimulation test in evaluating growth hormone and cortisol secretion in adults. Pituitary. 2013;16(2):220-230. doi:10.1007/s11102-012-0407-7 [PubMed 22806554]
  55. Yuen KCJ, Biller BMK, Radovick S, et al. American Association Of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care. Endocr Pract. 2019;25(11):1191-1232. doi:10.4158/GL-2019-0405 [PubMed 31760824]
Topic 8493 Version 284.0