Glucagon intravenous for adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• Usually given by the subcutaneous or intramuscular route for the treatment of severe hypoglycaemia reactions
• Please ensure additional supplies are ordered by pharmacy if large doses by infusion are being administered
• Protect the airway in case of vomiting ^{(ref 2)}
• Equivalencies: a 1mg dose is the same as 1 unit

Available preparations

Glucagen Hypokit 1mg

Reconstitution

• Add 1.1mL water for injection (provided) to the vial containing the powder to produce a 1mg/1mL solution
• Shake gently until completely dissolved
• A syringe with a thinner needle and a finer graduation may be more suitable in diagnostic procedures

Infusion fluids

Glucose 5% or Sodium chloride 0.9% ^{(ref 1)}

Methods of intravenous administration

Bolus intravenous injection (doses of 1mg or less) ^{(ref 1)}

• Administer over one minute
• Rapid injection may be associated with increased nausea and vomiting ^{(ref 2)}

Slow intravenous injection (doses greater than 1mg) ^{(ref 1)}

• Administer over 3 to 5 minutes
• Rapid injection may be associated with increased nausea and vomiting ^{(ref 2)}

Intermittent intravenous infusion (unlicensed) ^{(ref 1)}

• There is no recommended final volume/concentration for dilution. It is usually convenient to dilute in 50 or 100mL, but larger or smaller volumes can be used if necessary

Dose in adults

Severe hypoglycaemia

• Usually 1mg, given by the subcutaneous or intramuscular route

Diagnostic indication (inhibition of gastrointestinal motility)

• Relaxation of stomach, duodenal bulb, duodenum and small bowel: 0.2 to 0.5mg as intravenous injection
• Relaxation of colon: 0.5 to 0.75mg as intravenous injection
• Higher doses may be given for these indications if by subcutaneous or intramuscular route- see SPC

Beta-blocker/calcium channel blocker toxicity (unlicensed) ^{(ref 2)}

• Consult poisons centre
• Give 3 to 10mg (0.05 to 0.15mg/kg) as a slow intravenous injection over 2 to 5 minutes, followed by an infusion of 3 to 5mg/hour (0.05 to 0.1mg/kg/hour)
• Titrate the infusion to achieve an adequate clinical response

Anaphylactic reaction (refractory) in patients on beta-blocker therapy (unlicensed) ^{(ref 2)}

• Give 1 to 5mg as a slow intravenous injection over 5 minutes, followed by an infusion of 5 to 15 micrograms/minute
• Titrate the infusion to achieve an adequate clinical response

Renal or hepatic impairment

• No dosage adjustment is required

Storage

• Store in a refrigerator between 2 and 8⁰C - for full shelf life of product
• May be stored at room temperature for up to 18 months (providing the expiry date is not exceeded)

References

SPC December 2019
1: Injectable medicines guide - Medusa, downloaded 24th November 2021
2: Uptodate- downloaded 24th November 2021

Therapeutic classification

Glycogenolytic hormone