Glucagon
GlucaGen HypoKit · Glucagon Novo Nordisk · Baqsimi · Ogluo
Two entirely different drugs in the same ampoule. In severe hypoglycaemia, 1 mg intramuscularly is the treatment that a family member can give when the patient cannot swallow and intravenous access is unavailable — the effect arrives within ten minutes through hepatic glycogenolysis. In beta-blocker intoxication, glucagon is instead an inotrope that bypasses the blocked beta receptor, and the doses are five to ten times higher. Never confuse the two indications.
Glucagon works only if the liver has glycogen to release. In alcohol-induced hypoglycaemia, starvation, anorexia, prolonged hypoglycaemia, or hepatic failure the effect is absent — intravenous glucose is required. The effect is also short-lived, and the patient must receive carbohydrates orally as soon as consciousness returns, otherwise hypoglycaemia recurs.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Severe hypoglycaemia, adults and children ≥ 25 kg | 1 mg im or sc, may be repeated after 15 minutes if consciousness does not return | carer administration; always call emergency services simultaneously |
| Severe hypoglycaemia, children < 25 kg (below approximately 6–8 years) | 0,5 mg im or sc | half the syringe in the HypoKit |
| Severe hypoglycaemia, nasal formulation | Baqsimi 3 mg nasal powder in one nostril, fixed dose regardless of age from 4 years | requires no inhalation and works even with nasal congestion |
| Beta-blocker intoxication | 3–10 mg iv slowly over 3–5 minutes, then infusion 3–5 mg per hour titrated to haemodynamic response | contact the Poisons Centre; nausea and vomiting are the rule |
| Calcium channel blocker intoxication | Same doses as for beta-blocker intoxication, as an adjunct to calcium, vasopressor, and high-dose insulin-glucose | less well documented than for beta-blockers |
No dose adjustment.
No formal dose adjustment, but the hypoglycaemic indication fails — in hepatic failure glycogen stores are absent and glucose must be given instead.
0,5 mg im or sc at weight below 25 kg, 1 mg at 25 kg or more. Baqsimi nasal powder 3 mg is approved from age 4 years.
Do not rely on glucagon in the alcohol-intoxicated patient with hypoglycaemia — glycogen stores are depleted and the effect is absent. Give intravenous glucose instead. The same applies to prolonged hypoglycaemia caused by sulphonylurea or long-acting insulin, where glucagon at most produces a brief and misleading recovery.
Pharmacokinetics
- ONSET (IM)
- approximately 10 minutes
- PEAK EFFECT
- 12–30 minutes
- DURATION
- 60–90 minutes
- t½ (IV)
- 3–6 minutes
- t½ (NASAL)
- approximately 35 minutes
- MECHANISM
- Glucagon receptor → adenylate cyclase → cAMP
- BREAKDOWN
- Enzymatic in liver, kidney, and plasma
- EXCRETION
- Renal (peptide fragments)