glucagon: clinical use

Prescribing considerations

• Ensure patients at risk of severe hypoglycaemia have trained relatives, carers or colleagues who can locate, prepare and administer the kit.
• Glucagon may have little or no effect when hepatic glycogen is depleted, including after prolonged fasting, alcohol-induced hypoglycaemia, chronic hypoglycaemia or in adrenal insufficiency.
• After recovery, oral carbohydrate is needed where safe and the cause of the severe event should be reviewed.
• For diagnostic use, monitor patients with cardiac disease and monitor glucose in people with diabetes.

Contraindications and cautions

• Hypersensitivity to glucagon or an excipient.
• Phaeochromocytoma, because glucagon can provoke substantial catecholamine release and an acute hypertensive reaction.
• Use caution in insulinoma and, for diagnostic use, glucagonoma.

Monitoring

• Assess clinical response and blood glucose; arrange intravenous glucose if adequate recovery does not occur.
• Monitor for recurrent hypoglycaemia after initial recovery.
• During diagnostic use, monitor blood glucose in diabetes and cardiovascular status in cardiac disease.
• Record the product name and batch number to support biological-medicine traceability.

Clinical pharmacology

Glucagon mobilises hepatic glycogen, producing a rapid rise in circulating glucose, and inhibits gastrointestinal smooth-muscle tone and motility. It is rapidly cleared, mainly through the liver and kidneys, and has a short plasma half-life.

Formulation and product differences

• The selected HypoKit contains glucagon powder and solvent in a pre-filled syringe for reconstitution before injection.
• The reconstituted solution is unstable and must be used immediately; it must not be administered as an intravenous infusion.
• Store refrigerated and protected from light. The unopened kit may alternatively be stored below the stated room-temperature limit for the permitted period without exceeding its expiry date; do not freeze.