ADMINISTRATION ROUTES:
IV, IM
ALTERNATIVE NAMES:
Glucagon Hypokit
ICU INDICATIONS:
- Treatment of beta blocker or calcium channel blocker overdoses that are refractory to standard management with fluids, inotropes and calcium
Note: glucagon is not recommended as a 1st line treatment of hypoglycaemia in the ICU
PRESENTATION AND ADMINISTRATION:
IV Use
1 mg vial + phenol containing solvent (prefilled syringe)
1 unit = 1 mg
FOR INFUSIONS IN ICU, DO NOT USE SOLVENT THAT COMES WITH THE VIAL. Instead, reconstitute 25 vials of glucagon using water for injection, then dilute to a total of 25 mL using 5% dextrose giving a concentration of 1 mg/mL
Compatible with the following IV fluids:
5% dextrose, Water for injection
Store at room temperature
Note: glucagon administration by infusion in ICU can rapidly deplete the hospital glucagon supplies. Alternative sources of glucagon should be sourced. Call the Pharmacist if commencing a glucagon infusion
IM:
Dissolve 1 mg vial in phenol containing solvent (prefilled syringe) and administer by IM injection
DOSAGE:
For treatment of beta blocker or calcium channel blocker overdoses:
5 mg bolus IV stat
If no response, repeat dose after 5 minutes
If clinical response occurs, commence IV infusion at 2-5 mg/hr
Note: if there is no clinical response to an initial loading dose of 10 mg of glucagon, further administration of the drug is futile and use of glucagon should be abandoned
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
Beta blocker overdose:
0.1 mg/kg IV stat followed by infusion of 0.3 - 2 mcg/kg/min
CLINICAL PHARMACOLOGY:
Glucagon for injection (rDNA origin) is a polypeptide hormone identical to human glucagon that increases blood glucose and relaxes smooth muscle of the gastrointestinal tract. Glucagon has positive inotropic and chronotropic effects similar to those of beta adrenergic agonists. These occur due to binding to specific intracellular glucagon receptors leading to activation of cardiac adenylate cyclise and increase cAMP concentrations.
CONTRAINDICATIONS:
- Hypersensitivity to glucagon
WARNINGS:
Glucagon is not a first line therapy for beta blocker or calcium channel overdose with use not supported by adequate clinical trials. Glucagon therapy should be used only for patients who are refractory to fluids and inotropes
PRECAUTIONS:
General:
Generalised allergic reactions, including urticaria, respiratory distress, and hypotension, have been reported in patients who received glucagon by injection
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None reported
IMPORTANT DRUG INTERACTIONS IN ICU:
None of note
ADVERSE REACTIONS:
Body as a whole:
Allergic reaction
Metabolic and endocrine:
Hyperglycaemia, hypokalaemia
Gastrointestinal:
Nausea, vomiting