Glucagon

Glucagon

[1mg syringe $28.50]

ADMINISTRATION ROUTES:

  • IV, IM

ALTERNATIVE NAMES:

  • Glucagon

ICU INDICATIONS:

  1. Treatment of beta blocker or calcium channel blocker overdoses that are refractory to standard management with fluids, inotropes and calciumNote: glucagon is not recommended as a 1st line treatment of hypoglycaemia in the ICU

PRESENTATION AND ADMINISTRATION:

  • IV Use:
    1mg vial + phenol containing solvent (prefilled syringe) 1 unit = 1 mg
    FOR INFUSIONS, 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 25ml using 5% dextrose (i.e. 1mg/ml)
    Compatible with the following IV fluids:
    5% dextrose, Water for injection
    Store at room temperature

    Note: glucagon administration can rapidly deplete the hospital glucagon supplies and alternative sources of glucagon should be sourced. Call the Pharmacist if commencing a glucagon infusion.

  • IM:
    Dissolve 1mg vial in phenol containing solvent (prefilled syringe) and administer by IM injection

DOSAGE:

  • For treatment of beta blocker or calcium channel blocker overdoses:
    1. give an initial bolus of 5mg IV. If no response, repeat after 5 minutes.
    2. if there is an adequate clinical response to the loading dose, commence an IV infusion of 2-5mg/hr
    Note: if there is no clinical response to an initial loading dose of 10mg 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:
    0.1mg/kg IV stat followed by 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:

  1. hypersensitivity to glucagon

WARNINGS

  • Glucagon is not a first line therapy for beta blocker or calcium channel overdose. Its use is 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 FOR THE ICU

  • None of note

ADVERSE REACTIONS

  • Body as a whole:
    Allergic reaction
  • Metabolic and endocrine:
    Hyperglycaemia, hypokalaemia
  • Gastrointestinal:
    Nausea, vomiting

Critical Care Drug Manual

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