Glucagon Injection - Uses, Dose, MOA, Brands, Side effects

Glucagon is a pancreatic hormone produced by the alpha cells of the pancreas. It is available as injections for intramuscular and intravenous use to treat refractory hypoglycemia, beta-blockers, and calcium-channel blocker toxicity (refractory to epinephrine), and as a diagnostic agent.

Indications of Glucagon:

  • Diagnostic aid:

    • During radiologic examinations, it is used as a diagnostic tool as it temporarily inhibits movement of the GI tract in adults.
  • Hypoglycemia:

    • Used to treat both adult and paediatric patients with severe hypoglycemia.
    • Note: According to the ADA, all diabetic individuals at risk of level 2 hypoglycemia (less than 54 mg/dl) should be prescribed glucagon. On when and how to administer glucagon, caregivers, educators, or family members of such people should receive training.
    • Restrictions on use: The emergency treatment of hypoglycemia is not suggested for products that are not provided with a syringe and diluent necessary for quick preparation and administration during an emergency outside of a healthcare facility.
  • Off Label Use of Glucagon in Adults:

    • Anaphylaxis
    • Beta-blocker overdose
    • Calcium channel blocker overdose

Glucagon dose in adults:

Glucagon dose as a diagnostic aid:

  • Relaxation of the stomach, duodenal bulb, duodenum, and small bowel:

    • IM: 1 mg.
    • IV: 0.2 to 0.5 mg.
  • Relaxation of colon:

    • IM: 1 to 2 mg.
    • IV: 0.5 to 0.75 mg.

Glucagon dose in the treatment of Hypoglycemia:

  • IM, IV, SubQ: 1 mg; may be repeated in 15 minutes as required.
  • Intranasal: three milligrammes (one actuation) into one nostril (the dose may be repeated in 15 minutes)
  • Note: Administer IV dextrose as soon as it is available; if there is no response to glucagon, must give IV dextrose.

Glucagon dose in the treatment of Anaphylaxis (refractory to epinephrine) in patients on beta-blocker therapy (off-label):

  • IV: Initial: 1 to 5 mg bolus, then 5 to 15 mcg/minute of infusion; the infusion rate should be adjusted to produce an appropriate clinical response.

Glucagon dose in the treatment of Beta-blocker overdose (off-label):

  • IV: 3 to 10 mg bolus; if no clinical response, repeat the bolus dosage; if there is a clinical response to the bolus dose, start the continuous infusion at 3 to 5 mg/hour; titrate the infusion rate to reach the desired hemodynamic response.

Glucagon dose in the treatment of Calcium channel blocker overdose (off-label):

  • IV: 3 to 10 mg bolus; if no clinical response occurs, the bolus dose may be repeated; if a clinical response occurs, the continuous infusion should begin at 3 to 5 mg/hour;

Glucagon Dose in Childrens

Glucagon Dose in the treatment of severe Hypoglycemia:

  • Weight-directed dosing:

    • Manufacturer's labeling:

      • Infants, Children, or Adolescents weighing less than 20 kg:
      • Glucagon: IM, IV, SubQ: 0.02-0.03 mg/kg.
      • max dose: 0.5 mg
    • Alternate dosing:

      • Infants, Children, and Adolescents:
        • AAP: IM, IV, Subcutaneous: 0.03 mg/kg; max dose: 1 mg.
        • IDF-ISPAD: IM, Subcutaneous: 0.01-0.03 mg/kg; max dose-dependent on age: <12 years: 0.5 mg; ≥12 years: 1 mg.
  • Fixed dosing; age-directed:

    • Manufacturer's labeling: GlucaGen: IM, IV, SubQ:

      • Infants and Children <6 years: 0.5 mg
      • Children and Adolescents ≥6 years: 1 mg
    • Alternate dosing: IM, Subcutaneous:

      • IDF-ISPAD (IDF-ISPAD, 2011):

        • Infants and Children <12 years: 0.5 mg
        • Children and Adolescents ≥12 years: 1 mg
      • CDA (Canadian Diabetes Association, 2013):

        • Infants and Children ≤5 years: 0.5 mg
        • Children and Adolescents >5 years: 1 mg
  • Fixed dosing; weight-directed:

    • Infants, Children, and Adolescents:

      • Manufacturer's labeling: IM, IV, SubQ:

        • Glucagon: Patient weight:

          • <20 kg: 0.5 mg
          • ≥20 kg: 1 mg
        • GlucaGen: Patient weight:

          • <25 kg: 0.5 mg
          • ≥25 kg: 1 mg

Glucagon dose for the prevention of Hypoglycemia, during illness (fixed dosing, mini-dose): SubQ:

Note: These doses are lower than those used to treat hypoglycemia, and they have been demonstrated to prevent hypoglycemia for several hours in conditions like gastroenteritis and nausea/vomiting that are linked to hypoglycemia.

  • Infants and Children <2 years:

    • 0.02 mg.
  • Children and Adolescents 2-15 years:

    • 0.01 mg per year of age.
  • Adolescents >15 years:

    • 0.15 mg.

Glucagon dose for the treatment of Beta-blocker or calcium channel blocker toxicity/overdose:

  • Infants and Children: Limited data available : IV:

    • Loading dose: 0.03-0.15 mg/kg.
    • Continuous IV infusion: 0.07 mg/kg/hour; max rate: 0.5 mg/hour.
  • Adolescents: IV:

    • Loading dose: 5-10 mg over several minutes.
    • Continuous IV infusion: 1-5 mg/hour.

Pregnancy Risk Category: B

  • During animal reproduction studies, there were no adverse events.

Glucagon use during breastfeeding:

  • Breastfeeding infants are less likely to experience side effects because glucagon is not absorbed through the GI tract.

Dose adjustment in renal disease:

No dosage adjustments are provided in the manufacturer’s labeling.

Dose adjustment in liver disease:

No dosage adjustments are provided in the manufacturer’s labeling.

Side Effects of Glucagon:

  • Gastrointestinal:

    • Nausea (With Rapid Administration Of High Doses)
    • Vomiting (With Rapid Administration Of High Doses)
  • Cardiovascular:

    • Hypotension (Up To 2 Hours After GI Procedures)
    • Increased Blood Pressure
    • Increased Pulse
  • Dermatologic:

    • Skin Rash
  • Hypersensitivity:

    • Anaphylactic Shock
    • Hypersensitivity Reaction
  • Respiratory:

    • Dyspnea

Contraindications to Glucagon:

  • Hypersensitivity to glucagon, lactose or any other component of the formulation
  • Pheochromocytoma
  • Insulinoma
  • Glucagonoma (excluding GlucaGen)

Warnings and precautions

  • Hypersensitivity reactions

    • Allergic reactions to glucagon have been reported and are usually associated with endoscopic patients
    • These reactions include anaphylactic shock and skin rash (with hypotension or respiratory problems).
  • Necrolytic migratory Erythema:

    • Necrolytic migratory Erythema (NME) is rarely reported after continuous glucagon injections.
    • This cutaneous disease is frequently linked to glucagonomas (glucagon producing tumors). Erythematous bullae and plaques are its defining features.
    • It can affect the face, legs, groin, perineum and legs.
    • NME can lead to serious side effects. You should consider all options.
  • Insufficiency of the adrenals:

    • Patients with adrenal insufficiency should be cautious as the glucose stores in their liver may be reduced.
  • Cardiac disease

    • Be careful.
  • Hypoglycemia chronic:

    • Patients with hypoglycemia should be cautious as the liver glucose stores can be reduced.
  • Diabetes:

    • Use it as a diagnostic tool for diabetics on insulin.
  • Glucagonoma

    • Be careful.
    • Patients with this condition (except GlucaGen) are not advised to use glucagon.
  • Insulinoma

    • Blood sugar levels may increase as a result of exogenous glucagon, followed by rebound hypoglycemia.
    • Patients with this condition should not take glucagon.
  • Pheochromocytoma:

    • Catecholamines may be released by exogenous glucagon, raising blood pressure.
    • Patients with this condition should not take glucagon.
  • Fasting and starvation:

    • Keep in mind that prolonged fasting or starvation may result in the depletion of hepatic glycogen.

Glucagon: Drug Interaction

Risk Factor C (Monitor therapy)

Anticholinergic Agents

May intensify Glucagon's negative or hazardous effects. Particularly, there may be a higher chance of unfavourable gastrointestinal consequences.

Antidiabetic Agents

The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents.


May reduce Glucagon's therapeutic impact.

Vitamin K Antagonists (eg, warfarin)

The anticoagulant action of Vitamin K antagonists may be increased by glucagon.


Monitoring parameters:

  • Bp
  • Heart rate
  • Blood glucose levels
  • Electrocardiogram
  • Mentation
  • Signs or symptoms of a hypersensitivity reaction.

How to administer Glucagon?

Diagnostic aid:

  • For administration by IM or IV. Administering intravenously should take more than a minute.
  • If it is appropriate given the diagnostic process used, patients who have been fasting should be given oral carbohydrates after the diagnostic procedure. Bolus intravenous dosages more than 1 mg are not advised.


  • Upper arms, thighs, or buttocks may be used as injection sites for intravenous, subcutaneous, or intramuscular injections. Fast and long-acting oral carbohydrates should be administered to the patient as soon as feasible following the response to treatment.


  • Rapid intravenous injection may cause nausea and vomiting; the patient should be positioned in a lateral recumbent position to protect the airway and prevent choking when consciousness returns.
  • Patients on beta-blockers should get an IV bolus over a 5-minute period if they experience epinephrine-refractory anaphylaxis.

Beta-blocker/calcium channel blocker toxicity:

  • Give a IV bolus over 3 to 5 minutes; consider using continuous infusions.

Mechanism of action of Glucagon:

  • Stimulation of adenylate cyclase results in an increased production of cyclic AMP.
  • This causes hepatic glucose to rise and gluconeogenesis.
  • The stomach, duodenum, and small bowel's smooth muscles can relax as an extrahepatic impact.

The onset of action: Blood glucose levels:

  • Peak effect seen with IV administration is 5 to 20 minutes with IM is 30 minutes and with subcutaneous administration, it is 30 to 45 minutes.


  • It takes 60-90 minutes for glucose elevation with IV, IM, SubQ injection.
  • GI relaxation occurs in 9-25 minutes with IV and in 12-32 mins in case of IM injection.


  • The liver is the primary site, with kidneys and plasma also experiencing some inactivation.

Half-life elimination,

  • The plasma half-life is 8-18 mins in case of IV and 26-45mins in case of IM injection

Time to peak:

  • Almost 10-12.5 mins in IM and 20 mins in case of subcutaneous injection.

International Brand Names of Glucagon:

  • GlucaGen Diagnostic
  • GlucaGen HypoKit
  • Glucagon Emergency
  • Garcon
  • Glucagen
  • GlucaGen
  • Glucagen G
  • Glucagen Novo
  • Glucagon Novo Nordisk
  • R-Glucagon Lil

Glucagon Brand Names in Pakistan:

No Brands Available in Pakistan.