Glucagon belongs to the group of medications called hyperglycemic agents. It is used to treat severe hypoglycemia (low blood sugar) when someone with insulin-treated diabetes is unable to give glucose to themselves (e.g., unconscious). Symptoms of severely low blood sugar include disorientation, unconsciousness, and seizures.

This medication works in the liver to produce glucose (sugar) and increase blood sugar. It usually works within 10 to 15 minutes. If a person does not respond to this medication within 10 to 15 minutes, get immediate medical attention.

Glucagon can also be used as part of certain radiologic tests to temporarily reduce the movement of the stomach and intestines.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

The usual dose for adults and children who weigh more than 25 kg (55 lbs) and are 6 to 8 years and older is 1 mg (1 unit) injected into a muscle. For children who weigh less than 25 kg (55 lbs) and are younger than 6 to 8 years, the dose is 0.5 mg (0.5 units) or based on body weight.
To give a glucagon injection, first prepare the injection. Do not prepare the injection until the medication is needed. Once prepared, use it immediately and do not store for later use.

• Remove the plastic cap from the vial.
• Pull the needle cap cover off the syringe.
• Draw up the water for injection (1.1 mL) in a disposable syringe (not needed for Hypokit).
• Insert the needle through the rubber stopper (within the marked circle) and inject the water for injection into the vial containing the freeze-dried glucagon.
• Without taking the needle out of the vial, shake the vial gently until the glucagon is completely dissolved and the solution is clear.
• Make sure the plunger is completely down. While keeping the needle in the liquid, slowly withdraw the solution back into the syringe.
• Remove any air bubbles from the syringe by tapping on the needle with the needle pointing upwards, and push the plunger slightly to release any air that has collected at the top of the syringe.
• Continue to push the plunger until you have the correct dose.
• Inject into a muscle.

As soon as someone responds to this medication, they should eat glucose (e.g., candy, orange juice, regular pop) to prevent low blood sugar from returning and contact their doctor.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you use the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor.

Store this medication in the refrigerator at 2°C to 8°C and keep it out of the reach of children. The Hypokit form of this medication can be stored at a temperature no greater than 25°C for up to 18 months, provided the expiry date is not exceeded.

Each 1 mg/mL vial is supplied as a sterile, freeze-dried white powder of glucagon in a 2 mL vial and accompanying solvent also in a 2 mL vial. Glucagon powder is reconstituted with 1.0 mL of water for injection (WFI), forming a solution of 1 mg (1 IU) glucagon and 107 mg of lactose monohydrate in each mL prior to use. One stoppered glass vial contains 1 mg glucagon, corresponding to 1 mg glucagon/mL after reconstitution. Nonmedicinal ingredients: lactose monohydrate, hydrochloric acid and/or sodium hydroxide (pH adjusters), and water for injection.

GlucaGen Hypokit

Each 1 mg/mL vial is supplied as a sterile, freeze-dried white powder of glucagon in a 2 mL vial and accompanying solvent in a 1.5 mL disposable syringe. Glucagon powder is reconstituted with 1.0 mL of water for injection (WFI), forming a solution of 1 mg (1 IU) glucagon and 107 mg of lactose monohydrate in each mL prior to use. Nonmedicinal ingredients: lactose monohydrate, hydrochloric acid and/or sodium hydroxide (pH adjusters), and water for injection.

Do not use this medication if you:

• are allergic to glucagon or any ingredients of the medication
• have pheochromocytoma (a tumour on the adrenal glands)

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses.

Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people using this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• dizziness
• nausea
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• fast, pounding heartbeat

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs and symptoms of a severe allergic reaction (hives, itchy skin, difficulty breathing or swallowing, swelling of the face, mouth, tongue, or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are using this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Alcohol: Alcohol ingestion (acute or chronic) can reduce the effectiveness of this medication.

Insulinoma/glucagonoma: If you have an insulinoma (a tumour of the pancreas that produces insulin) or a glucagonoma (tumour of the pancreas that produces glucagon), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Knowledge of use: This medication is usually given by family members, friends, or coworkers, as it should not be used unless the individual needing the medication cannot take glucose by mouth. Make sure that these people are familiar with when and how to use this medication and where you store it.

Pheochromocytoma: This is a tumour of the adrenal gland that affects how and when the body produces chemicals that increase heart rate and blood pressure. For people with pheochromocytoma, glucagon can cause the tumour to release larger than normal amounts of these chemicals, causing a rapid, possibly dangerous, climb in blood pressure. If you have a history of pheochromocytoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks, and only if sugar cannot be given.

Breast-feeding: It is not known if glucagon passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

There may be an interaction between glucagon and any of the following:

• alcohol
• indomethacin
• insulin
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.