Dosing & Uses
Dosage Forms & Strengths
intranasal powder
- 3mg/actuation
Hypoglycemia
Indicated for severe hypoglycemic reactions in patients with diabetes
3 mg administered as 1 actuation using the intranasal device into 1 nostril
If no response after 15 minutes, administer an additional 3-mg dose from a new device while waiting for emergency assistance
Dosage Forms & Strengths
intranasal powder
- 3mg/actuation
Hypoglycemia
Indicated for severe hypoglycemic reactions in children aged ≥4 years with diabetes
<4 years: Safety and efficacy not established
≥4 years: 3 mg administered as 1 actuation using the intranasal device into 1 nostril
If no response after 15 minutes, administer an additional 3-mg dose from a new device while waiting for emergency assistance
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (18)
- aclidinium
glucagon intranasal increases toxicity of aclidinium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- atropine
glucagon intranasal increases effects of atropine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- benztropine
glucagon intranasal increases toxicity of benztropine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- dicyclomine
glucagon intranasal increases toxicity of dicyclomine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- glycopyrrolate
glucagon intranasal increases toxicity of glycopyrrolate by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- glycopyrrolate inhaled
glucagon intranasal increases toxicity of glycopyrrolate inhaled by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- hyoscyamine
glucagon intranasal increases toxicity of hyoscyamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- hyoscyamine spray
glucagon intranasal increases toxicity of hyoscyamine spray by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- ipratropium
glucagon intranasal increases toxicity of ipratropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- methscopolamine
glucagon intranasal increases toxicity of methscopolamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- orphenadrine
glucagon intranasal increases toxicity of orphenadrine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- propantheline
glucagon intranasal increases toxicity of propantheline by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- scopolamine
glucagon intranasal increases toxicity of scopolamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- tiotropium
glucagon intranasal increases toxicity of tiotropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- trihexyphenidyl
glucagon intranasal increases toxicity of trihexyphenidyl by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- tropicamide
glucagon intranasal increases toxicity of tropicamide by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- umeclidinium bromide
glucagon intranasal increases toxicity of umeclidinium bromide by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- umeclidinium bromide/vilanterol inhaled
glucagon intranasal increases toxicity of umeclidinium bromide/vilanterol inhaled by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
Monitor Closely (43)
- acebutolol
glucagon intranasal decreases toxicity of acebutolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- antithrombin alfa
glucagon intranasal increases effects of antithrombin alfa by unknown mechanism. Use Caution/Monitor.
- antithrombin III
glucagon intranasal increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor.
- argatroban
glucagon intranasal increases effects of argatroban by unknown mechanism. Use Caution/Monitor.
- atenolol
glucagon intranasal decreases toxicity of atenolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- bemiparin
glucagon intranasal increases effects of bemiparin by unknown mechanism. Use Caution/Monitor.
- betaxolol
glucagon intranasal decreases toxicity of betaxolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- bisoprolol
glucagon intranasal decreases toxicity of bisoprolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- bivalirudin
glucagon intranasal increases effects of bivalirudin by unknown mechanism. Use Caution/Monitor.
- carvedilol
glucagon intranasal decreases toxicity of carvedilol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- celiprolol
glucagon intranasal decreases toxicity of celiprolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- dalteparin
glucagon intranasal increases effects of dalteparin by unknown mechanism. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and glucagon intranasal both decrease serum potassium. Use Caution/Monitor.
- enoxaparin
glucagon intranasal increases effects of enoxaparin by unknown mechanism. Use Caution/Monitor.
- esmolol
glucagon intranasal decreases toxicity of esmolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- fondaparinux
glucagon intranasal increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor.
- heparin
glucagon intranasal increases effects of heparin by unknown mechanism. Use Caution/Monitor.
- indomethacin
indomethacin decreases effects of glucagon intranasal by unknown mechanism. Use Caution/Monitor. In patients taking indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia.
- insulin aspart
glucagon intranasal decreases effects of insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin aspart protamine/insulin aspart
glucagon intranasal decreases effects of insulin aspart protamine/insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin degludec
glucagon intranasal decreases effects of insulin degludec by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin degludec/insulin aspart
glucagon intranasal decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin detemir
glucagon intranasal decreases effects of insulin detemir by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin glargine
glucagon intranasal decreases effects of insulin glargine by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin glulisine
glucagon intranasal decreases effects of insulin glulisine by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin inhaled
glucagon intranasal decreases effects of insulin inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin isophane human/insulin regular human
glucagon intranasal decreases effects of insulin isophane human/insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin lispro
glucagon intranasal decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin lispro protamine/insulin lispro
glucagon intranasal decreases effects of insulin lispro protamine/insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin NPH
glucagon intranasal decreases effects of insulin NPH by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- insulin regular human
glucagon intranasal decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Endogenous glucagon is a regulatory hormone that increases blood glucose levels; exogenous glucagon is often used to treat hypoglycemia in patients with diabetes mellitus.
- labetalol
glucagon intranasal decreases toxicity of labetalol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- metformin
glucagon intranasal decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.
- metoprolol
glucagon intranasal decreases toxicity of metoprolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- nadolol
glucagon intranasal decreases toxicity of nadolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- nebivolol
glucagon intranasal decreases toxicity of nebivolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- penbutolol
glucagon intranasal decreases toxicity of penbutolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- phenindione
glucagon intranasal increases effects of phenindione by unknown mechanism. Use Caution/Monitor.
- pindolol
glucagon intranasal decreases toxicity of pindolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- propranolol
glucagon intranasal decreases toxicity of propranolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- protamine
glucagon intranasal increases effects of protamine by unknown mechanism. Use Caution/Monitor.
- sotalol
glucagon intranasal decreases toxicity of sotalol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- timolol
glucagon intranasal decreases toxicity of timolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
Minor (5)
- magnesium chloride
glucagon intranasal increases levels of magnesium chloride by decreasing renal clearance. Minor/Significance Unknown.
- magnesium citrate
glucagon intranasal increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.
- magnesium hydroxide
glucagon intranasal increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.
- magnesium oxide
glucagon intranasal increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.
- magnesium sulfate
glucagon intranasal increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.
Adverse Effects
>10%
Adults
- Watery eyes (58.8%)
- Nasal congestion (42.5%)
- Nasal itching (39.2%)
- Nausea (26.1%)
- Eye redness (24.8%)
- Itchy eyes (21.6%)
- Sneezing (19.6%)
- Headache (18.3%)
- Vomiting (15%)
- Upper respiratory tract irritation (12.4%)
- Throat itching (12.4%)
Children
- Watery eyes (47.2%)
- Nasal congestion (41.7%)
- Vomiting (30.6%)
- Nasal itching (27.8%)
- Headache (25%)
- Runny nose (25%)
- Sneezing (19.4%)
- Upper respiratory tract irritation (16.7%)
- Itchy eyes (16.7%)
- Eye redness (13.9%)
1-10%
Children
- Throat itching (2.8%)
- Ears itching (2.8%)
Adults
- Ears itching (3.3%)
Frequency Not Defined
Adults and children
- Dysgeusia
- Pruritus
- Tachycardia
- Hypertension
- Additional upper respiratory tract irritation (nasal pruritus, throat irritation, parosmia)
Warnings
Contraindications
Pheochromocytoma
Insulinoma
Hypersensitivity to glucagon or to any excipients
Cautions
Allergic reactions reported including anaphylactic shock with breathing difficulties and hypotension
Contraindicated with pheochromocytoma; glucagon may stimulate catecholamine release from the tumor; if blood pressure (BP) increases dramatically and undiagnosed pheochromocytoma is suspected, administer phentolamine 5-10 mg IV to lower BP
Contraindicated with insulinoma; glucagon administration may produce initial increase in blood glucose; however, glucagon may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia; treat with glucose PO or IV
Effective for hypoglycemia only if sufficient hepatic glycogen is present; patients in states of starvation, with adrenal insufficiency, or chronic hypoglycemia may not have adequate levels of hepatic glycogen for glucagon to be effective; treat these patients with glucose
Drug interaction overview
- Patients taking beta-blockers may have transiently increased pulse and BP when administered glucagon
- In patients taking indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia
- Glucagon may increase anticoagulant effect of warfarin
Pregnancy & Lactation
Pregnancy
Available data from case reports and a small number of observational studies with glucagon use in pregnant women over decades of use have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
Multiple small studies have demonstrated a lack of transfer of pancreatic glucagon across the human placental barrier during early gestation
Lactation
There is no information available on the presence of glucagon in human or animal milk, the effects of the drug on the breastfed infant, or the effects of the drug on milk production
However, glucagon is a peptide and would be expected to be broken down to its constituent amino acids in the infant's digestive tract and is therefore unlikely to cause harm to an exposed infant
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Insulin antagonist
Activates hepatic glucagon receptors that stimulate cAMP synthesis; this accelerates hepatic glycogenolysis and gluconeogenesis, causing an increase in blood glucose levels
Preexisting hepatic glycogen stores necessary to be effective in treating hypoglycemia
Mean maximum glucose increase from baseline
- Adults: 140 mg/dL
- Children aged 4 yr to <8 yr: 138 mg/dL
- Children aged 8 yr to <12 yr: 133 mg/dL
- Children aged 12 yr to <17 yr: 102 mg/dL
Absorption
Peak plasma concentration: 6130 pg/mL
Peak plasma time: 15 minutes (adults); 15-20 minutes (children)
Distribution
Vd: 885 L
Metabolism
Degraded in the liver, kidneys, and plasma
Elimination
Half-life: ~35 minutes (adults); 21-31 minutes (children)
Administration
Intranasal Administration
For intranasal use only
Instruct patients and their caregivers on the signs and symptoms of severe hypoglycemia
Severe hypoglycemia requires help of others to recover; instruct the patient to inform those around them about intranasal glucagon and how to use it
Administer as soon as possible when severe hypoglycemia is recognized
Emphasize the following instructions to the patient or caregiver
- Do not push plunger or test the device before administering
- Administer according to instructions on the shrink-wrapped tube label
- Administer by inserting the tip into 1 nostril and pressing the device plunger all the way in until the green line is no longer showing; dose does not need to be inhaled
- Call for emergency assistance immediately after administering
- When patient responds to treatment, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia
- Do not attempt to reuse the glucagon intranasal device; each device contains 1 dose of glucagon and cannot be reused
Storage
May store up to 86ºF (30ºC) in the shrink-wrapped tube provided
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