glucagon (Rx)

Brand and Other Names:Glucagen, Glucagon Emergency Kit, more...GlucaGen HypoKit, Gvoke
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection, powder for reconstitution (GlucaGen, generic)

  • 1mg/vial

injectable solution (Gvoke)

  • 1mg/0.2mL (single-dose prefilled syringe or HypoPen autoinjector)

Hypoglycemia

Indicated for severe hypoglycemic reactions in patients with diabetes treated with insulin

1 mg (1 unit) IM/SC/IV if no IV for dextrose

Repeat q15min once or twice; give dextrose as soon as it is available and if no response

Administer supplemental carbohydrate to replete glycogen stores

Diagnostic Aid

GlucaGen only

Indicated for use during radiologic examinations to temporarily inhibit movement of the gastrointestinal tract

To inhibit motility of stomach and small bowel: 0.2-0.5 mg IV over 1 min or 1 mg IM

To inhibit motility of colon: 0.5-0.75 mg IV over 1 min or 1-2 mg IM

Bolus doses >1 mg administered IV may cause nausea and vomiting and are not recommended

After completing the diagnostic procedure, give oral carbohydrates to patients who have been fasting, if compatible with the diagnostic procedure applied

Beta-Blocker & Calcium Channel Blocker Toxicity (Off-label)

Indicated off-label for overdose of beta blockers or calcium channel blockers

Load: 50-150 mcg/kg IVP over 1 minute, THEN  

3-5 mg/hr or 50-100 mcg/kg/hr IV; titrate infusion to achieve adequate clinical response

Dosage Forms & Strengths

injection, powder (GlucaGen, generic)

  • 1mg/vial

injectable solution (Gvoke)

  • 0.5mg/0.1mL (single-dose prefilled syringe or HypoPen autoinjector)
  • 1mg/0.2mL (single-dose prefilled syringe or HypoPen autoinjector)

Hypoglycemia

Indicated for severe hypoglycemic reactions in patients with diabetes treated with insulin

Administer oral glucose/IV dextrose to replete glycogen stores

GlucaGen

  • Weight <25 kg or unknown weight and age <6 years: 0.5 mg SC/IM/IV; may repeat in 15 min if necessary
  • Weight ≥25 kg or unknown weight and age ≥6 years: 1 mg SC/IM/IV; may repeat in 15 min if necessary

Glucagon Emergency Kit

  • Weight <20 kg or unknown weight and age <6 years: 0.5 mg SC/IM/IV q15min PRN, OR 0.02-0.03 mg/kg/dose SC/IM/IV; may repeat in 15 min if necessary
  • Weight ≥20 kg or unknown weight and age ≥6 years: 1 mg SC/IM/IV; may repeat in 15 min if necessary q20min PRN

Gvoke

  • Indicated for severe hypoglycemia in pediatric and adult patients with diabetes aged ≥2 years
  • <2 years: Safety and efficacy not established
  • 2 to <12 years
    • <45 kg: 0.5 mg SC; may repeat in 15 min if necessary
    • ≥45 kg: 1 mg SC; may repeat in 15 min if necessary
  • ≥12 years
    • 1 mg SC; may repeat in 15 min if necessary

Hyperinsulinemic Hypoglycemia (Orphan)

Orphan designation for treatment of hyperinsulinemic hypoglycemia (HH)

Sponsor

  • Xeris Pharmaceuticals, Inc; 3208 Red River Street, Suite 300; Austin, TX 78705
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Interactions

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              Serious - Use Alternative (18)

              • aclidinium

                glucagon 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 (31)

              • acebutolol

                glucagon 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.

              • atenolol

                glucagon 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.

              • betaxolol

                glucagon 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 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.

              • carvedilol

                glucagon 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 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.

              • esmolol

                glucagon 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.

              • indomethacin

                indomethacin decreases effects of glucagon 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.

              • metoprolol

                glucagon 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 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 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 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.

              • pindolol

                glucagon 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 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.

              • sotalol

                glucagon 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 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.

              • warfarin

                glucagon increases effects of warfarin by unknown mechanism. Use Caution/Monitor.

              Minor (0)

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                Adverse Effects

                >10%

                Gvoke

                • Nausea (36-54%)
                • Hypoglycemia (27-54%)
                • Vomiting (14-23%)
                • Headache (15%)
                • Hyperglycemia (8-14%)

                1-10%

                GlucaGen

                • Nausea (<10%)

                Gvoke

                • Injection site reaction (9%)
                • Abdominal pain (8%)
                • Injection site discomfort (8%)
                • Urticaria (8%)

                <1%

                GlucaGen

                • Vomiting
                • Hypoglycemia
                • Hypoglycemia coma

                Frequency Not Defined

                Nausea and vomiting

                Rash

                Hypotension

                Tachycardia

                Increased blood pressure

                Increased pulse

                Respiratory distress

                Urticaria

                Hypoglycemic coma

                Hypoglycemia

                Postmarketing Reports

                Necrolytic migratory erythema

                Gvoke

                • Hypoglycemia and hypoglycemic coma
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                Warnings

                Contraindications

                Hypersensitivity

                Pheochromocytoma

                Insulinoma

                Glucagonoma when used as diagnostic tool

                Cautions

                Contraindicated in patients with pheochromocytoma; glucagon may stimulate the release of catecholamines from the tumor; if the patient develops a dramatic increase in blood pressure, 5-10 mg of phentolamine mesylate has been shown to be effective in lowering blood pressure for the short time that control would be needed

                Used as diagnostic aid may increase myocardial oxygen demand, blood pressure, and pulse rate which may be life-threatening in patients with cardiac disease; cardiac monitoring recommended in patients with cardiac disease during use as a diagnostic aid, and an increase in blood pressure and pulse rate may require therapy

                Generalized allergic reactions, including urticaria, respiratory distress, and hypotension reported; if symptoms occur discontinue and treat as indicated

                Treatment is effective in treating hypoglycemia only if sufficient hepatic glycogen present; patients in states of starvation, with adrenal insufficiency or chronic hypoglycemia may not have adequate levels of hepatic glycogen for therapy to be effective; patients with these conditions should be treated with glucose

                Increased blood pressure and heart rate in patients with cardiac disease reported; monitor patients with known cardiac disease

                Caution should be observed when used as an adjunct in endoscopic or radiographic procedures to inhibit gastrointestinal motility in patients with known cardiac disease

                Consider measuring blood glucose to monitor response

                Treatment with in patients with diabetes mellitus may cause hyperglycemia; monitor diabetic patients for changes in blood glucose levels during treatment and treat if indicated

                Necrolytic migratory erythema

                • Necrolytic migratory erythema (NME), a skin rash commonly associated with glucagonomas (glucagon-producing tumors) and characterized by scaly, pruritic erythematous plaques, bullae, and erosions, reported postmarketing following continuous glucagon infusion
                • NME lesions may affect face, groin, perineum and legs or be more widespread
                • In reported cases NME resolved with discontinuation of glucagon, and treatment with corticosteroids was not effective
                • Should NME occur, consider whether benefits of continuous glucagon infusion outweigh risks

                Insulinoma and glucagonoma

                • Do not be administered to patients suspected of having insulinoma
                • In patients with insulinoma, IV glucagon may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia
                • Administration may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma
                • A patient developing symptoms of hypoglycemia after dose should be given glucose PO/IV
                • Use contraindicated in patients with glucagonoma when used as diagnostic aid; test patients suspected of having glucagonoma for blood levels of glucagon prior to treatment, and monitor for changes in blood glucose levels during treatment

                Drug interaction overview

                • Beta-blockers
                  • Patients taking beta-blockers may have a greater increase in both pulse and blood pressure, an increase of which will be temporary because of glucagon’s short half-life.
                • Indomethacin
                  • Use with caution
                  • When used with indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia
                • Anticholinergic drugs
                  • Coadministration with an anticholinergic drug is not recommended due to increased gastrointestinal side effects
                • Warfarin
                  • Use with caution
                  • Glucagon may increase the anticoagulant effect of warfarin
                • Insulin
                  • Insulin reacts antagonistically towards glucagon
                  • Use with caution when used as a diagnostic aid in diabetes patients
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                Pregnancy & Lactation

                Pregnancy

                Available data from case reports and a small number of observational studies 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 human placental barrier during early gestation

                Animal data

                • In rat and rabbit reproduction studies, no embryofetal toxicity was observed with glucagon administered by injection during period of organogenesis at doses representing up to 100 and 200 times the human dose, respectively, based on body surface area (mg/m2)

                Lactation

                There is no information available on presence of glucagon in human or animal milk, effects on breastfed child or on milk production; however, glucagon is a peptide and would be expected to be broken down to its constituent amino acids in 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.

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                Pharmacology

                Mechanism of Action

                Insulin antagonist

                Stimulates cAMP synthesis to accelerate hepatic glycogenolysis and gluconeogenesis, causing an increase in blood glucose levels

                Preexisting hepatic glycogen stores necessary to be effective in treating hypoglycemia

                Glucagon also relaxes smooth muscles of GI tract

                Absorption

                Peak plasma concentration

                • GlucaGen IM: 1686 pg/mL
                • Gvoke SC: 2481.3 pg/mL

                Peak plasma time

                • Glucagen IM: 12.5 min
                • SC: 30-45 min (GlucaGen); 50 min (Gvoke)

                AUC

                • Gvoke SC: 3454.6 pg⋅min/mL

                Onset

                • GlucaGen IV: 45 sec (0.25- to 0.5-mg, 2-mg dose)
                • GlucaGen IM: 8-10 min (1-mg dose); 12-27 min (2-mg dose)

                Duration of smooth muscle relaxation

                • GlucaGen IV: 9-17 min (0.25-0.5 mg-dose); 22-25 min (2-mg dose)
                • GlucaGen IM: 12-27 min (1-mg dose); 21-32 min (2-mg dose)

                Time of maximal glucose concentration

                • GlucaGen IV: 5-20 min
                • GlucaGen IM: 30 min

                Distribution

                Vd

                • Gvoke SC: 137-2425 L

                Metabolism

                • IM: Degraded by the liver, kidney, and plasma

                Elimination

                Half-life

                • Glucagen IM: 45 min
                • Gvoke SC: 32 min
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                Administration

                IV Preparation

                Reconstitute by adding 1 or 10 mL of sterile diluent to a vial containing 1 or 10 units of drug, respectively, to yield solutions containing 1 mg/mL

                If dose <2 mg, use only diluent provided by Mfr

                If >2 mg, use SWI

                Use immediately after reconstitution

                Parenteral Administration

                GlucaGen

                • May be give IV, IM, or SC
                • Administer IM or SC in upper arm, thigh, or buttocks
                • Emergency assistance should be sought immediately after SC or IM administration
                • IV glucose must be administered if patient fails to respond to glucagon
                • Once patient responds to treatment, give fast-acting and long-acting oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia

                Gvoke

                • SC administration only in lower abdomen, outer thigh, or outer upper arm
                • Severe hypoglycemia requires the help of others to recover, instruct patient to inform those around them about glucagon and its use
                • Administer as soon as possible when severe hypoglycemia is recognized
                • Call for emergency assistance immediately after administering the dose
                • When patient responds to treatment, give oral carbohydrates to restore the liver glycogen and prevent recurrence of hypoglycemia
                • Do not attempt to reuse injection; each device contains a single dose of glucagon and cannot be reused
                • Preparation
                  • Do not open foil pouch until ready to administer; administer according to the printed instructions on the foil pouch label, carton, or instructions for use
                  • Visually inspect before administration; solution should appear clear and colorless to pale yellow and be free of particles; if the solution is discolored or contains particulate matter, do not use

                Storage

                GlucaGen

                • Unopened package: Store at room temperatures (20-25ºC [68-77ºF]); do not freeze; protect from light
                • Reconstituted vials: Use immediately; discard any unused portion

                Gvoke

                Store at room temperatures (20-25ºC [68-77ºF]); excursions permitted between 15-30ºC (59-86ºF)

                Do not refrigerate or freeze

                Store in original sealed foil pouch until time of use; do not expose to extreme temperatures

                Do not use after the expiration date printed on carton and foil pouch

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                Formulary

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
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                QL Quantity Limits
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                ST Step Therapy
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.