A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Glucagon Indications, Dosage, Storage, Stability - Glucagon
Glucagon Indications, Dosage, Storage, Stability - Glucagon
INDICATIONS
For the treatment of hypoglycemia:
Glucagon is indicated as a treatment
for severe hypoglycemia.
Because patients with type
1 diabetes may have
less of an increase in blood
glucose levels compared
with a stable type 2 patient,
supplementary carbohydrate
should be given as soon as possible, especially to a pediatric
patient.
For use as a diagnostic aid:
Glucagon is indicated as a diagnostic
aid in the radiologic examination
of the stomach, duodenum,
small bowel, and colon when diminished intestinal
motility would be advantageous.
Glucagon is as effective for this examination as are the anticholinergic
drugs. However, the addition
of the anticholinergic agent may result in increased side
effects.
DOSAGE AND ADMINISTRATION
General Instructions for Use:
- The diluent is provided
for use only in the preparation
of glucagon for parenteral
injection and for
no other use.
- Glucagon should not be used at concentrations greater than 1
mg/ mL (1 unit/ mL).
- Reconstituted glucagon
should be used immediately. Discard any unused portion.
- Reconstituted glucagon
solutions should be used only if they are clear and of a water-like
consistency.
- Parenteral drug products
should be inspected visually for particulate
matter and discoloration
prior to administration.
Directions for Treatment of Severe Hypoglycemia:
Severe hypoglycemia
should be treated initially with intravenous
glucose, if possible.
- If parenteral
glucose can not be
used, dissolve the lyophilized glucagon
using the accompanying diluting solution
and use immediately.
- For adults and for pediatric
patients weighing more than 44 lb
(20 kg), give 1 mg (1 unit)
by subcutaneous,
intramuscular, or intravenous
injection.
- For pediatric
patients weighing less than 44 lb
(20 kg), give 0.5 mg (0.5
unit) or a dose equivalent to 20- 30 µg/
kg.
- Discard any unused portion.
- An unconscious
patient will
usually awaken within 15 minutes following the glucagon
injection. If the response
is delayed, there is no
contraindication
to the administration
of an additional dose of glucagon; however, in view of the deleterious
effects of cerebral hypoglycemia, emergency
aid should be sought so
that parenteral
glucose can be given.
- After the patient
responds, supplemental carbohydrate should be given to restore
liver glycogen
and to prevent secondary hypoglycemia.
Directions for Use as a Diagnostic Aid:
Dissolve the lyophilized glucagon
using the accompanying diluting solution
and use immediately. Discard any unused portion.
The doses in the following table
may be administered for relaxation
of the stomach, duodenum,
and small bowel, depending on the onset and duration
of effect required for
the examination. Since the stomach is less sensitive
to the effect of glucagon,
0.5 mg (0.5 units) IV or
2 mg (2 units) IM are recommended.
|
Dose
|
Route of Administration
|
Time of Onset of Action
|
Approximate Duration of Effect
|
| 0.25- 0.5 mg
(0.25- 0.5 units)
|
IV
|
1 minute
|
9- 17 minutes
|
| 1 mg
(1 unit) |
IM
|
8- 10 minutes
|
12- 27 minutes
|
| 2 mg*( 2 units) |
IV
|
1 minute
|
22- 25 minutes
|
| 2 mg*( 2 units) |
IM
|
4- 7 minutes
|
21- 32 minutes
|
*Administration of 2 mg
(2 units) doses produces a higher incidence
of nausea and vomiting
than do lower doses.
For examination
of the colon, it is recommended that a 2 mg
(2 units) dose be administered
intramuscularly approximately 10 minutes prior to the procedure.
Colon relaxation
and reduction of patient
discomfort may allow the radiologist
to perform a more satisfactory examination.
HOW SUPPLIED
Glucagon Emergency Kit for Low Blood Sugar (Glucagon for Injection
[rDNA origin])
1 mg (1 unit)--( VL7529),
with 1 mL of diluting solution (Hyporet ® * HY7530) (1s) NDC
Glucagon Diagnostic Kit (Glucagon for Injection [rDNA origin])
(MS8085):
1 mg (1 unit)--( VL7529),
with 1 mL of diluting solution (Hyporet ® * HY7530) (1s) NDC
*Hyporet ® (disposable syringe,
Lilly).
Stability and Storage:
Before Reconstitution -- Vials of Glucagon, as well
as the Diluting Solution for Glucagon ,may be stored at controlled
room temperature 20 ° to 25 ° C (68 ° to 77 ° F)[see
USP].
The USP defines controlled room
temperature by the following: A temperature
maintained thermostatically that encompasses the usual and customary
working environment
of 20° to 25° C (68° to 77° F); that results in
a mean kinetic
temperature calculated
to be not more than 25° C; and that allows for excursions between
15° and 30° C (59° and 86° F) that are experienced
in pharmacies, hospitals, and warehouses.
After Reconstitution -- Glucagon for Injection (rDNA
origin) should be used immediately. Discard any unused portion.
REFERENCES
1. Drug Information for the Health Care Professional
. 18th ed. Rockville, Maryland: The United States Pharmacopeial
Convention, Inc; 1998;I: 1512.
2. Gibbs et al: Use of glucagon
to terminate insulin reactions in diabetic
children. Nebr Med J 1958; 43: 56- 57.
3. Cornblath M, et al: Studies of carbohydrate
metabolism in the newborn: Effect of glucagon
on concentration
of sugar in capillary
blood of newborn
infant. Pediatrics 1958; 21: 885- 892.
4. Carson MJ, Koch R: Clinical studies with glucagon
in children. J Pediatr 1955; 47: 161-170.
5. Shipp JC, et al: Treatment of insulin hypoglycemia
in diabetic campers.
Diabetes 1964; 13: 645- 648.
6. Aman J, Wranne L: Hypoglycemia in childhood
diabetes II: Effect of subcutaneous
or intramuscular
injection of different
doses of glucagon. Acta Pediatr Scand 1988; 77: 548- 553.
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