Chemical formula: C₁₅₃H₂₂₅N₄₃O₄₉S Molecular mass: 3,482.7 g/mol
Glucagon interacts in the following cases:
Glucagon reacts antagonistically towards insulin and caution should be observed if glucagon is used in patients with insulinoma. Caution should also be observed in patients with glucagonoma.
Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure, an increase of which will be temporary because of glucagon’s short half-life. The increase in blood pressure and pulse rate may require therapy in patients with coronary artery disease.
Glucagon may lose its ability to raise blood glucose or paradoxically may even produce hypoglycaemia.
Glucagon may increase the anticoagulant effect of warfarin.
Glucagon will not be effective in patients whose liver glycogen is depleted. For that reason, glucagon has little or no effect when the patient has been fasting for a prolonged period, or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol induced hypoglycaemia.
Caution should be observed when glucagon is used as an adjunct in endoscopic or radiographic procedures in diabetic patients or in elderly patients with known cardiac disease.
Glucagon does not cross the human placenta barrier. The use of glucagon has been reported in pregnant women with diabetes and no harmful effects are known with respect to the course of pregnancy and the health of the unborn and the neonate. Glucagon can be used during pregnancy.
Glucagon is cleared from the bloodstream very fast (mainly by the liver) (t1/2= 3–6 min.); thus the amount excreted in the milk of nursing mothers following treatment of severe hypoglycaemic reactions is expected to be extremely small. As glucagon is degraded in the digestive tract and cannot be absorbed in its intact form, it will not exert any metabolic effect in the child. Glucagon can be used during breast-feeding.
Animal reproduction studies have not been conducted with glucagon. Studies in rats have shown that glucagon does not cause impaired fertility.
After a severe hypoglycaemic event, the patient’s ability to concentrate and react may be impaired. Therefore the patient should not drive or operate machinery after a severe hypoglycaemic event until the patient has stabilised.
After diagnostic procedures hypoglycaemia has been reported infrequently. Therefore driving a vehicle and operating machinery should be avoided until the patient has had a meal with oral carbohydrates.
Severe adverse reactions are very rare, although nausea, vomiting and abdominal pain may occur occasionally. Hypersensitivity reactions, including anaphylactic reactions, have been reported as ‘very rare’ (less than 1 case per 10,000 patients). When used in the diagnostic indication, hypoglycaemia/hypoglycaemic coma have been reported, especially in patients who have fasted. Cardiovascular adverse events, such as tachycardia and blood pressure changes have only been reported when glucagon is used as an adjunct in endoscopic or radiographic procedures.
Frequencies of undesirable effects considered related to treatment with glucagon during clinical trials and/or post-marketing surveillance are presented below. Undesirable effects which have not been observed in clinical trials, but have been reported spontaneously, are presented as ‘very rare’. During marketed use reporting of adverse drug reactions is very rare (<1/10,000). However, post-marketing experience is subject to under-reporting and this reporting rate should be interpreted in that light.
Therapeutic indication:
| System Organ Class | Subject incidence | Adverse drug reaction |
|---|---|---|
| Immune system disorders | Very rare <1/10,000 | Hypersensitivity reactions including anaphylactic reaction/shock |
| Gastrointestinal disorders | Common ≥1/100 to <1/10 Uncommon ≥1/1,000 to <1/100 Rare ≥1/10,000 to <1/1,000 | Nausea Vomiting Abdominal pain |
Based on data from clinical trials and post-marketing experience, the frequency, type and severity of adverse reactions observed in children are expected to be the same as in adults.
Based on data from clinical trials and post-marketing experience, the frequency, type and severity of adverse reactions observed in elderly patients and in patients with renal or hepatic impairment are expected to be the same as in the general population.
Diagnostic indication:
| System Organ Class | Subject incidence | Adverse drug reaction |
|---|---|---|
| Immune system disorders | Very rare <1/10,000 | Hypersensitivity reactions including anaphylactic reaction/shock |
| Metabolism and nutrition disorders | Uncommon ≥1/1,000 to <1/100 Very rare <1/10,000 | Hypoglycaemia*1 Hypoglycaemic coma |
| Cardiac disorders | Very rare <1/10,000 | Tachycardia*2 |
| Vascular disorders | Very rare <1/10,000 Very rare <1/10,000 | Hypotension*2 Hypertension*2 |
| Gastrointestinal disorders | Common ≥1/100 to <1/10 Uncommon ≥1/1,000 to <1/100 Rare ≥1/10,000 to <1/1,000 | Nausea Vomiting Abdominal pain |
*1 After a diagnostic procedure this could be more pronounced in patients that have fasted.
*2 Cardiovascular adverse events have only been reported when glucagon is used as an adjunct in endoscopic or radiographic procedures.
There are no data available on the diagnostic use of glucagon in children.
Based on data from clinical trials and post-marketing experience, the frequency, type and severity of adverse reactions observed in elderly patients and in patients with renal or hepatic impairment are expected to be the same as in the general population.
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