Usual Adult Dose for Diagnostic

For relaxation of the stomach, duodenal bulb, duodenum, and small bowel:
IV: 0.2 mg to 0.5 mg IV prior to procedure
IM: 1 mg IM prior to procedure

For relaxation of the colon:
IV: 0.5 mg to 0.75 mg IV prior to procedure
IM: 1 mg to 2 mg IM prior to procedure

Comments:

• May be given IV or IM; onset of action will depend on the route of administration and the organ under examination.
• This drug is not recommended in combination with anticholinergic agents due to the possibility of increased side effects.
• After completion of the diagnostic procedure, oral carbohydrates should be given to patients who have been fasting as long as it is compatible with the procedure performed.

Use: As diagnostic aid during radiologic examinations to temporarily inhibit movement of the gastrointestinal tract.

Usual Adult Dose for Hypoglycemia

Glucagon Emergency Kit and GlucaGen HypoKit: 1 mg IM/IV or subcutaneously once
GVOKE Auto-Injector and Prefilled Syringes: 1 mg subcutaneously once

REPEAT DOSE: An unconscious patient will usually awaken within 15 minutes following treatment; if response is delayed, may repeat dose while waiting for emergency assistance

Nasal:
1 actuation (3 mg) into 1 nostril once

• If there is no response after 15 minutes, may administer an additional 3 mg dose from a new device while waiting for emergency assistance

Comments:

• Administer IV only under medical supervision.
• Patients should receive supplemental carbohydrates as soon as possible to restore liver glycogen and prevent recurrence of hypoglycemia.
• Patients who do not respond should receive IV glucose.

Use: For the treatment of severe hypoglycemia.

Usual Pediatric Dose for Hypoglycemia

Glucagon Emergency Kit and GlucaGen HypoKit:
WEIGHT-BASED DOSING:
Glucagon: Less than 20 kg: 0.5 mg (or 20 to 30 mcg/kg) IM/IV or subcutaneously once
Glucagon: 20 kg or greater: 1 mg IM/IV or subcutaneously once
GlucaGen: Less than 25 kg: 0.5 mg IM/IV or subcutaneously once
GlucaGen: 25 kg or greater: 1 mg IM/IV or subcutaneously once

AGE-BASED DOSING (when weight is unknown):
Less than 6 years: 0.5 mg IM/IV or subcutaneously once
6 years or older: 1 mg IM/IV or subcutaneously once

GVOKE Auto-Injector and Prefilled Syringes:
2 to 12 years (weight less than 45 kg): 0.5 mg subcutaneously once
2 to 12 years (weight 45 kg or greater): 1 mg subcutaneously once
12 years or older: 1 mg subcutaneously once

REPEAT DOSE: An unconscious patient will usually awaken within 15 minutes following treatment; if response is delayed, may repeat dose while waiting for emergency assistance

NASAL:
4 years or older: 1 actuation (3 mg) into 1 nostril once

• If there is no response after 15 minutes, an additional 3 mg dose from a new device may be administered while waiting for emergency assistance

Comments:

• Administer IV only under medical supervision.
• After patient has responded to treatment, supplemental carbohydrates should be given to restore liver glycogen and prevent recurrence of hypoglycemia.
• Patients who do not respond should receive IV glucose.

Uses: For the treatment of severe hypoglycemia.

• Gvoke auto-injector and prefilled syringes for subcutaneous use are indicated in patients 2 years or older; Baqisimi nasal powder is indicated in patients 4 years or older.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Elderly Patients: Diagnostic use: Dosing should be conservative, usually starting at the low end of the dosing range.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to active substance or any product excipients; anaphylactic shock with breathing difficulties and hypotension have been reported
• Pheochromocytoma because of risk of substantial increase in blood pressure
• Insulinoma because of risk of hypoglycemia
• Glucagonoma (when used as a diagnostic aid) due to risk of hypoglycemia

Safety and efficacy for use as a diagnostic aid have not been established in patients younger than 18 years.
Safety and efficacy of nasal administration have not been established in patients younger than 4 years.
Safety and efficacy of Gvoke autoinjector and prefilled syringes have not been established in patients younger than 2 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
Nasal Use:

• Do not push the plunger or test device prior to administration; each tube contains 1 device/1 dose; store in shrink wrapped tube until ready to use
• Administer 1 actuation into 1 nostril by inserting tip of intranasal device into 1 nostril and pressing device plunger all the way until the green line is no longer showing; the dose does not need to be inhaled
• If there is no response after 15 minutes, administer a second dose from a new device

Parenteral Use:
Glucagon Emergency Kit and GlucaGen HypoKit:

• Completely dissolve powder with diluent provided in the kit; shake vial gently until dissolved; use immediately after reconstitution; discard any unused portion; if a second injection is needed, use a new kit
• Administer IV, IM or subcutaneously; common injection sites include upper arms, thighs, or buttocks

GVOKE Auto-Injector and Prefilled Syringes:

• Do not open foil pouch until ready to administer
• Administer subcutaneously in lower abdomen, outer thigh, or outer upper arm
• Do not attempt to reuse; each device contains a single dose and cannot be reused

Treatment of Severe Hypoglycemia:

• Caregivers, family members, and school personnel may safely administer this drug after receiving proper instruction; emergency assistance should be sought immediately after administration
• An unconscious patient will usually awaken within 15 minutes following treatment; if there is no response after 15 minutes, a second dose should be given while waiting for emergency assistance

As a Diagnostic Aid: Restricted to use by medical personnel

• The GlucaGen diagnostic kits and GlucaGen 10-packs are not intended to treat severe hypoglycemia because they are not packaged with a syringe and diluent necessary for rapid preparation and administration during an emergency
• Completely dissolve powder with diluent provided or with 1 mL of sterile water for reconstitution; shake vial gently until dissolved

Storage requirements:

• Store at room temperature in original package; protect from light; do not freeze
• Glucagon Emergency Kit and GlucaGen HypoKit: Use immediately after reconstitution; discard any unused portion
• Gvoke Autoinjector and Prefilled Syringes: Store in original sealed foil pouch until time of use
• Nasal: Store in shrink wrapped tube until ready to use; if tube has been opened, moisture may cause the product to be ineffective; discard tube after use

General:

• An unconscious person experiencing severe hypoglycemia will usually awaken within 15 minutes following glucagon administration; if response is delayed, a second dose may be administered; emergency aid should be sought so that IV glucose may be given if needed.
• Once patient has responded to treatment for severe hypoglycemia, supplemental carbohydrates should be taken as soon as possible to restore liver glycogen and prevent recurrence of hypoglycemia.
• When used as a diagnostic aid, oral carbohydrates should be given to patients who have been fasting as long as it is compatible with the procedure performed.

Monitoring:

• Severe hypoglycemia; Blood glucose should be obtained until patient is asymptomatic

Patient advice:

• Patients should be instructed to read the FDA-approved patient labeling (Patient Information and Instructions for Use)
• Patients, family members, and caregivers should understand that severe hypoglycemia is a medical emergency and emergency medical assistance should be sought immediately after administering glucagon.
• Patients, family members, and caregivers should be familiar with preparation and product use prior to the emergence of severe hypoglycemia; his/her physician should be informed each time a severe hypoglycemic reaction occurs.
• Patients should understand that hypoglycemia affects a person's ability to concentrate and therefore tasks that require these abilities such as driving should be avoided until the risk of hypoglycemia is minimized.

Frequently asked questions

• Are glucagon and glycogen the same thing?
• When should you use glucagon?
• Insulin vs Glucagon - What do they have in common?
• How does the release of glucagon affect blood glucose levels?
• How long does Baqsimi last?
• How much does Baqsimi cost?
• Is Baqsimi covered by Medicare?
• How do you use Baqsimi nasal powder?
• How do you administer a glucagon injection kit?
• How do you use the GlucaGen hypokit?
• What is Gvoke (glucagon) used for and how does it work?