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brand glucagon 1 mg emergency kit

In stock Manufacturer ELI LILLY & CO. 00002803101
$286.01 / Vial

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Uses

Hypoglycemia

Glucagon is used for the emergency treatment of severe hypoglycemia. Glucagon is only effective in patients with hypoglycemia if liver glycogen is available; the drug is of little or no value in patients with chronic hypoglycemia or in those with hypoglycemia associated with starvation or adrenal insufficiency. The increase in blood glucose concentration produced by glucagon is not as great in patients with type 1 diabetes mellitus as compared to those with type 2 diabetes mellitus; supplemental carbohydrate should be administered as soon as possible, especially to pediatric patients. The hyperglycemic response produced by glucagon may be reduced in emaciated or undernourished patients or in those with uremia or hepatic disease. Unlike IV dextrose, parenteral administration of glucagon results in a smooth, gradual termination of insulin coma. Glucagon is convenient for use in emergency situations when dextrose cannot be administered IV.

Depending on the stage of coma and the route of administration, patients usually become conscious within 5-20 minutes following parenteral administration of glucagon. After the patient responds, supplemental carbohydrate should be administered to restore liver glycogen and prevent secondary hypoglycemia. In patients in very deep coma, IV dextrose should be administered in addition to glucagon. If an unconscious diabetic patient suspected of being in insulin coma does not awaken following administration of glucagon, an additional dose of glucagon can be administered; emergency assistance should be sought. Other causes of coma should be considered. Failure of glucagon to relieve the coma may be caused by marked depletion of hepatic glycogen stores or irreversible brain damage resulting from prolonged hypoglycemia. In emergency situations in which hypoglycemia is suspected but not established, glucagon shouldnot be substituted for IV dextrose.

Radiographic Examination of the GI Tract

Glucagon is used as a diagnostic aid in the radiographic examination of the stomach, duodenum, small intestine, and colon when a hypotonic state would be advantageous. Glucagon appears to be as effective as antimuscarinics for this purpose and is associated with fewer adverse effects. Concomitant administration of glucagon and an antimuscarinic agent may result in increased adverse effects.

Other Uses

Glucagon has been used with some success as a cardiac stimulant for the management of cardiac manifestations (e.g., bradycardia, hypotension, myocardial depression) associated with severe β-adrenergic blocking agent overdosage or calcium-channel blocking agent overdosage. Glucagon has successfully reversed such manifestations in patients unresponsive to other drugs (e.g., atropine, epinephrine, dopamine, dobutamine), and should be administered early in the management of severe β-blocker overdosage. Experience in calcium-channel blocker overdosage is more limited, but glucagon (combined with inamrinone in at least one case) has been similarly effective in some patients.

Dosage and Administration

Reconstitution and Administration

Glucagon and glucagon hydrochloride may be administered by subcutaneous, IM, or IV injection.

Glucagon (rDNA origin) for injection (Lilly) is reconstituted by adding 1 mL of sterile diluent to a vial labeled as containing 1 mg of the drug to provide a solution containing 1 mg of glucagon per mL. Concentrations greater than 1 mg/mL should not be used. Only the diluent provided by the manufacturer (Lilly) should be used to reconstitute glucagon, and the diluent should not be used to reconstitute other drugs.

Glucagon (rDNA origin) for injection (GlucaGen) is reconstituted by adding 1 mL of sterile water for injection to a vial labeled as containing 1 mg of glucagon to provide a solution containing approximately 1 mg of glucagon per mL.

Reconstituted solutions of glucagon should be used immediately; any unused portion should be discarded.

Dosage

Dosage of glucagon hydrochloride (GlucaGen) is expressed in terms of glucagon.

Hypoglycemia

For the emergency treatment of severe hypoglycemia in adults and children weighing more than 20 kg, the usual subcutaneous, IM, or IV dose of glucagon (rDNA origin, Lilly) is 1 mg. The usual subcutaneous, IM, or IV dose of glucagon (rDNA origin, Lilly) in children weighing less than 20 kg is 0.5 mg; alternatively, a dose of 20-30 mcg/kg can be administered in children weighing less than 20 kg.

For the emergency treatment of severe hypoglycemia in adults and children weighing 25 kg or more, the usual subcutaneous, IM, or IV dose of glucagon (rDNA origin, GlucaGen) is 1 mg. The usual subcutaneous, IM, or IV dose of glucagon (rDNA origin, GlucaGen) in children weighing less than 25 kg or younger than 6-8 years of age is 0.5 mg. After the patient responds, supplemental carbohydrate should be administered to restore liver glycogen and prevent secondary hypoglycemia.

If the patient does not awaken within 15 minutes following administration of the drug, an additional dose may be administered; however, because of the potential serious adverse effects associated with prolonged cerebral hypoglycemia emergency aid should be sought so that parenteral dextrose can be given. If the patient fails to respond to glucagon, IV dextrose must be given.

Radiographic Examination of the GI Tract

When glucagon (rDNA) is used as a diagnostic aid in the radiographic examination of the stomach, duodenum, and small intestine in adults, 1 or 2 mg may be given IM or 0.25-2 mg may be given IV, depending on the onset of action and duration of effect required for the specific examination.(See Pharmacokinetics: Absorption.) Since the stomach is less sensitive to the effect of glucagon, the manufacturer (Lilly) recommends that doses of 0.5 mg IV or 2 mg IM be used when relaxation of the stomach is desired.

To facilitate a more satisfactory radiographic examination of the colon, a dose of 2 mg may be given as a single IM injection approximately 10 minutes prior to initiation of the procedure.

Other Uses

For the management of cardiac manifestations of β-blocker or calcium-channel blocker overdosage, glucagon has been administered as an initial IV dose of 50 mcg/kg over 1-2 minutes; higher doses may be needed if this is ineffective, and up to 10 mg may be needed in some adults. In many cases, the initial dose(s) may be followed by a continuous IV infusion at a rate of 2-5 mg/hour (maximum: 10 mg/hour) diluted in 5% dextrose injection; the infusion rate can then be tapered downward according to response.

Cautions

Adverse Effects

Glucagon is generally well tolerated, and adverse effects occur only rarely following administration of usual dosages of the drug for short periods of time. The most frequent adverse effects of glucagon are nausea and vomiting, which are dose related; however, these adverse effects may be caused by hypoglycemia rather than the drug. Allergic reactions, including rash, urticaria, and rarely, hypotension and anaphylactic shock with respiratory distress have been reported in patients receiving glucagon. Anaphylactic reactions generally have occurred in patients undergoing endoscopic examination who received glucagon as well as contrast media and local anesthetics.

Precautions

Glucagon should be used with caution in patients with a history of insulinoma and/or pheochromocytoma. Although IV administration of glucagon produces an initial increase in blood glucose concentration in patients with insulinoma, hypoglycemia may subsequently develop as a result of glucagon's insulin-releasing effect. Exogenous administration of glucagon stimulates the release of catecholamines, which may cause a marked increase in blood pressure in patients with pheochromocytoma.

When glucagon is used for the treatment of hypoglycemic shock, liver glycogen must be available. Administration of dextrose by IV injection or by gavage should be considered in patients with hypoglycemia.

Patients with diabetes mellitus should be fully and completely advised about the nature of the disease, what they must do to prevent and detect complications, and how to control their condition. Patients should be instructed that dietary regulation is the principal consideration in the management of diabetes, and that antidiabetic therapy is only used as an adjunct to, and not a substitute for, proper dietary regulation. Patients should also be advised that they cannot neglect dietary restrictions, develop a careless attitude about their condition, or disregard instructions about body weight control, exercise, hygiene, and avoidance of infection. Patients should be properly instructed in the early detection and treatment of hypoglycemia, and should be advised to routinely carry sugar, candy, or other readily absorbable carbohydrate so that it may be taken at the first sign of a developing hypoglycemic reaction; if patients are unaware of the symptoms of hypoglycemia, they may lapse into insulin shock. Patients (and their families) should be properly instructed in the technique of preparing and administering glucagon for injection before an emergency situation occurs. Although glucagon may be used for the treatment of hypoglycemia by the patient during an emergency, patients should be instructed to notify their physician when hypoglycemic reactions occur so that appropriate adjustment of insulin dosage can be made.

Since glucagon is a protein, the possibility of hypersensitivity reactions should be considered. In a 3-month study in individuals receiving either animal-source glucagon or biosynthetic glucagon (rDNA origin), glucagon-specific antibodies were not detected in either treatment group.

Pediatric Precautions

Glucagon has been used safely and effectively for the treatment of hypoglycemia in children. Safety and efficacy of glucagon in diagnostic procedures in children have not been established.

Pharmacokinetics

Absorption

Because of its polypeptide nature, glucagon is destroyed in the GI tract, and therefore must be administered parenterally.

Following parenteral administration of glucagon, maximum plasma or blood glucose concentrations occur within 30 minutes; hyperglycemic activity persists for 60-90 minutes. Following IV administration of a single 0.25- to 0.5-mg or 2-mg dose of the drug, relaxation of GI smooth muscle occurs within 1 minute and persists for 9-17 or 22-25 minutes, respectively. Following IM administration of a single 1-mg dose of the drug, relaxation of GI smooth muscle occurs within 8-10 minutes and persists for 12-27 minutes; after a single 2-mg IM dose, relaxation of GI smooth muscle occurs within 4-7 minutes and persists for 21-32 minutes.

Elimination

Following IV administration, glucagon has a plasma half-life of about 8-18 minutes. Following IM administration, a mean apparent half-life of 45 minutes has been reported. Although the exact metabolic fate of glucagon is not clearly established, the drug is extensively degraded in the plasma, liver, and kidneys.

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