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Endogenous peptide hormone / antidote Pregnancy: Safe to use for severe hypoglycaemia in pregnancy.

Glucagon

Brand names: GlucaGen, Baqsimi (intranasal)

Adult dose

Dose: Hypoglycaemia: 1 mg IM/SC/IV; Beta-blocker/CCB overdose: 5–10 mg IV bolus, then 1–10 mg/hour infusion
Route: IM, SC, IV, or intranasal
Frequency: Single dose (hypoglycaemia); repeat if no response after 15 min
Max: 10 mg IV bolus (overdose protocol)
Severe hypoglycaemia (unable to swallow): 1 mg IM/SC immediately; repeat after 15 min if no response. Baqsimi: 3 mg intranasal single dose. Beta-blocker or CCB overdose: 5–10 mg IV bolus over 1 min, then continuous infusion matching bolus response rate.

Paediatric dose

Route: IM
Frequency: Single dose; repeat if needed
Max: 1 mg/dose
Concentration: 1 mg/ml
<25 kg: 0.5 mg IM. >25 kg: 1 mg IM. Baqsimi intranasal (≥4 years): 3 mg single dose. Neonatal hypoglycaemia: 0.2 mg/kg IM/SC (max 1 mg) — specialist guidance.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Use with caution in fasting states or hepatic failure (liver glycogen depleted — less effective).

Clinical pearls

  • Glucagon requires hepatic glycogen stores — may be ineffective in prolonged fasting, alcohol-related hypoglycaemia, or liver disease
  • Baqsimi nasal powder: lay patient on side (prevent aspiration from vomiting); works even if sniffing not optimal
  • After glucagon for hypoglycaemia: follow with oral carbohydrate when conscious and swallowing safely
  • Overdose protocol: high dose glucagon (5–10 mg IV) bypasses blocked beta-receptors — useful for severe beta-blocker or CCB toxicity
  • Contact NPIS for complex beta-blocker/CCB overdose management

Contraindications

  • Phaeochromocytoma (releases catecholamines)
  • Insulinoma
  • Glucagonoma

Side effects

  • Nausea and vomiting
  • Tachycardia
  • Hypertension
  • Hypokalaemia
  • Hyperglycaemia (rebound)

Interactions

  • Warfarin — may increase anticoagulant effect

Monitoring

  • Blood glucose every 15 min
  • HR and BP (overdose protocol)
  • Level of consciousness

Reference: BNFc; BNF; JBDS Hypoglycaemia Guidelines; TOXBASE. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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