Hypoglycaemia Antidote / Endocrine Agent Pregnancy: Can be used in pregnancy — hypoglycaemia risk to fetus outweighs any theoretical risk from glucagon.

Glucagon

Brand names: GlucaGen, Baqsimi (nasal powder)

Adult dose

Dose: Severe hypoglycaemia: 1mg IM, SC, or IV; Nasal powder (Baqsimi): 3mg intranasally (one actuation into one nostril)

Route: IM (preferred for out-of-hospital use) / IV / SC / Intranasal

Frequency: Single dose; repeat once after 15 minutes if no response (IM/SC route)

Max: 1mg per dose IM/IV; 3mg intranasally (single actuation only)

Administer with patient on their side (recovery position) — vomiting is common after glucagon. Once patient recovers consciousness, give oral fast-acting carbohydrate followed by complex carbohydrate. IV glucose preferred in hospital if IV access available. Baqsimi nasal powder: no reconstitution required — useful in emergency when IV access not possible.

Paediatric dose

Route: IM / SC

Frequency: Single dose

Max: 1mg

BNFc: <25kg or <8 years: 500 micrograms (0.5mg) IM/SC; ≥25kg or ≥8 years: 1mg IM/SC. Baqsimi nasal powder: licensed 4+ years (3mg intranasal). Seek specialist opinion for neonatal hypoglycaemia.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Reduced glycogen stores in hepatic failure may limit glucagon effectiveness — IV dextrose preferred.

Clinical pearls

Primary antidote for insulin-induced hypoglycaemia — every insulin-dependent diabetic should have glucagon kit at home with trained carer
Ineffective when hepatic glycogen stores depleted (prolonged fasting, alcohol excess, hepatic failure) — IV dextrose is more reliable in these situations
Beta-blocker overdose antidote: glucagon IV 5–10mg bolus then infusion 5–10mg/hr (high-dose regimen — seek toxicology advice)
Baqsimi nasal powder (3mg) — non-invasive option; equivalent efficacy to IM glucagon in studies; no IV access required

Contraindications

Phaeochromocytoma (releases catecholamines → hypertensive crisis)
Insulinoma (transient hyperglycaemia may stimulate further insulin secretion)
Hypersensitivity to glucagon or lactose (in formulation)

Side effects

Nausea and vomiting (common)
Transient hyperglycaemia followed by rebound hypoglycaemia
Hypertension and tachycardia (especially in phaeochromocytoma)

Interactions

Warfarin — glucagon enhances anticoagulant effect
Beta-blockers — glucagon used as antidote for beta-blocker overdose (large doses IV: 50–150 micrograms/kg bolus)

Monitoring

Blood glucose 15 minutes after administration
Level of consciousness
Vital signs
Blood glucose hourly for 2–3 hours after recovery (rebound hypoglycaemia risk)

Reference: BNFc; BNF 90; JBDS Hypoglycaemia Guidelines 2018; NICE NG17; Baqsimi SPC (Eli Lilly). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways

Same specialty