Glucagon Injection

WHY is this medicine prescribed?

Glucagon is used along with emergency medical treatment to treat very low blood sugar. Glucagon is also used in diagnostic testing of the stomach and other digestive organs. Glucagon is in a class of medications called glycogenolytic agents. It works by causing the liver to release stored sugar to the blood. It also works by relaxing smooth muscles of the stomach and other digestive organs for diagnostic testing.

Are there OTHER USES for this medicine?

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Glucagon comes as a solution (liquid) in a prefilled syringe and an auto-injector device to inject subcutaneously (just under the skin). It also comes as a powder to be mixed with a provided liquid to be injected subcutaneously, intramuscularly (into the muscle), or intravenously (into a vein). It is usually injected as needed at the first sign of severe hypoglycemia. After the injection, the patient should be turned onto their side to prevent choking if they vomit. Use glucagon injection exactly as directed; do not inject it more often or inject more or less of it than prescribed by your doctor.

Ask your doctor or pharmacist to show you, family, or caregivers who could be injecting the medication how to use and prepare glucagon injection. Before a friend or family member uses glucagon injection for the first time, read the patient information that comes with it. This information includes directions for how to use the injection device. Be sure to ask your pharmacist or doctor if you or your caregivers have any questions about how to inject this medication.

Following a glucagon injection, an unconscious person with hypoglycemia (low blood sugar) will usually wake within 15 minutes. Once the glucagon has been given, immediately contact a doctor and get emergency medical treatment. If the person does not awaken within 15 minutes after an injection, give one more dose of glucagon. Feed the individual a fast-acting source of sugar (e.g., regular soft drink or fruit juice) and then a long-acting source of sugar (e.g., crackers, cheese or a meat sandwich) as soon as they awaken and are able to swallow.

Always look at the glucagon solution before it is injected. It should be clear, colorless, and free of particles. Do not use glucagon injection if it is cloudy, contains particles, or if the expiration date has passed. Ask your doctor or pharmacist how to dispose of the puncture-resistant container.

Glucagon can be injected with the prefilled syringe or autoinjector in the upper arm, thigh, or stomach. Never inject glucagon prefilled syringe or autoinjector into a vein or muscle.

It is important that all patients have a household member who knows the symptoms of low blood sugar and how to administer glucagon. If you have low blood sugar often, keep glucagon injection with you at all times. You should and a family member or friend should be able to recognize some of the signs and symptoms of low blood sugar (i.e., shakiness, dizziness or lightheadedness, sweating, confusion, nervousness or irritability, sudden changes in behavior or mood, headache, numbness or tingling around the mouth, weakness, pale skin, sudden hunger, clumsy or jerky movements). Try to eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, before it is necessary to administer glucagon.

Follow the directions on your prescription label carefully, and ask your pharmacist or doctor to explain any part you or your household members do not understand. Use glucagon exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

What SPECIAL PRECAUTIONS should I follow?

Before using glucagon injection,

• tell your doctor and pharmacist if you are allergic to glucagon, lactose, any other medications, beef or pork products, or any of the ingredients in glucagon injection. Ask your doctor or pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticholinergic medications such as benztropine (Cogentin), dicyclomine (Bentyl), or diphenhydramine (Benadryl); beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal, Innopran); indomethacin (Indocin); insulin; or warfarin (Coumadin, Jantoven). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have pheochromocytoma (tumor on a small gland near the kidneys) or insulinoma (pancreatic tumors), Your doctor will probably tell you not to use glucagon injection.

• tell your doctor if you have ever had glucagonoma (pancreatic tumor), adrenal gland problems, malnutrition or heart disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What SIDE EFFECTS can this medicine cause?

Glucagon may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• hives
• injection site swelling or redness
• headache
• fast heartbeat

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• difficulty breathing
• loss of consciousness
• rash with scaly, itchy red skin on the face, groin, pelvis, or legs

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not refrigerate or freeze it. Dispose of any medication that is damaged or should otherwise not be used and be sure to have a replacement available.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory.

Do not let anyone else use your medication. If your glucagon injection is used, be sure to get a replacement right away. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.