Glucagon Injection / Solution

Glucagon injection (as Gvoke HypoPen, Gvoke Kit, and Gvoke PFS) is an emergency medicine for severe low blood sugar. Here is the full set of supported uses:

• Gvoke HypoPen, Gvoke Kit, and Gvoke PFS (subcutaneous injection): treatment of severe hypoglycemia in adults and children aged 2 years and older with diabetes

Glucagon is a naturally occurring hormone that works on the liver. When injected, it activates receptors on liver cells, telling them to break down stored glycogen (a form of stored sugar) and release glucose into the bloodstream — raising blood sugar back to a safe level. It also relaxes smooth muscle in parts of the stomach and intestines. For glucagon to raise blood sugar effectively, the liver must have enough stored glycogen. If glycogen stores are depleted — due to starvation, adrenal insufficiency, or prolonged low blood sugar — the drug may not work as expected.

Gvoke HypoPen, Gvoke Kit, and Gvoke PFS are each given as a single subcutaneous injection into the lower abdomen, outer thigh, or outer upper arm — use whichever site is most accessible in an emergency. Each device contains one dose; do not reuse it. After injecting, call for emergency assistance immediately. If there is no response after 15 minutes, a second dose from a new device may be given while waiting for help to arrive.

• Inject as soon as severe hypoglycemia is recognized — do not delay
• Once the person responds, give oral carbohydrates (like juice or crackers) to help restore the liver's glycogen stores and prevent the low blood sugar from coming back
• Always read the Instructions for Use that came with your prescription before an emergency happens — so you and caregivers are prepared

The most common side effects reported in clinical studies include:

• Nausea and vomiting (very common in both adults and children)
• Headache
• Injection site swelling, discomfort, or reaction
• Abdominal pain (in children)
• Low blood sugar after the dose — hypoglycemia (especially in children)
• High blood sugar after the dose — hyperglycemia (especially in children)
• Hives (urticaria) in some children

Serious reactions are less common but require immediate attention: a severe allergic reaction (rash, trouble breathing, very low blood pressure) or a significant spike in blood pressure or heart rate should be treated as a medical emergency.

• Pheochromocytoma: Do not use glucagon if you have this adrenal tumor — it can cause a dangerous, rapid rise in blood pressure.
• Insulinoma: Do not use if you have an insulin-producing tumor — glucagon can paradoxically trigger severe low blood sugar.
• Serious allergic reactions: Anaphylaxis (a life-threatening allergic reaction with trouble breathing and very low blood pressure) has been reported. Seek emergency care immediately if this occurs.
• Liver glycogen stores: Glucagon won't work well if the liver has little stored glycogen — this can happen with starvation, adrenal insufficiency, or chronic low blood sugar. Emergency backup (intravenous glucose) may be needed.
• Necrolytic migratory erythema (NME): A skin rash has been reported with continuous glucagon infusions — Gvoke products are not approved for continuous infusion use.
• Beta-blockers: Taking a beta-blocker medicine can cause a temporary rise in blood pressure and heart rate when glucagon is given — this may need treatment in people with coronary artery disease.

A few medications can change how glucagon works or increase side effects — tell your prescriber about everything you take:

• Beta-blockers (e.g., metoprolol, atenolol): may cause a temporary spike in pulse and blood pressure after glucagon — may need treatment in people with heart disease
• Indomethacin (an anti-inflammatory pain reliever): may blunt glucagon's ability to raise blood sugar, or may even cause low blood sugar — blood glucose should be monitored
• Warfarin (a blood thinner): glucagon can increase warfarin's blood-thinning effect — watch for unusual bruising or bleeding, and warfarin dose adjustments may be needed
• Insulin: insulin works against glucagon — blood glucose should be monitored when both are involved in care

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Do not use if you have a pheochromocytoma (an adrenal tumor) — risk of dangerous blood pressure surge
• Do not use if you have an insulinoma (an insulin-producing pancreatic tumor) — risk of severe low blood sugar
• Do not use if you have had a previous serious allergic reaction to glucagon or any ingredient in Gvoke
• Tell your prescriber if you are pregnant — available evidence has not shown harm to the baby, but data are limited
• Breastfeeding is likely safe — glucagon is a protein expected to break down in the infant's gut and is unlikely to cause harm; discuss with your doctor
• Not approved for children under 2 years of age
• May be less effective if you are malnourished, have adrenal insufficiency, or have had prolonged or repeated episodes of low blood sugar — the liver may lack sufficient glycogen stores
• Older adults: clinical studies did not include enough patients over 65 to know if they respond differently; use with the same caution and follow your prescriber's guidance

Too much glucagon can cause nausea, vomiting, a slowdown of the digestive tract, and a rise in blood pressure and heart rate. Blood potassium levels may drop and should be monitored and corrected if needed. If you suspect an overdose, contact the Poison Help line at 1-800-222-1222 or seek emergency medical care right away.

After a subcutaneous injection, glucagon raises blood glucose by triggering the liver to release stored sugar. In adults with type 1 diabetes, blood sugar levels rise significantly within a short window after injection. In children with type 1 diabetes (ages 2 to under 18), meaningful rises in blood glucose are also seen, with the size of the increase varying somewhat by age group. Glucagon also relaxes smooth muscle in the stomach, small intestine, and colon — an effect that has separate uses in medical imaging procedures.

After a subcutaneous injection in adults, glucagon is absorbed relatively quickly, reaching peak levels in the bloodstream in about 50 minutes. Its half-life — the time it takes for the body to clear half the drug — is about 32 minutes. Glucagon is broken down extensively by the liver, kidneys, and blood plasma. In children, age-appropriate doses produce similar glucagon blood levels across age groups, with peak levels reached somewhat earlier in younger children.

Store GVOKE HypoPen, GVOKE PFS, and GVOKE Kit (these three presentations are referred to as GVOKE in this labeling), and GVOKE VialDx at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Do not refrigerate or freeze.