Beta Blockers
Moderate
Database
Glucagon used to bypass beta-blockade (intended)
High-dose glucagon protocol with monitoring
Source: Kimi deep-research + Cla
Drug reference
Glucagon
Pancreatic alpha-cell peptide hormone (29 aa) · Antihypoglycemic
Also known as glucagon (as hydrochloride)
START
Severe hypoglycaemia: 1 mg IM/SC (or 3 mg nasal)
TYPICAL MAX
10 mg IV bolus (BB/CCB overdose); 1 mg/dose hypoglycaemia
STOP IF
Adverse cardiovascular event or phaeochromocytoma crisis
WATCH
Glucose, BP, ECG; give carbohydrate as soon as patient can swallow
CDSCO approvedATC H04AA01
KDIGO 2024 + manufacturer label
- ONSET
- 3min · IV onset
- PEAK
- 24min · peak effect
- t½
- 12min · t½ ~12 min
- DURATION
- 45min · per dose
EXCRETION
Hepatic/renal peptidases; no intact excretion
route + CYP
INTERACTIONS
—
none in our sources
PREGNANCY
Acceptable in emergency (severe hypoglycaemia) — benefit outweighs risk.
FDA category + note
Mechanism
Binds hepatic glucagon receptors → cAMP-mediated glycogenolysis and gluconeogenesis, raising plasma glucose; positive inotropic/chronotropic effects via cAMP at supratherapeutic doses (beta-blocker overdose); smooth-muscle relaxation (gut imaging).
Indications
Severe hypoglycaemia (rescue)Beta-blocker / calcium-channel-blocker overdose with shockGastrointestinal radiologic procedures (smooth-muscle relaxation)Adjunctive endoscopy (motility reduction)
Dosing
- Adult
- Severe hypoglycaemia: 1 mg IM/SC/IV (nasal 3 mg). Beta-blocker overdose: 5–10 mg IV bolus, then 1–10 mg/h infusion. GI imaging: 0.25–2 mg IV/IM.
- Pediatric
- <25 kg: 0.5 mg; ≥25 kg: 1 mg IM/SC for severe hypoglycaemia.
- Renal adjustment
- No adjustment.
- Hepatic adjustment
- Effect attenuated in severe hepatic disease (low glycogen stores).
- Geriatric
- Standard emergency dose; lower threshold for cardiac monitoring.
- Max dose
- 10 mg IV bolus (beta-blocker overdose); 1 mg per emergency dose
Pharmacokinetics
Onset
IV ~1 min; IM/SC ~5–15 min
Peak effect
~15–30 min
Duration
~30–60 min
Half-life
~8–18 min
Bioavailability
IV/IM/SC/nasal (rapidly degraded orally)
Protein binding
Minimal
Metabolism
Hepatic/renal peptidase degradation
Excretion
Catabolised (no intact excretion)
Contraindications
- Phaeochromocytoma (catecholamine release)
- Insulinoma
- Hypersensitivity to glucagon (bovine/porcine remnants)
- Glucagonoma (relative)
Side effects
Common
Nausea/vomitingHeadacheTransient hyperglycaemiaInjection-site reactions
Serious
- Severe hypertension (phaeochromocytoma)
- Severe hyperglycaemia (insulinoma rebound)
- Anaphylaxis (rare)
- Hypokalaemia (potassium shift)
Pregnancy & lactation
Pregnancy
Acceptable in emergency (severe hypoglycaemia) — benefit outweighs risk.
Lactation
Compatible (peptide; rapidly degraded; not orally bioavailable to infant).
Drug interactions
Indomethacin
Moderate
Database
Antagonism of glucagon hyperglycaemic effect
Use alternative or higher dose; give carbohydrate
Source: Kimi deep-research + Cla
Insulin
Moderate
Database
Direct antagonism
Standard sequence in hypoglycaemia management
Source: Kimi deep-research + Cla · p58
Warfarin
Moderate
Database
Possible enhanced anticoagulation
Monitor INR if repeated dosing
Source: Kimi deep-research + Cla
Anticholinergics
Mild
Database
Additive GI motility reduction
Standard imaging adjunct use
Source: Kimi deep-research + Cla
7 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Glucagon
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20