From the Guidelines
Repeated glucagon use can lead to several concerning side effects, including nausea, vomiting, tachyphylaxis, hypersensitivity reactions, hypokalemia, hyperglycemia, and increased risk of necrolytic migratory erythema, and patients should be monitored for these effects, especially those with cardiovascular disease, and alternative hypoglycemia management strategies should be considered if frequent use becomes necessary. The most common immediate reactions to repeated glucagon use are nausea and vomiting, affecting up to 30% of patients 1. With frequent administration, patients may develop tachyphylaxis (decreased effectiveness) as glycogen stores become depleted, particularly in malnourished individuals or those with liver disease. Hypersensitivity reactions can occur, ranging from rash to anaphylaxis in rare cases. Hypokalemia may develop due to increased potassium uptake into cells. Hyperglycemia can worsen in diabetic patients with repeated use. Blood pressure and heart rate increases are common due to glucagon's catecholamine-like effects. Patients may experience headache, dizziness, and weakness. Some key points to consider when managing patients with repeated glucagon use include:
- Monitoring for signs of hypoglycemia and adjusting treatment regimens as needed 1
- Educating patients on the risks and benefits of glucagon use and alternative hypoglycemia management strategies 1
- Considering the use of alternative hypoglycemia treatments, such as glucose tablets or gel, for patients who experience frequent or severe hypoglycemia 1
- Regularly assessing cognitive function and adjusting treatment regimens as needed to prevent hypoglycemia-related cognitive decline 1
- Ensuring that patients have access to glucagon and know how to administer it in case of an emergency 1
- Considering the potential for increased risk of necrolytic migratory erythema with long-term or high-dose glucagon use 1
From the FDA Drug Label
What are the possible side effects of Glucagon Glucagon may cause serious side effects, including: High blood pressure. Glucagon can cause high blood pressure in certain people with tumors in their adrenal glands. Low blood sugar. Glucagon can cause low blood sugar in patients with tumors in their pancreas called insulinomas and Glucagonomas by making too much insulin in their bodies. Serious allergic reactions Call your doctor or get medical help right away if you have a serious allergic reaction including: rash difficulty breathing low blood pressure High blood sugar. If you receive Glucagon before your radiology exam it can cause high blood sugar. Your doctor will monitor your blood sugar levels during your treatment. Heart problems If you have heart problems and receive Glucagon before your radiology exam, you may have an increase in your blood pressure and pulse while using Glucagon which could be life threatening. Your doctor will monitor your heart during treatment. The most common side effects of Glucagon include: swelling at the injection site redness at the injection site vomiting nausea decreased blood pressure weakness headache dizziness pale skin diarrhea sleepiness or drowsiness The side effects of repeated glucagon use are not explicitly stated in the label, but the possible side effects of glucagon use in general include:
- Serious side effects: high blood pressure, low blood sugar, serious allergic reactions
- Common side effects: swelling at the injection site, redness at the injection site, vomiting, nausea, decreased blood pressure, weakness, headache, dizziness, pale skin, diarrhea, sleepiness or drowsiness 2
From the Research
Side Effects of Repeated Glucagon Use
- The provided studies do not directly address the side effects of repeated glucagon use 3, 4, 5, 6, 7.
- However, some studies mention side effects related to glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are not the same as glucagon, but may provide some insight into potential gastrointestinal side effects 6, 7.
- A study on GLP-1 RAs found that nausea and vomiting were frequent gastrointestinal adverse events, and that female sex, retinopathy, and treatment with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) were statistically significant risk factors for these side effects 6.
- Another study on GLP-1 RAs provided recommendations for managing gastrointestinal side effects in clinical practice, but did not specifically address repeated glucagon use 7.
- A case report on insulin glargine-associated nausea mentioned that the patient experienced episodes of nausea and emesis, but this is not directly related to glucagon use 5.
- Overall, there is limited information available on the side effects of repeated glucagon use, and more research is needed to fully understand the potential risks and benefits of repeated glucagon administration 3, 4.