From the Guidelines
Glucagon is not a first-line treatment for anaphylaxis, but it may be considered in specific situations where a patient is experiencing anaphylaxis and is on beta-blocker medications, which can make them resistant to epinephrine treatment. Epinephrine (adrenaline) is the primary medication for treating anaphylaxis, typically administered as 0.3-0.5 mg intramuscularly in adults or 0.15 mg in children, which can be repeated every 5-15 minutes if needed 1. Glucagon may be used in cases where beta-blocker therapy complicates treatment, as it has inotropic and chronotropic effects that are not mediated through β-receptors 1. In these cases, glucagon (1-5 mg intravenously over 5 minutes, followed by infusion of 5-15 μg/min) may help improve cardiac output and blood pressure 1, 2.
Key Points to Consider
- Glucagon should only be administered by healthcare professionals familiar with its use in this specific context.
- The use of glucagon in anaphylaxis is a specialized application and not part of routine anaphylaxis management.
- Glucagon works by increasing blood glucose levels and has cardiac effects that can counteract beta-blocker resistance.
- Aspiration precautions should be observed because glucagon can cause nausea and emesis 2.
Administration Guidelines
- A single dose of 1 to 5 mg in adults (in children, 20 to 30 μg/kg, to a maximum of 1 mg) administered intravenously over 5 minutes is recommended, which may be repeated or followed by an infusion of 5 to 15 μg/minute 1.
- Rapid administration of glucagon can induce vomiting, so caution is advised 1.
From the FDA Drug Label
Allergic reactions have been reported with glucagon, these include generalized rash, and in some cases anaphylactic shock with breathing difficulties and hypotension. The FDA drug label does not answer the question of how glucagon works in anaphylaxis, it only mentions that anaphylactic shock is a possible allergic reaction to glucagon.
From the Research
Role of Glucagon in Anaphylaxis
- Glucagon is considered an adjunct medication in the treatment of anaphylaxis, to be used after epinephrine administration 3.
- The use of glucagon in anaphylaxis is mentioned as part of the supportive care for patients, particularly in cases where beta-blockers may be involved, as glucagon can help bypass the beta-adrenergic blockade caused by these medications.
- However, the primary studies provided do not extensively discuss the role of glucagon in anaphylaxis management, focusing more on epinephrine, antihistamines, and corticosteroids 4, 3, 5, 6, 7.
Management of Anaphylaxis
- The key to managing anaphylaxis is early epinephrine administration, which can improve outcomes and prevent progression to severe and fatal anaphylaxis 4, 3, 5, 7.
- Other essential components of anaphylaxis management include positioning in a recumbent supine position, airway management, and intravenous fluids 4.
- Antihistamines and glucocorticosteroids should not be prescribed in place of epinephrine but may be considered as adjunct treatments after epinephrine administration 4, 3.
Adjunct Treatments
- Adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered after epinephrine administration 3.
- The decision to use these medications should be based on the patient's specific condition and response to initial treatment with epinephrine.