What is the dose of glucagon (Glucagon) for treating globus?

Glucagon Dosing for Globus Pharyngeus

The recommended dose of glucagon for treating globus pharyngeus is 0.5-1.0 mg administered intravenously or intramuscularly. 1

Mechanism and Rationale

Glucagon can be helpful in the management of globus pharyngeus by:

• Relaxing the smooth muscle of the upper esophageal sphincter (UES)
• Reducing the elevated UES pressure that may contribute to globus sensation 2
• Providing temporary relief of the "lump in throat" sensation

Administration Protocol

1. Initial dose:

   • Adults: 0.5-1.0 mg IV/IM 1
   • Children: 20-30 μg/kg with maximum of 1 mg 1

2. Administration method:

   • Administer slowly over 3-5 minutes if given intravenously
   • Can be given as intramuscular injection if IV access is not available

3. Monitoring:

   • Observe for tachycardia, which is a common side effect 3
   • Monitor vital signs during and after administration
   • Be prepared for potential nausea/vomiting (occurs in approximately 80% of patients) 3

Important Considerations

• Temporary effect: Glucagon provides only temporary relief and is not a definitive treatment for globus
• Diagnostic use: May be used as part of a diagnostic workup to determine if muscle relaxation improves symptoms
• Contraindications:
  • Pheochromocytoma
  • Insulinoma
  • Known hypersensitivity to glucagon

Management of Side Effects

If tachycardia develops during glucagon administration:

• Discontinue or reduce the infusion rate 3
• Ensure adequate hydration
• Monitor vital signs frequently
• Consider ECG monitoring for arrhythmia detection 3

Comprehensive Management Approach

Glucagon should be considered as part of a broader approach to globus pharyngeus:

1. Rule out organic causes through nasolaryngoscopy and other appropriate tests
2. Consider acid suppression with high-dose proton pump inhibitors as empiric therapy 4
3. For persistent symptoms:
   • Speech and language therapy
   • Neuromodulators (antidepressants)
   • Cognitive-behavioral therapy 4, 5

Efficacy and Limitations

While glucagon can provide temporary relief by relaxing the UES, it does not address the underlying cause of globus pharyngeus. The condition often has multifactorial etiology including:

• Gastroesophageal reflux disease
• Psychological factors (stress, anxiety)
• Lifestyle factors (smoking, alcohol, high salt intake) 2

For long-term management, addressing these underlying factors is essential for symptom improvement.