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Diazoxide

, Oral

Pronunciation: DIE-aze-OX-ide
Class: Glucose-elevating agent

Trade Names

Proglycem
- Oral suspension 50 mg/mL

Pharmacology

Produces prompt dose-related increase in blood glucose by inhibiting pancreatic insulin release.

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Pharmacokinetics

Distribution

90% protein bound. Crosses the placenta.

Elimination

t ½ is 24 to 36 h. Excreted by kidneys.

Onset

Within 1 h.

Duration

Less than 8 h.

Special Populations

Renal Function Impairment

t ½ is prolonged.

Indications and Usage

Management of hypoglycemia caused by hyperinsulinism in adults with inoperable islet cell adenoma or carcinoma, or extrapancreatic malignancy, in infants and children with leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma or adenomatosis.

Contraindications

Hypersensitivity to thiazides; functional hypoglycemia.

Dosage and Administration

Adults and Children

PO 3 to 8 mg/kg/day in 2 to 3 equal doses every 8 to 12 h.

Infants and Newborns

PO 8 to 15 mg/kg/day in 2 to 3 equal doses every 8 to 12 h.

Storage/Stability

Store at room temperature. Protect from light.

Drug Interactions

Antihypertensive agents

Enhanced antihypertensive effect.

Hydantoins

Possible loss of seizure control.

Sulfonylureas

Decreased pharmacologic effects of both drugs.

Thiazide diuretics

Increased hyperglycemic and hyperuricemic effects of diazoxide; hypotension.

Laboratory Test Interactions

Hypoglycemia and hyperuricemia produced by diazoxide may affect assessment of these metabolic states. Increased renin secretion and IgG concentrations and decreased cortisol secretion may occur. False-negative insulin response to glucagon may occur.

Adverse Reactions

Cardiovascular

Tachycardia; palpitations; hypotension; transient hypertension; chest pain.

CNS

Headache; weakness; malaise; anxiety; dizziness; insomnia; polyneuritis; paresthesia; extrapyramidal signs; fever.

Dermatologic

Hirsutism of lanugo type on forehead, back and limbs; skin rash; pruritus; monilial dermatitis; herpes; loss of scalp hair.

EENT

Transient cataracts; subconjunctival hemorrhage; ring scotoma; blurred vision; diplopia; lacrimation.

GI

Anorexia; nausea; vomiting; abdominal pain; ileus; diarrhea; transient loss of taste; acute pancreatitis; pancreatic necrosis.

Genitourinary

Azotemia; decreased Ccr; reversible nephrotic syndrome; decreased urinary output; hematuria; albuminuria; glycosuria.

Hematologic

Thrombocytopenia with or without purpura; transient neutropenia; eosinophilia; decreased Hgb or Hct; excessive bleeding; decreased IgG.

Metabolic

Hyperglycemia; increased serum uric acid; gout; galactorrhea; breast lump enlargement; increased AST and alkaline phosphatase.

Miscellaneous

Sodium and fluid retention; advance in bone age.

Precautions

Monitor

Observe for signs of hirsutism. Monitor for signs of ecchymosis, petechiae, or hemorrhage; drug may need to be discontinued.


Pregnancy

Category C .

Lactation

Undetermined.

Labor and Delivery

May cause cessation of uterine contractions.

Renal Function

May have decreased protein binding of diazoxide resulting in increased hypotensive effect.

Blood levels

May be higher with liquid than with capsule formulation; use caution when changing dosage forms.

Fluid retention

May precipitate CHF in patients with compromised cardiac reserve.

Ketoacidosis and nonketotic hyperosmolar coma

May occur with recommended doses.

Overdosage

Symptoms

Hypotension, hyperglycemia.

Patient Information

  • Instruct patient to take medicine as directed at the same time each day.
  • Review symptoms of hypoglycemia and hyperglycemia with patient and family.
  • Advise patient to follow prescribed diet, medication and exercise regimen to prevent hypoglycemic or hyperglycemic reactions.
  • Instruct patient to monitor blood glucose, urine glucose and ketones daily.
  • Instruct patient to report these symptoms to health care provider: bruising, bleeding, fluid retention.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension. Inform patient that hirsutism is common adverse reaction but should be reversed when drug is discontinued.

Copyright © 2009 Wolters Kluwer Health.

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