Medically reviewed on Jan 27, 2019
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Proglycem: 50 mg/mL (30 mL) [chocolate mint flavor]
Brand Names: U.S.
- Antidote, Hypoglycemia
- Vasodilator, Direct-Acting
Opens ATP-dependent potassium channels on pancreatic beta cells in the presence of ATP and Mg2+, resulting in hyperpolarization of the cell and inhibition of insulin release. Diazoxide binds to a different site on the potassium channel than the sulfonylureas (Doyle, 2003).
Urine (50% as unchanged drug)
Onset of Action
Hyperglycemic: Oral: Within 1 hour
Duration of Action
Hyperglycemic: Oral: Normal renal function: ≤8 hours
Oral: Children: 9.5 to 24 hours; Adults: 24 to 36 hours
Special Populations: Renal Function Impairment
Plasma half-life is prolonged.
Use: Labeled Indications
Hyperinsulinemic hypoglycemia: Management of hypoglycemia due to hyperinsulinism due to the following conditions in adults (ie, inoperable islet cell adenoma or carcinoma, or extrapancreatic malignancy) and infants and children (ie, leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma, or adenomatosis; may be used preoperatively as a temporary measure, and postoperatively, if hypoglycemia persists).
Note: Consider treatment with diazoxide when other specific medical therapy or surgical management for hypoglycemia due to the above conditions either has been unsuccessful or is not feasible.
Hypersensitivity to diazoxide, other thiazides, or any component of the formulation; functional hypoglycemia
Hyperinsulinemic hypoglycemia: Oral: Initial dose: 3 mg/kg/day divided into 3 equal doses every 8 hours; dosing range: 3 to 8 mg/kg/day divided into 2 or 3 equal doses every 8 to 12 hours. Adjust dose until the desired clinical and laboratory effects are produced. Note: In certain instances, patients with refractory hypoglycemia may require higher doses. Discontinue if no effect after 2 to 3 weeks.
Refer to adult dosing.
Hyperinsulinemic hypoglycemia: Note: Diazoxide may not be effective for all types of hyperinsulinemic hypoglycemia. Dose should be individualized and may vary based on the cause (eg, genetic mutation, insulinomas) and severity of the hypoglycemic condition, blood glucose concentration, and clinical response of patient. Use the least amount of drug that achieves the desired clinical and laboratory results. For some hyperinsulinemic conditions, onset of action may vary; the manufacturer recommends discontinuation if no effect after 2 to 3 weeks; however, this may vary based on condition being treated and this timeframe. Often used in combination with a thiazide diuretic to ameliorate possible fluid retention that may occur with diazoxide therapy (Shah 2017).
Infants: Oral: Initial: 5 mg/kg/day in divided doses every 8 hours; gradually titrate; due to the long half-life it may take several days (eg, 5 days) to assess dose-response (Eichenwald 2017); usual range: 8 to 15 mg/kg/day in divided doses every 8 to 12 hours; reported range: 5 to 20 mg/kg/day in divided doses every 8 to 12 hours (Demirbilek 2017; Kapoor 2009; Shah 2017). Note: Pulmonary hypertension has been observed in neonates and infants while on diazoxide therapy; most frequently reported at doses ≥10 mg/kg/day; monitor neonates and infants closely while on therapy; consider baseline and periodic echocardiogram (Timlin 2017).
Children and Adolescents: Oral: Initial: 5 mg/kg/day in divided doses every 8 hours; reported range: 5 to 20 mg/kg/day in divided doses every 8 to 12 hours; usual range: 3 to 8 mg/kg/day in divided doses every 8 to 12 hours (Demirbilek 2017; Shah 2017; Sperling 2014).
Shake suspension well before each use. Assure accuracy of dosage in infants and young children.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light. Store in carton until contents are used.
Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy
Blood Pressure Lowering Agents: Diazoxide may enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Fosphenytoin: Diazoxide may decrease the serum concentration of Fosphenytoin. Total phenytoin concentrations may be affected more than free phenytoin concentrations. Monitor therapy
Phenytoin: Diazoxide may decrease the serum concentration of Phenytoin. Total phenytoin concentrations may be affected more than free phenytoin concentrations. Monitor therapy
Thiazide and Thiazide-Like Diuretics: May enhance the adverse/toxic effect of Diazoxide. Monitor therapy
Thiopental: May enhance the hypotensive effect of Diazoxide. Monitor therapy
Serum renin concentrations and IgG concentrations may be increased. Serum cortisol concentrations may be decreased. May cause a false-negative insulin response to glucagon.
Frequency not defined.
Cardiovascular: Cardiac failure (due to sodium and water retention), hyperosmolar coma (nonketotic), hypertension (transient), hypotension, palpitations, tachycardia
Central nervous system: Anxiety, dizziness, extrapyramidal reaction, headache, insomnia, malaise, paresthesia, peripheral neuritis (poly)
Dermatologic: Cutaneous candidiasis, loss of scalp hair, pruritus, purpura, skin rash
Endocrine & metabolic: Albuminuria, diabetic ketoacidosis, fluid retention, galactorrhea, glycosuria, gout, hirsutism, hyperglycemia, sodium retention
Gastrointestinal: Abdominal pain, acute pancreatitis, ageusia (transient), anorexia, diarrhea, intestinal obstruction, nausea, pancreatic necrosis, vomiting
Genitourinary: Azotemia, decreased urine output, hematuria, lump in breast (enlargement), nephrotic syndrome (reversible), uricosuria
Hematologic & oncologic: Decreased hematocrit, decreased hemoglobin, decreased serum immunoglobulins (IgG), eosinophilia, hemorrhage (excessive), lymphadenopathy, neutropenia (transient), thrombocytopenia
Hepatic: Increased serum alkaline phosphatase, increased serum AST
Infection: Herpes virus infection
Neuromuscular & skeletal: Accelerated bone maturation, craniofacial abnormality (children with chronic use), weakness
Ophthalmic: Blurred vision, cataract (transient), diplopia, lacrimation, scotoma (ring), subconjunctival hemorrhage
Renal: Decreased creatinine clearance
<1%, postmarketing, and/or case reports: Chest pain, pulmonary hypertension (infants and neonates)
Concerns related to adverse effects:
• Abnormal facial features: Development of abnormal facial features was reported in children treated >4 years for hypoglycemia hyperinsulinism.
• Hyperosmolar coma: Nonketotic hyperosmolar coma may occur during treatment; usually in patients with concomitant illness; prompt recognition and treatment are essential. Transient cataracts have been reported which subside following correction of hyperosmolarity.
• Ketoacidosis: Ketoacidosis may occur during treatment, usually in patients with concomitant illness.
• Heart failure: Use may lead to increased fluid retention due to antidiuretic properties and may precipitate heart failure in patients with compromised cardiac reserve.
• Gout: Use with caution in patients with hyperuricemia or a history of gout.
• Renal impairment: Use with caution in patients with renal impairment; a reduced dose should be considered.
• Pediatric: May displace bilirubin from albumin; use caution in newborns with hyperbilirubinemia. Pulmonary hypertension has been reported in newborns and young infants and was reversible upon drug discontinuation; monitor patients (especially patients with risk factors for pulmonary hypertension) for respiratory distress and discontinue diazoxide if pulmonary hypertension is suspected.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
Clinical response, blood glucose, serum uric acid, BUN, creatinine clearance, CBC with differential, AST; urine glucose and ketones (especially under stress conditions and during prolonged treatment); serum electrolytes and uric acid; respiratory distress (neonates and infants [especially those with risk factors for pulmonary hypertension]).
Adverse events have been observed in animal studies. Diazoxide crosses the human placenta and appears in cord blood. Altered carbohydrate metabolism, hyperbilirubinemia, and thrombocytopenia have been reported in the fetus or neonate. Alopecia and hypertrichosis lanuginosa have also been reported in infants following maternal use of diazoxide during the last 19 to 60 days of pregnancy.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience nausea, vomiting, lack of appetite, diarrhea, change in taste, or loss of strength and energy. Have patient report immediately to prescriber signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of pancreatitis (severe abdominal pain, severe back pain, severe nausea, or vomiting), blue/gray skin discoloration (children), fast breathing (children), flaring of nostrils (children), grunting (children), abnormal chest movements (children), difficulty eating (children), shortness of breath, excessive weight gain, swelling of arms or legs, severe constipation, severe abdominal pain, tachycardia, abnormal heartbeat, bruising, bleeding, severe dizziness, passing out, severe headache, angina, urinary retention, change in amount of urine passed, vision changes, tremors, difficulty moving, hair growth on forehead, back, arms, and legs, or stiffness (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
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