Diazoxide oral
Diazoxide oral (Proglycem)
Diazoxide Oral
(dye-az- OX-eyed)
Pregnancy Category: C Proglycem (Rx)

Classification: Insulin antagonist, hypotensive agent

Action/Kinetics: Related to the thiazide diuretics. It inhibits the release of insulin from beta islet cells of the pancreas, leading to an increase in blood glucose levels. Effect is dose related. Causes sodium, potassium, uric acid, and water retention. Other effects include increased pulse rate, increased serum uric acid levels, increased serum free fatty acids, decreased para-aminohippuric acid clearance from the kidneys (little effect on GFR). Onset: 1 hr. t 1/2: 24-36 hr (up to 53 hr in clients with anuria). Duration: 8 hr. Over 90% bound to plasma proteins. Metabolized in the liver although 50% is excreted through the kidneys unchanged.

Uses: Management of hypoglycemia due to hyperinsulinism, including inoperable islet cell adenoma or carcinoma or extrapancreatic malignancies in adults. In children, for treatment of hyperinsulinemia due to leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma or adenomatosis. Preoperatively as a temporary measure and postoperatively if hypoglycemia persists. The drug is used parenterally as an antihypertensive agent (see Diazoxide IV).

Contraindications: Functional hypoglycemia, hypersensitivity to diazoxide or thiazides.

Special Concerns: Infants are particularly prone to development of edema. Use with extreme caution in clients with history of gout and in those in whom edema presents a risk (cardiac disease).

Side Effects: CV: Sodium and fluid retention (common); precipitation of CHF in clients with compromised cardiac reserve, palpitations, increased HR, hypotension, transient hypertension, chest pain (rare). Metabolic: Hyperglycemia, glycosuria, diabetic ketoacidosis, hyperosmolar nonketotic coma. GI: N&V;, diarrhea, transient taste loss, anorexia, ileus, abdominal pain. CNS: Weakness, headache, insomnia, extra-pyramidal symptoms, dizziness, paresthesia, fever, malaise, anxietypolyneuritis. Hematologic: Thrombocytopenia with or without purpura, eosinophilia, neutropenia, decreased hemoglobin/hematocrit, excessive bleeding, decreased IgG. Dermatologic: Skin rashes, hirsutism, herpes, loss of hair from scalp, monilial dermatitis, pruritus. GU: Hematuria, decrease in urine production, nephrotic syndrome (reversible), azotemia, albuminuria. Ophthalmologic: Blurred or double vision, lacrimation, transient cataracts, ring scotoma, subconjunctival hemorrhage. Other: Pancreatitis, pancreatic necrosis galactorrhea, gout, premature aging of bone, polyneuritis, enlargement of lump in breast.

Laboratory Test Alterations: Serum uric acid, AST, alkaline phosphatase; C _CR.

Overdose Management: Symptoms: Hypotension; excessive hyperglycemia. Treatment: Insulin to treat hyperglycemia; use Trendelenburg maneuver to reverse hypotension.

Drug Interactions: Alpha-adrenergic blocking agents / Diazoxide effect Anticoagulants, oral / Anticoagulant effect R/T plasma protein binding Antihypertensives / Excessive BP due to additive effects Phenothiazines / Diazoxide effects, including hyperglycemia Phenytoin / Phenytoin effect R/T liver breakdown Sulfonylureas / Effect of both drugs Thiazide diuretics / Hyperglycemic and hyperuricemic effects; hypotension may occur.

How Supplied: Capsule: 50 mg; Suspension: 50 mg/mL

Dosage
?Capsules, Oral Suspension Diabetes.
Dosage is individualized on the basis of blood glucose level and response of client. Adults and children, usual, initial: 1 mg/kg q 8 hr (adjust according to response); maintenance: 3-8 mg/kg/day divided into two or three equal doses q 8-12 hr. Infants and newborns, initial: 3.3 mg/kg q 8 hr (adjust according to response); maintenance: 8-15 mg/kg/day divided into two or three equal doses q 8-12 hr.