Diazoxide
PROGLYCEM
“Violet cat Dyes socks”
What it isKATP channel opener suppressing insulin release; hyperinsulinemic hypoglycemia.
Why this oneThe only oral agent that turns off inappropriate insulin secretion — the exact mirror of a sulfonylurea.
What limits itFluid retention and pulmonary hypertension in neonates; a diuretic is often needed. Hypertrichosis with prolonged use.
FDA-approved for
- Hyperinsulinemic hypoglycemia (1973)
Principal riskFluid retention; pulmonary hypertension in neonates
Sulfonamide
Sulfonamide-derived drug — label silent
A benzothiadiazine (cyclic sulfonamide) that Khan lists among the thiazide-type drugs with no or weak evidence of cross-reactivity; its label is contraindicated with hypersensitivity to diazoxide or other thiazides and never mentions sulfonamides6.
Open the sulfonamide hypersensitivity presentation → · sources [n] are on its References slide.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityFluid retention, hyperglycemia, and neonatal pulmonary hypertension
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypoglycemia due to hyperinsulinism (inoperable islet cell adenoma/carcinoma, extrapancreatic malignancy) | Adults | 3 mg/kg/day PO divided q8h (3 doses) or q12h (2 doses) | Individualize to blood glucose and clinical response | 8 mg/kg/day (refractory hypoglycemia may require more) |
| Hypoglycemia due to hyperinsulinism (leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma, adenomatosis) | Children | 3 mg/kg/day PO divided q8h (3 doses) or q12h (2 doses) | Individualize to blood glucose and clinical response | 8 mg/kg/day (refractory hypoglycemia may require more) |
| Hypoglycemia due to hyperinsulinism (same conditions as children) | Infants and newborns | 8 mg/kg/day PO divided q8h (3 doses) or q12h (2 doses) | Individualize to blood glucose and clinical response | 15 mg/kg/day |
Renal Consider reduced dosage (half-life prolonged); evaluate serum electrolytes
Hepatic Undefined
Use only after hypoglycemia due to a listed condition is definitely established; may be used preoperatively and postoperatively if hypoglycemia persists
Instructions
- Shake well before each use; dropper calibrated to deliver 10, 20, 30, 40 and 50 mg
- Start under close clinical supervision; monitor blood glucose until stable (usually several days)
- Discontinue if not effective after 2 or 3 weeks
- Take special care with dose accuracy in infants and young children
- Take on a regular schedule; do not skip or take extra doses
Available strengths
- susp 50 mg/mL
- tab 25, 75, 150 mg
- ER tab 25, 75, 150 mg
Contraindications
- Functional hypoglycemia
- Hypersensitivity to other thiazides
Cautions
- Fluid retention — may precipitate CHF with compromised cardiac reserve
- Thiazides potentiate hyperglycemic/hyperuricemic effects
- Ketoacidosis and nonketotic hyperosmolar coma; prolonged surveillance (long half-life)
- Abnormal facial features with chronic use in children
- Pulmonary hypertension in neonates/infants — discontinue if suspected
- Necrotizing enterocolitis in neonates/infants (incl. fatal) — discontinue if suspected
- Monitor urine glucose/ketones on prolonged treatment
- Hematologic effects; serum uric acid (hyperuricemia/gout)
- May enhance antihypertensives; coumarin dose may need reduction; displaces bilirubin (newborns)
Adverse reactions
- Sodium and fluid retention
- Lanugo-type hirsutism
- Hyperglycemia or glycosuria
- GI intolerance (anorexia, nausea, vomiting, abdominal pain, ileus, diarrhea, taste loss)
- Tachycardia, palpitations
- Increased serum uric acid
- Thrombocytopenia ± purpura
- Transient neutropenia
- Skin rash, headache, weakness, malaise
- Diabetic ketoacidosis/hyperosmolar coma (infrequent, serious)
Pregnancy Safety not established; animal fetal toxicity — crosses placenta (neonatal hyperbilirubinemia, thrombocytopenia, altered carbohydrate metabolism, alopecia/hypertrichosis reported); IV use in labor may stop contractions
Lactation No information on passage into breast milk; decide whether to discontinue nursing or the drug
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 50 mg/mL | susp | per unit | $7.38/mL | offered |
Open Diazoxide in the interactive console ↗
Self-check
- What pulmonary complication can diazoxide cause in neonates?
Pulmonary hypertension. - What prolonged-use hair effect occurs with diazoxide?
Hypertrichosis.