Diazoxide

FDA label

Read the full label on DailyMed ↗

Titration Increase every 2 weeks per weight-based schedule (Weeks 1-2 -> 3-4 -> 5-6) to target maintenance dose; if glucose elevation or fluid overload during titration, titrate longer and/or to lower dose

Renal Not recommended (not studied)

Hepatic Not recommended (not studied)

After interruption/missed dose >=7 days, re-titrate from starting schedule; with strong CYP1A2 inhibitors use reduced schedule (max 3.6 mg/kg/day, 325 mg/day)

Instructions

• Swallow tablets whole; do not split, crush, or chew (ER)
• QD with or without food
• Before initiation: test fasting plasma glucose and HbA1c; optimize glucose if hyperglycemic
• Do NOT substitute with diazoxide oral suspension (different PK)
• Monitor fasting glucose weekly x2 weeks then q4wk, HbA1c q3mo; interrupt/reduce for significant glucose elevation or fluid overload
• May discontinue without tapering

Contraindications

• Hypersensitivity to thiazides (cross-reactive; erythema multiforme reported)

Cautions

• Hyperglycemia incl. diabetic ketoacidosis (inhibits insulin release); monitor fasting glucose and HbA1c
• Fluid overload/edema incl. pulmonary edema; may precipitate CHF in compromised cardiac reserve (not studied; use with caution)
• Not approved for hyperinsulinemic hypoglycemia; in that (unapproved) population other diazoxide products caused pulmonary hypertension in infants <6 mo

Adverse reactions

• Hypertrichosis (36%)
• Edema (27%)
• Hyperglycemia (17%)
• Rash (12%)
• Pyrexia
• Arthralgia
• Erythema multiforme (rare)
• Diabetic ketoacidosis (rare, serious)

Pregnancy Case-report data insufficient; neonatal hyperglycemia, alopecia, hypertrichosis reported after in-utero exposure; caution during labor (IV diazoxide may stop contractions)

Lactation Present in human milk; no infant/milk data — weigh benefit vs risk; consider monitoring infant blood glucose