diazoxide

Absorption: Well absorbed following oral administration.

Distribution: Crosses the blood-brain barrier.

Protein Binding: >90%.

Metabolism/Excretion: 50% metabolized by the liver; 50% excreted unchanged by the kidneys.

Half-Life: 10–36 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(blood glucose concentrations)lood glucose concentrations

ROUTE	ONSET	PEAK	DURATION
PO	1 hr	8–12 hr	8 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity; cross-sensitivity to thiazide diuretics may occur;
Functional hypoglycemia

Use Cautiously in:

Diabetes (hyperglycemia accompanies use);
HF;
Gout
Renal impairment;
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Newborns and infants with meconium aspiration syndrome, respiratory distress syndrome, transient tachypnea, pneumonia, sepsis, congenital diaphragmatic hernia, or congenital heart disease (may ↑ risk of pulmonary hypertension)
Pedi: Newborns with hyperbilirubinemia (may ↑ risk of kernicterus)

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, hypotension, tachycardia, HF, palpitations

Derm: hirsutism, rash

Endo: hyperglycemia, DIABETIC KETOACIDOSIS, HYPEROSMOLAR NONKETOTIC COMA

GI: abdominal pain, diarrhea, ILEUS, loss of taste, nausea, vomiting

GU: glycosuria

Hemat: neutropenia, thrombocytopenia

Metab: hyperuricemia

Neuro: headache, weakness

Resp: PULMONARY HYPERTENSION

Interactions ⬆ ⬇

Drug-drug:

Diuretics may potentiate hyperglycemic, hyperuricemic, and hypotensive effects.
May enhance BP lowering response of any antihypertensive.
May ↓ levels and effectiveness of phenytoin.
Corticosteroids may ↑ risk of hyperglycemia.
May ↑ effects of warfarin.
May alter the effects of insulin or oral hypoglycemic agents.

Drug-Natural Products:

Glucosamine may worsen hyperglycemia.

Route/Dosage ⬆ ⬇

Hyperinsulinemic Hypoglycemia

PO (Adults and Children ): 1 mg/kg every 8 hr initially; further adjustments made on the basis of response. Usual maintenance dose is 3–8 mg/kg/day given in 2–3 divided doses every 8–12 hr.
PO (Infants and Newborns): 2.7 mg/kg every 8 hr initially; further adjustments made on the basis of response. Usual maintenance dose is 8–15 mg/kg/day in 2–3 divided doses every 8–12 hr.

Availability ⬆ ⬇

(Generic available)

Capsules: 100 mg
Oral suspensionchocolate-mint flavor: 50 mg/mL (contains 7.25% alcohol)

Assessment ⬆ ⬇

Assess patient for signs/symptoms hyperglycemia (Early: polyuria, polydipsia, ↓ appetite, nausea, facial flushing, blurry vision, drowsiness, fruit-like breath odor; Late: early signs plus tachypnea, dry mucus membranes, confusion, lethargy) during therapy. .
Assess for allergy to sulfonamide drugs.
- Assess patient routinely for signs/symptoms of HF (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention). Notify health care provider if these occur.If clinical significant fluid overload occurs, consider dosage ↓ or temporary dosage interruption. If fluid overload resolves after a dosage ↓: For patients weighing <30 kg, titrate the dosage in increments of ≤25 mg every 2 wk or titrate over longer duration. For patients weighing ≥30 kg, titrate the dosage in increments of ≤75 mg every 2 wk or titrate over longer duration.
- Monitor for signs/symptoms of ileus (abdominal distention, constipation, decreased or absent bowel sounds).

Lab Test Considerations:

Monitor blood glucose periodically until stabilized. Monitor urine for glucose and ketones during therapy, especially during periods of stress. May ↑ glucose
- Monitor BUN. creatinine, and sodium periodically during therapy. May cause ↑ BUN and sodium.
- Monitor hematocrit, platelet count, total and differential leukocyte counts periodically during therapy.
- Monitor AST, alkaline phosphatase, and uric acid levels periodically during therapy. May ↑ alkaline phosphatase, AST, and uric acid levels.

Toxicity and Overdose:

If severe hypotension occurs, treatment includes Trendelenburg position, volume infusion, and sympathomimetics (norepinephrine).
- Patients who develop marked hyperglycemia must be monitored for 7 days while blood glucose concentrations stabilize.

Implementation ⬆ ⬇

Loop diuretics are commonly given concurrently with this medication to prevent sodium and water retention.
- Solution must be protected from light; keep in carton. Do not administer darkened solution.
PO: Shake oral suspension well. Use calibrated measuring device to ensure accurate dose.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of diazoxide. Instruct patient to take medication as directed, at the same time each day. Do not skip or take extra doses. Do not share medication with others, even if they have similar symptoms; may be harmful. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
- Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
- Review signs/symptoms of hypoglycemia and hyperglycemia with patient.
- Advise patient not to switch from capsule to oral suspension form without consulting health care professional, because oral suspension produces higher blood concentrations.
- Warn patient to report signs/symptoms and seek treatment for HF.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
- Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
- Emphasize the importance of routine follow-up exams, especially during the first few wk of therapy.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Caution is advised when administering IV diazoxide during labor and delivery which may cause cessation of uterine contractions; administration of oxytocic agents may be needed to restart labor. Monitor infants who were exposed to diazoxide in utero for adverse reactions and treat accordingly. Monitor a breastfed infant for hyperglycemia.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇