Diazoxide, Oral
| (DIE-aze-OX-ide) |
| Proglycem |
| Class: Glucose-elevating agent |
Action Produces prompt dose-related increase in blood glucose by inhibiting pancreatic insulin release.
Indications Management of hypoglycemia caused by hyperinsulinism in adults with inoperable islet cell adenoma or carcinoma or extrapancreatic malignancy, in infants and children with leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma or adenomatosis.
Contraindications Hypersensitivity to thiazides; functional hypoglycemia.
Route/DosageADULTS & CHILDREN: PO 3–8 mg/kg/day in 2–3 equal doses q 8–12 hr. INFANTS & NEWBORNS: PO 8–15 mg/kg/day in 2–3 equal doses q 8–12 hr.
InteractionsAntihypertensive agents: Enhanced antihypertensive effect. Hydantoins: Possible loss of seizure control. Sulfonylureas: Decreased pharmacologic effects of both drugs. Thiazide diuretics: Increased hyperglycemic and hyperuriciemic effects of diazoxide; hypotension.
Lab Test Interferences Hypoglycemia and hyperuricemia produced by diazoxide may affect assessment of these metabolic states. Increased renin secretion and IgG concentrations and decreased cortisol secretion may occur. False-negative insulin response to glucagon may occur.
Adverse ReactionsCV: Tachycardia; palpitations; hypotension; transient hypertension; chest pain. CNS: Headache; weakness; malaise; anxiety; dizziness; insomnia; polyneuritis; paresthesia; extrapyramidal signs; fever. DERM: Hirsutism of lanugo type on forehead, back and limbs; skin rash; pruritus; monilial dermatitis; herpes; loss of scalp hair. EENT: Transient cataracts; subconjunctival hemorrhage; ring scotoma; blurred vision; diplopia; lacrimation. GI: Anorexia; nausea; vomiting; abdominal pain; ileus; diarrhea; transient loss of taste; acute pancreatitis; pancreatic necrosis. GU: Azotemia; decreased creatinine clearance; reversible nephrotic syndrome; decreased urinary output; hematuria; albuminuria; glycosuria. HEMA: Thrombocytopenia with or without purpura; transient neutropenia; eosinophilia; decreased hemoglobin or hematocrit; excessive bleeding; decreased IgG. META: Hyperglycemia; increased serum uric acid; gout; galactorrhea; breast lump enlargement; increased AST and alkaline phosphatase. OTHER: Sodium and fluid retention; advance in bone age.
PrecautionsPregnancy: Category C. Lactation: Undetermined. Labor: May cause cessation of uterine contractions. Blood levels: May be higher with liquid than with capsule formulation; use caution when changing dosage forms. Fluid retention: May precipitate CHF in patients with compromised cardiac reserve. Ketoacidosis and nonketotic hyperosmolar coma: May occur with recommended doses. Renal impairment: may have decreased protein binding of diazoxide resulting in increased hypotensive effect.
| PATIENT CARE CONSIDERATIONS |
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Administration/Storage- Shake oral suspension well before administering.
- Store at room temperature. Protect suspension from light.
Assessment/Interventions- Obtain patient history, including drug history and any known allergies. Note cardiac or renal impairment.
- Ensure that baseline laboratory tests have been obtained before beginning therapy.
- Monitor BP (lying, standing) for hypotensive effect, especially if patient is taking antihypertensive agent.
- Monitor blood and urine glucose and ketones carefully until stabilized, usually within 1 wk.
- Monitor I&O and weight ³ weekly to monitor fluid retention.
- Monitor for signs of CHF: peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular vein distention. Notify physician immediately if these occur.
- Observe for signs of hirsutism.
- If ecchymosis, petechiae or hemorrhage occur, notify physician immediately. Drug may need to be discontinued.
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Patient/Family Education- Instruct patient to take medicine as directed at the same time each day. Warn patient not to switch from capsule to suspension without notifying physician.
- Review symptoms of hypoglycemia and hyperglycemia with patient and family.
- Advise patient to follow prescribed diet, medication and exercise regimen to prevent hypoglycemic or hyperglycemic reactions.
- Instruct patient to monitor blood glucose, urine glucose and ketones daily.
- Instruct patient to report these symptoms to physician: bruising, bleeding or fluid retention.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension. Inform patient that hirsutism is common side effect but should be reversed when drug is discontinued.
- Instruct patient not to take otc medications without consulting physician.
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