diazoxide (Rx)

Brand and Other Names:Proglycem
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension

  • 50mg/mL

Hypoglycemia

Indicated for hypoglycemia due to hyperinsulinism associated with inoperable islet cell adenoma or carcinoma, or extrapancreatic malignancy

3 mg/kg/day PO divided q8-12hr initially; typical dose range 3-8 mg/kg/day  

Patients with refractory hypoglycemia may require higher doses

Prader-Willi Syndrome (Orphan)

Orphan designation for diazoxide choline for treatment of Prader-Willi Syndrome

Sponsor

  • Essentialis, Inc; 7915 Corte Cardo; Carlsbad, CA 92009

Dosage Forms & Strengths

oral suspension

  • 50mg/mL

Hypoglycemia

Indicated for hypoglycemia due to hyperinsulinism associated with leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma, or adenomatosis

Newborn/infant: 10 mg/kg/day PO divided q8hr initially; typical dosage range is 8-15 mg/kg/day PO divided q8-12hr (also see Cautions regarding suspected pulmonary hypertension in newborns and infants)

Children: 3 mg/kg/day PO divided q8hr initially; typical dose range is 3-8 mg/kg/day PO divided q8-12hr  

Dosing Considerations

May be used preoperatively as a temporary measure, and postoperatively, if hypoglycemia persists

Prader-Willi Syndrome (Orphan)

Orphan designation for diazoxide choline in DDRC (crystalline salt of diazoxide in a controlled-release, once-a-day tablet formulation)

Orphan sponsor

  • Essentialis Therapeutics, Inc; 7915 Corte Cardo; Carlsbad, CA 92009
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Interactions

Interaction Checker

and diazoxide

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              Serious - Use Alternative (0)

                Monitor Closely (18)

                • amifostine

                  amifostine, diazoxide. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Monitor blood pressure and adjust dose accordingly.

                • atazanavir

                  atazanavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • benazepril

                  diazoxide increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Diazoxide may enhance the hypotensive effect of antihypertensive agents.

                • captopril

                  diazoxide, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

                • darunavir

                  darunavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • fosamprenavir

                  fosamprenavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • hydrochlorothiazide

                  hydrochlorothiazide increases toxicity of diazoxide by unspecified interaction mechanism. Use Caution/Monitor. May enhance hyperglycemic effects of diazoxide.

                • indinavir

                  indinavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • insulin degludec

                  diazoxide decreases effects of insulin degludec by pharmacodynamic antagonism. Use Caution/Monitor. Diazoxide increases blood glucose by inhibiting pancreatic insulin release and stimulating catecholamines release.

                • insulin degludec/insulin aspart

                  diazoxide decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Diazoxide increases blood glucose by inhibiting pancreatic insulin release and stimulating catecholamines release.

                • insulin inhaled

                  diazoxide decreases effects of insulin inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Diazoxide increases blood glucose by inhibiting pancreatic insulin release and stimulating catecholamines release.

                • lopinavir

                  lopinavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • metformin

                  diazoxide decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.

                • nelfinavir

                  nelfinavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • ritonavir

                  ritonavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • saquinavir

                  saquinavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                • tesamorelin

                  tesamorelin will decrease the level or effect of diazoxide by altering metabolism. Modify Therapy/Monitor Closely. Monitor glucose levels

                • tipranavir

                  tipranavir increases effects of diazoxide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

                Minor (12)

                • bendroflumethiazide

                  diazoxide, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • chlorothiazide

                  diazoxide, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • chlorthalidone

                  diazoxide, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • cyclopenthiazide

                  diazoxide, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • ethotoin

                  diazoxide decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

                • fosphenytoin

                  diazoxide decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown.

                • hydralazine

                  diazoxide, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

                • hydrochlorothiazide

                  diazoxide, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • indapamide

                  diazoxide, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • methyclothiazide

                  diazoxide, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • metolazone

                  diazoxide, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hyperglycemia.

                • phenytoin

                  diazoxide decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown.

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                Adverse Effects

                Frequency Not Defined

                Angina

                Cardiac arrest

                Anxiety

                Fever

                Polyneuritis

                CHF

                Hypotension

                Palpitation

                Tachycardia

                Dizziness

                Anorexia

                Abdominal pain

                Constipation

                Diarrhea

                Loss of taste

                Nausea

                Vomiting

                Diabetic ketoacidosis

                Hirsutism

                Scalp hair loss

                Hyperglycemia

                Sodium and fluid retention

                Postmarketing reports

                Pulmonary hypertension in neonates and young infants

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                Warnings

                Contraindications

                Hypersensitivity to diazoxide, thiazides, or sulfonamide derivatives

                Cautions

                Use caution in coronary or cerebral insufficiency, DM, extravasation, heart failure (may increase fluid retention), cardiovascular insufficiency, gout, hypotension, hypokalemia, liver disease, renal dysfunction

                Pregnancy

                Compensatory HTN (aortic coarctation, arteriovenous shunt)

                Ineffective in pheochromocytoma

                Nonketotic hyperosmolar coma may occur during treatment; transient cataracts reported

                May displace bilirubin from albumin; use caution in newborns with hyperbilirubinemia

                The antidiuretic property of diazoxide may lead to significant fluid retention, which in patients with compromised cardiac reserve, may precipitate congestive heart failure; the fluid retention will respond to conventional therapy with diuretics

                Concomitantly administered thiazides may potentiate the hyperglycemic and hyperuricemic actions of diazoxide

                Ketoacidosis and nonketotic hyperosmolar coma reported in patients treated with recommended doses usually during intercurrent illness; prompt recognition and treatment essential and prolonged surveillance following the acute episode necessary because of long drug half-life of approximately 30 hours; occurrence of these serious events may be reduced by careful education of patients regarding monitoring urine for sugar and ketones and for prompt reporting of abnormal findings and unusual symptoms to healthcare provider

                Effects of diazoxide on the hematopoietic system and the level of serum uric acid kept in mind; the latter should be considered particularly in patients with hyperuricemia or a history of gout

                Antihypertensive effect of other drugs may be enhanced by diazoxide; should keep this in mind when administering it concomitantly with antihypertensive agents

                Because of protein binding, administration of diazoxide with coumarin or its derivatives may require reduction in dosage of anticoagulants

                Pulmonary hypertension in newborns and infants

                • July 16, 2015: FDA warns clinicians to watch for signs of pulmonary hypertension in infants treated for hypoglycemia with diazoxide and discontinue the drug if symptoms appear
                • There have been 11 cases identified since the drug was approved (1973) and once diazoxide was discontinued, the symptoms resolved
                • Signs of respiratory distress include flaring nostrils, grunting, unusual chest movements, rapid breathing, difficulty feeding, or a bluish tint to the lips or skin
                • Monitoring is especially important for infants who have other risk factors for pulmonary hypertension (eg, meconium aspiration syndrome, respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, sepsis, congenital diaphragmatic hernia, and congenital heart disease)
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                Pregnancy & Lactation

                Pregnancy Category: C

                Lactation: Excretion in milk unknown; not recommended

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Inhibits pancreatic insulin release resulting increased blood glucose; activates potassium channels

                Relaxes smooth muscle to decrease PVR, increases HR & CO; precise mechanism of hypotensive effect not fully elucidated; antagonism of calcium may be involved

                Pharmacokinetics

                Half-Life: 9-24 hr (children); 24-36 hr (adults), increases in patients with renal impairment

                Duration: varies greatly, may last to 3-12 hr

                Protein binding: 90%

                Metabolism: In liver by oxidation and sulfate conjugation

                Renal Clearance: 4-5 mL/min

                Excretion: urine by glomerular filtration as unchanged drug and metabolites

                Dialyzable: HD: yes, PD: yes; no supplemental dose is required

                Excretion: Urine

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Proglycem oral
                -
                50 mg/mL suspension

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                diazoxide oral

                DIAZOXIDE - ORAL

                (dye-uh-ZOX-ide)

                COMMON BRAND NAME(S): Proglycem

                USES: This medication is used to treat very low blood sugar (hypoglycemia). Certain conditions (such as tumor on the pancreas, cancer, leucine sensitivity) can cause the release of too much insulin. Insulin is a natural substance that lowers blood sugar. This drug works by preventing insulin release from the pancreas, helping to return the blood sugar to normal levels. Diazoxide is a thiazide drug, but has no diuretic ("water pill") effects like other thiazides.Diazoxide should not be used to treat low blood sugar from poor nutrition/diet (functional hypoglycemia).

                HOW TO USE: Take this medication by mouth, as directed by your doctor, usually 2 to 3 times daily (every 8 to 12 hours). Your doctor may direct you to follow a special diet for your condition. Consult your doctor, pharmacist, or dietician for more details.Do not switch between the capsule and suspension form of this medication without talking with your doctor first. Your dose may need to be adjusted. If you are using the suspension, shake the bottle thoroughly before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. Do not use the suspension if it has turned a dark color. Discard it. (See Storage section.)The dosage is based on your weight, medical condition, and response to treatment. You will need to check your blood sugar and check your urine for sugar and ketones regularly as directed and share the results with your doctor. Your doctor will adjust the dose based on these tests. Your doctor may change your dose frequently when you first start taking the drug to find the best dose for you. Follow your doctor's directions carefully.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Tell your doctor if your condition persists or worsens after 2 to 3 weeks.

                SIDE EFFECTS: Nausea, loss of appetite, stomach upset, and changes in sense of taste may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Abnormal growth of body hair, especially on the forehead/back/arms/legs, may occur. This is usually not permanent and will go away when the drug is stopped.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication can cause sodium and water retention which can cause serious heart problems. Tell your doctor right away if any of these serious side effects occur: swelling of arms/legs/hands/feet, unexplained weight gain, shortness of breath, unusual tiredness.This medication may cause your blood sugar to become too high. Checking your blood sugar and urine for sugar/ketones regularly and telling your doctor the results will help prevent this side effect. High blood sugar can be very serious and worsen quickly. Tell your doctor right away if any of these signs of very high blood sugar occur: need to urinate more often, unusual thirst, fruity breath odor, dizziness, unusual weight loss, deep/rapid breathing, bluish color of lips/skin, extreme drowsiness/confusion, weakness.Tell your doctor right away if any of these unlikely but serious side effects occur: easy bruising/bleeding, fainting, fast/pounding heartbeat, face/muscle twitching, toe/joint pain, unusual restlessness, muscle cramps/stiffness, shaking (tremor).A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before taking diazoxide, tell your doctor or pharmacist if you are allergic to it; or to other thiazides (such as hydrochlorothiazide); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low blood minerals (low potassium blood levels), diabetes, heart disease (such as heart failure, past heart attack), kidney disease, gout, liver disease.The suspension (liquid) form of this medication contains alcohol. Caution is advised if you have diabetes, liver disease, or any other condition that requires you to limit/avoid alcohol in your diet. Ask your doctor or pharmacist about using this product safely.This medication may raise your blood sugar too high under certain conditions. For example, your body may need more insulin while you are under stress due to infection, surgery, or injury. Certain medications (such as corticosteroids like hydrocortisone/prednisone, hormones such as birth control pills) may raise your blood sugar. Your dose may need to be adjusted. Consult your doctor for more details. Tell your doctor right away if any signs of high blood sugar occur (see Side Effects section).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. If you become pregnant, think you may be pregnant, or plan to become pregnant, tell your doctor right away.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.Some products that may interact with this drug include: drugs for high blood pressure (such as enalapril, methyldopa, prazosin), "blood thinners" (such as warfarin), phenytoin.This medication may interfere with certain laboratory tests (such as a glucagon test), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: need to urinate more often, unusual thirst, fruity breath odor.

                NOTES: Do not share this medication with others.For best results, this medication should be used along with a doctor-approved diet plan. Consult your doctor for more details.Laboratory and/or medical tests (such as blood sugar, urine sugar/ketones, kidney test, complete blood count, potassium/uric acid levels) should be performed periodically to monitor your progress or check for side effects. This is especially important during times of stress because a dosage adjustment may be needed. Consult your doctor for more details.

                MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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                NC NOT COVERED – Drugs that are not covered by the plan.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.