Diazoxide
Mechanism :
Diazoxide is a potassium channel activator, which causes local relaxation in smooth muscle by increasing membrane permeability to potassium ions. This switches off voltage-gated calcium ion channels which inhibits the generation of an action potential
It is used as a vasodilator in the treatment of acute hypertension, and to decrease the secretion of insulin in disease states such as insulinoma.
Indication :
- Intractable hypoglycemia
- Prader Willi Syndrome
Contraindications :
Known hypersensitivity to any component of the preparation or to other thiazides. Use is contraindicated in hypoglycemia cases which are amenable to surgery or specific therapy. Blood pressure should be monitored and in cases of sodium and water retention diuretics may be used. Should be used with in caution in patients with Congestive Cardiac failure. Should be used with caution in patients with severe renal impairment. On extravasation leads to ischemia and necrosis. Monitor white blood cell and platelet counts regularly when used over a prolonged period and regularly assess bone growth and psychological maturation.
Dosing :
Hypoglycemia:
Newborn/Infant:
10 mg/kg/day orally in 3 divided doses (range: 8-15 mg/kg/day in 3 divided doses).
Children:
3 mg/kg/day orally in 3 divided doses (range: 3-8 mg/kg/day in three divided doses).
Adverse Effect :
Nausea, extrapyramidal effects, tachycardia, sodium and water retention, hyperglycemia, hypertrichosis and blood disorders.
Interaction :
Oral hypoglycemics: Cause antagonism of hypoglycaemic effect.
ACE Inhibitors, Anaesthetics, Antihypertensives, Diuretics, Beta-Blockers, Anxiolytics, Hypnotics, Calcium-Channel Blockers and Nitrates: Enhanced hypotensive effect.
NSAIDs and Corticosteroids: Antagonize the hypotensive effect.
Phenytoin: Diazoxide may reduce levels, and phenytoin may reduce the effect of diazoxide.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
20-50 | Dose as in normal renal function |
10-20 | Dose as in normal renal function |
<10 | Start with a lower dose and increase gradually according to response. Use with caution |
Dose in Patients undergoing Renal Replacement Therapies
CAPD | Dialysed. Dose as in GFR<10 mL/min |
HD | Dialysed. Dose as in GFR<10 mL/min |
HDF/High flux | Dialysed. Dose as in GFR<10 mL/min |
CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.