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Diazoxide is a benzothiadiazine that raises blood sugar by limiting insulin release; compounding pharmacies prepare it by prescription.
Diazoxide is a nondiuretic benzothiadiazine, chemically related to the thiazides. It raises blood glucose mainly by inhibiting insulin release from the pancreas, with an added effect outside the pancreas, and it causes the body to retain sodium and water. Proglycem (diazoxide oral suspension) is FDA-approved to manage low blood sugar caused by excess insulin: in adults with inoperable islet cell adenoma or carcinoma or extrapancreatic malignancy, and in infants and children with conditions such as leucine sensitivity, islet cell hyperplasia, nesidioblastosis or islet cell adenoma. StatPearls describes diazoxide as an option for insulinoma when surgery is not feasible. A separate product, diazoxide choline extended-release tablets, is used for constant hunger in Prader-Willi syndrome. A prescriber might order diazoxide compounded in a strength, flavor or form that is not manufactured. Compounded preparations are not FDA-approved and require a prescription.
Proglycem has no boxed warning. Fluid retention is frequent and serious and can bring on heart failure in people with limited heart reserve. Ketoacidosis and hyperosmolar coma have been reported, usually during another illness, so check urine glucose and ketones as directed. In neonates and infants the label warns of pulmonary hypertension and of necrotizing enterocolitis, including fatal cases in neonates. Do not use diazoxide for functional hypoglycemia or if you are allergic to diazoxide or thiazides. Thiazides and other diuretics can strengthen its blood sugar and uric acid effects; coumarin anticoagulant doses may need lowering; it can displace bilirubin in newborns, may reduce seizure control with phenytoin, and adds to blood pressure lowering. Diazoxide crosses the placenta. LactMed reports low milk levels and says it is not a reason to stop breastfeeding, though infant glucose monitoring may be advisable. Talk to your prescriber or pharmacist about side effects.
Diazoxide produces a dose-related rise in blood glucose, primarily by inhibiting pancreatic insulin release, plus an extrapancreatic effect; alpha-adrenergic blockers antagonize the inhibition of insulin release, and insulin or tolbutamide reverses the hyperglycemia. Per the Proglycem label, the hyperglycemic effect begins within an hour and generally lasts no more than 8 hours with normal renal function. Diazoxide is more than 90% protein bound and renally excreted; plasma half-life is 28 ± 8.3 hours after IV administration, 24 and 36 hours in two adults given oral doses, and 9.5 to 24 hours in children on long-term oral therapy, and it is prolonged in renal impairment and overdose. Labeled indication: Proglycem for hypoglycemia due to hyperinsulinism in the conditions listed, once the diagnosis is definitely established; the label advises stopping if there is no response in 2 to 3 weeks. StatPearls describes it as an option to decrease insulin release in insulinoma when surgery is not feasible. Start under close supervision with blood glucose monitoring; follow urine glucose and ketones, serum uric acid, hematologic effects and, in renal impairment, electrolytes. In neonates, watch for pulmonary hypertension, necrotizing enterocolitis and hyperbilirubinemia. Dosing is per prescriber. Diazoxide is not a controlled substance.
Compounded at Bayview
Patient guides for the preparations we make most often. Each one is compounded to order and requires a prescription.
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Every preparation in our formulary that contains this ingredient. Strength, base and dose form are set by the prescription.
Other salt forms of this molecule, and ingredients commonly compounded alongside it.
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