Proglycem

Diazoxide (diazoxide) instructions
Common name: Diazoxide
Trade name: Progam
Full names: Diazoxide, Proglycem, diazoxide, Hyperstat, Proglycem oral Suspension, Eudaxen

Indications:
Used to treat low blood sugar (hypoglycemia) caused by certain cancers or other diseases that may cause the pancreas to release too much insulin. Diazoxide is used in adults and infants and young children.

Usage and Dosage:
For adults and children, the starting dose is 5mg/kg, divided into 2 or 3 equal doses every 24 hours and given to the patient, and the patient's response is determined. The dose can be increased thereafter until the symptoms and blood sugar level response are satisfactory. Regular blood glucose measurements are necessary during the initial stages of treatment. The general maintenance dose is 3-8 mg/kg/day, divided into two or three doses.
Patients with impaired renal function may require a reduced dose.
For children with leucine-sensitive hypoglycemia, the recommended dosage range is 15-20 mg/kg/day.
Benign or malignant islet cell tumors in adults produce large amounts of insulin, with doses up to 1,000 mg per day.

Adverse Reactions:
Rare
Chest pain

Incidence unknown
Abdominal or stomach pain
Dark, tarry stool
Blood in the urine
Bleeding from the nose
Blurred vision
Confusion
Dizziness
When rising suddenly from a lying or sitting position Dizziness, dizziness, or lightheadedness
Dry mouth
Extreme thirst
Fast, irregular, violent shaking or rapid heartbeat or pulse
Fever
Flushing, dry skin
Fruitous breath odor
Heavier menstrual periods
Increased hunger
Thirst
Increased urination
Loss of consciousness
Nausea
Pinpoint red spots on the skin
Seizures
Rush
Abdominal pain
Sweating
Trouble breathing
Weight loss
Unusual bleeding or bruising
Unusual tiredness or weakness
Pooping or infrequent urination
Vomiting
Weakness

More common
Promotes hair growth, Especially on the forehead, back, arms and legs

Incidence unknown
Loss of appetite
Reduced sense of taste
Weight loss

Contraindications:
Contraindicated in pregnant, lactating women
In the treatment of hypoglycemia, diazoxide is contraindicated in all cases suitable for surgery or other special treatment.

Allergy to any component of the preparation or other thiazides.

Notes:
Sodium and water retention may require treatment with oral diuretics such as fluosemide or ethacrinic acid. The dosage of the above two diuretics is up to 1g per day. If a diuretic is used, both the hypotensive and hyperglycemic activities of diazoxide may be enhanced and the diazoxide dose may need to be adjusted downward.
Diazoxide should be used with caution in patients with heart failure or compromised cardiac reserve, as sodium and water retention may worsen or precipitate congestive heart failure. Direct effects on myocardium and cardiac function cannot be excluded.
Diazoxide should be used with caution in patients with a history of hyperuricemia or gout, and it is recommended to monitor serum uric acid concentration.
Long-term use of diazoxide requires regular hematology tests to rule out changes in white blood cell and platelet counts.
Children should also be regularly evaluated for growth, skeletal and psychological maturity.
Plasma proteins may be lower in patients who use diazoxide than in those who do not.

Storage:
Sealed and stored in closed light

Mechanism of action:
As a diuretic, diazoxide inhibits early reabsorption of active chloride in the distal renal tubule through the N-CI co-transporter, resulting in increased excretion of sodium, chloride and water. Thiazosin-like diazoxides also inhibit sodium ion transport across renal tubular epithelial cells by binding to thiazide-sensitive sodium chloride transporters. This results in increased potassium excretion through the sodium-potassium exchange mechanism. The mechanism by which diazoxide lowers blood pressure is unknown, but it may be through its action on carbonic anhydrase in smooth muscle or through its action on large-conductance calcium-activated potassium channels (KCA) channels, also found in smooth muscle. As an antihypoglycemic agent, diazoxide inhibits insulin release from pancreatic islets, possibly by opening potassium channels in the beta cell membrane.

Efficacy and safety:
A randomized double-blind controlled study was conducted on infants with a gestational age of more than 32 weeks who were small for gestational age and developed hypoglycemia caused by hyperinsulinemia within 5 days of birth. Children with severe perinatal hypoxia, infection, or oral contraindications were excluded. The initial evaluation index is the time required to control hypoglycemia under the premise that the sugar input rate does not exceed 4 mg/(kg·min). Further evaluation indexes include: intravenous infusion time, infection incidence, time to reach normal feeding, and mortality rate.
Results
Of the 490 newborns, 30 met the study criteria and completed the study. Half were given diazoxide and the other half were given a placebo. The time to control hypoglycemia (40 vs 71.5 h, P=0.015), intravenous infusion time (114 vs 164 h, P=0.04) and the time required to achieve normal feeding (74 vs 124 h, P=0.02) were significantly shortened in the diazoxide group, and no adverse reactions occurred.
Conclusion
Using diazoxide to treat hypoglycemia caused by hyperinsulinemia in infants small for gestational age can control hypoglycemia early without adverse reactions.