Diazoxide Mechanism of Action

Diazoxide works by blocking the release of insulin from the pancreas, thus allowing recovery from hypoglycemia in, most commonly, pediatric patients with congenital hyperinsulinemic hypoglycemia.  This is a medication that is not likely to be required often, but is effective when it is called upon.

Of note, there was recently an FDA-issued warning in September 2015 regarding findings of pulmonary hypertension and respiratory distress in infants and children (especially those with other factors that may contribute to either of these).  This has been found to be reversible upon discontinuation of diazoxide.

Regarding cost, one bottle contains multiple doses, as each 30mL bottle contains 1500mg of diazoxide.  Depending on the age and weight of the child, a bottle would likely contain 15-30 days’ worth of medication.  The question that next needs to be answered is regarding the number of days of therapy.

This is addressed in the article, “Management strategies for neonatal hypoglycemia,” published in The Journal of Pediatric Pharmacology and  Therpeutics in 2013.  According to the authors, the typical time it takes for these patients to see normal blood glucose levels is roughly 2-4 days, but a trial of 5-8 days is recommended before stopping the dose.2 That being said, and per the above cost calculations, consider a patient who is one year old and weighs 11kg, and the plan is to trial diazoxide for a full eight days.  The total cost would be approximately $140, and the total dose over those eight days would be 17.6mL (just over half of one bottle).  Overall, diazoxide has been considered a first-line agent for congenital hyperinsulinemic hypoglycemia, and has been found to be especially effective for the treatment of this disorder in infants.

Generic (Trade) Name:diazoxide (Proglycem)
Drug Class:hyperglycemic agent
Formulation:oral suspension (for pediatric population)
FDA-Approved Indications:hypoglycemia, due to (usually congenital) hyperinsulinism
Off-Label Usage:none at this time
Mechanism of Action:increase in blood glucose via inhibition of insulin release from pancreas via opening of the β-cell KATP channels2


Adverse Drug Reactions

  • sodium and fluid retention (esp. young infants and adults)
  • hirsutism
  • pulmonary hypertension/respiratory distress (neonates, infants, children)
  • GI intolerance
  • hyperglycemia/glycosuria, diabetic ketoacidosis
  • hyperosmolar non-ketoacidotic coma
  • rarely: hypotension, eosinophilia, decreased hemoglobin/hematocrit, increased liver enzymes, decreased CrCl, decreased urinary output, anxiety, dizziness, insomnia, pruritis, extrapyramidal signs, blurred vision, diplopia, lacrimation, fever, lymphadenopathy, gout, thrombocytopenia


  • blood glucose
  • serum electrolytes and uric acid
  • BUN, SCr, CrCl
  • CBC with differential
  • LFTs, especially bilirubin
  • urine glucose and ketones
  • respiratory distress (especially in neonates and infants)



  • functional hypoglycemia (also called reactive hypoglycemia – low blood sugar in the four hours after eating, often accompanied by shakiness, sleepiness, lightheadedness, hunger)
  • hypersensitivity to diazoxide or other thiazide


  • treatment under close monitoring only with regular assessment of clinical response
  • prolonged use requires increased monitoring for glucosuria and ketones in the urine
  • take care when administering concomitantly with other medications that also have antihypertensive effects
  • may displace bilirubin from albumin (keep in mind if treating newborn with bilirubinemia)

Drug Interactions

  • diuretics – potentiation of hyperglycemic and hyperuricemic effects
  • warfarin – potentiation of hypoprothrombin effects
  • diphenylhydantoin – may lead to loss of seizure control
  • chlorpromazine – may enhance hyperglycemic action of diazoxide

How supplied, preparation, administration, and stability/storage

How supplied:

  • 50mg/mL suspension
  • 30 mL bottle


  • adults, children, adolescents  3 mg/kg/day divided into every 8 hour dosing
    usual range: 3-8 mg/kg/day divided into every 8 or 12 hour dosing
  • neonates and infants  10 mg/kg/day divided every 8 hours
    usual range: 8-12 mg/kg/day divided into every 8 or 12 hour dosing
    *range of 5-20 mg/kg/day divided every 8 hours has been used


  • shake suspension well prior to administration


  • store at room temperature-  25 °C (77°F)
  • may have “excursions”  between 15°C and 30°C (59°F and 86°F)
  • store in box until use and protect from light

Pharmacokinetics and Pharmacodynamics

  • onset of action = 1 hour
  • duration = 8 hours (normal renal function)
  • >90% bound to serum proteins, renal excretion
  • half-life = pediatrics 9-24 hours

adults 24-36 hours

  • per package insert, if no effect is seen within 2-3 weeks, diazoxide should be discontinued


Animal studies were inconclusive regarding risks, primarily risks that were found were related to the embryonic stage of development

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The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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