Details About Overdose or Poisoning Generic Salt ::  Diazoxide

Diazoxide

    

Drug Pharmacology ::

I. Pharmacology./b>

   

Diazoxide,a nondiuretic thiazide, is a direct arterial vasodilator that formerlywas used to treat severe hypertension. Heart rate and cardiac outputincrease owing to a reflex response to decreased peripheral vascularresistance. The duration of the hypotensive effect ranges from 3 to 12hours, although the elimination half-life is 20–40 hours.

Diazoxidehas been used in the treatment of oral hypoglycemic overdose because itincreases serum glucose by inhibiting insulin secretion, diminishingperipheral glucose utilization, and enhancing hepatic glucose release.However, octreotide (see Octreotide) has become the preferred agentbecause of its safety and efficacy.

Drug Indications ::

Indications

   

Managementof an acute hypertensive crisis, although other antihypertensive agentsare preferred (see Phentolamine (Phentolamine); Nitroprusside,(Nitroprusside); and Labetalol, Labetalol).

Oralhypoglycemic overdose when serum glucose concentrations cannot bemaintained adequately by intravenous 5% dextrose infusions and thepreferred agent, octreotide, is unavailable or intolerable to thepatient (known hypersensitivity).

Drug Contra-Indications ::

III. Contraindications./b>

   

Hypertension associated with aortic stenosis, aortic coarctation, hypertrophic cardiomyopathy, or arteriovenous shunt.

Known hypersensitivity to thiazides or other sulfonamide derivatives.

Drug Adverse Effects ::

IV. Adverse effects

   

Hypotension or excessive blood pressure reduction must be avoided in patients with compromised cerebral or cardiac circulation.

Fluid retention from prolonged therapy may compromise patients with congestive heart failure.

Hyperglycemia may occur, particularly in patients with diabetes or hepatic dysfunction.

Use in pregnancy. FDAcategory C (indeterminate). This drug has caused skeletal, cardiac, andpancreatic abnormalities in animals, but no adequate human data exist.Use of this drug near term may cause hyperbilirubinemia and alteredcarbohydrate metabolism in a fetus or neonate, and intravenousadministration during labor may cause cessation of uterinecontractions. These cautions, however, do not necessarily precludeacute, short-term use of the drug for a seriously symptomatic patient(see Table III–1).

Drug Lab Interactions ::

Drug or laboratory interactions

   

The hypotensive effect is potentiated by concomitant therapy with diuretics or beta-adrenergic blockers.

Diazoxide displaces warfarin from protein-binding sites and may transiently potentiate its anticoagulant effects.

Diazoxide can increase phenytoin metabolism.

Drug Dose Management ::

Dosage and method of administration (adults and children)

   

For oral hypoglycemic-induced hypoglycemia:

   

1. Givea 0.1–2 mg/kg/h infusion; initiate at a lower infusion rate and titrateup as needed. Hypotension is minimized by keeping the patient supineand increasing the infusion rate slowly. Duration of therapy has rangedfrom 22 to 60 hours.

2. Anoral dosing regimen of 3–8 mg/kg/day divided into two to three doses isrecommended for children and adults. If refractory, may require higherdoses of up to 10 to 15 mg/kg/day (200 mg every 4 hours has been used).

For hypertensive crisis, give 1–3 mg/kg IV (150 mg maximum) or 50 to 100 mg total every 5–15 minutes as needed. Note: The use of a 300-mg rapid bolus is no longer recommended.

Drug Chemical Formulations ::

Formulations

   

Parenteral. Diazoxide (Hyperstat), 15 mg/mL in 20-mL ampules.

Oral. Diazoxide (Proglycem), 50-mg/mL oral suspension (with alcohol and parabens).

The suggested minimum stocking levels to treat a 70-kg adult for the first 24 hours: parenteral, two vials (20 mL each); oral, 30 mL of suspension.

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