Indications And Dose
Chronic intractable hypoglycaemia ▶BY MOUTH ▶Adult: Initially 5 mg/kg daily in 2–3 divided doses, adjusted according to response; maintenance 3–8 mg/kg daily in 2–3 divided doses
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Drug reference
Chronic intractable hypoglycaemia ▶BY MOUTH ▶Adult: Initially 5 mg/kg daily in 2–3 divided doses, adjusted according to response; maintenance 3–8 mg/kg daily in 2–3 divided doses
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Aortic coarctation. aortic stenosis. arteriovenous shunt. heart failure. hyperuricaemia. impaired cardiac circulation. impaired cerebral circulation
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→Appendix 1: diazoxide
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Abdominal pain. albuminuria. appetite decreased (long term use). arrhythmia. azotaemia. cardiomegaly. cataract. constipation. diabetic hyperosmolar coma. diarrhoea. dizziness. dyspnoea. eosinophilia. extrapyramidal symptoms. fever. fluid retention. galactorrhoea. haemorrhage. headache. heart failure. hirsutism. hyperglycaemia. hyperuricaemia (long term use). hypogammaglobulinaemia. hypotension. ileus . ketoacidosis. leucopenia. libido decreased. musculoskeletal pain. nausea. nephritic syndrome. oculogyric crisis. pancreatitis. parkinsonism. pulmonary hypertension. skin reactions. sodium retention. taste altered. thrombocytopenia. tinnitus. vision disorders. voice alteration (long term use). vomiting
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Use only if essential; alopecia and hypertrichosis reported in neonates with prolonged use; may inhibit uterine activity during labour.
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Manufacturer advises avoid—no information available.
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Dose adjustments Dose reduction may be required.
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▶Monitor blood pressure. ▶Monitor white cell and platelet count during prolonged use.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution Tablet ▶Eudemine (RPH Pharmaceuticals AB) Diazoxide 50 mg Eudemine 50mg tablets | 100 tablet P £72.55 DT = £72.55 Capsule ▶Proglycem (Imported (Germany)) Diazoxide 25 mg Proglycem 25 capsules | 100 capsule P s Disorders of bone metabolism Osteoporosis Description of condition Osteoporosis is a progressive bone disease characterised by low bone mass measured by bone mineral density (BMD), and microarchitectural deterioration of bone tissue. This leads to an increased risk of fragility fractures as a result. Osteoporosis is considered severe if there have been one or more fragility fractures. Osteoporosis occurs most commonly in postmenopausal women, men over 50 years, and in patients taking long-term oral corticosteroids (glucocorticoids). Risk factors for osteoporosis include age, low body mass index (BMI), cigarette smoking, excess alcohol intake, lack of physical activity, vitamin D deficiency and low calcium intake, family history of hip fractures, a previous fracture at a site characteristic of osteoporotic fractures and early menopause. Some diseases are also known to be associated with osteoporosis such as rheumatoid arthritis and diabetes. Aims of treatment A combination of lifestyle changes and drug treatment aims to prevent bone fractures in patients with osteoporosis. Lifestyle changes g Patients should be encouraged to increase their level of physical activity, stop smoking, maintain a normal BMI level (between 20–25 kg/m2), and reduce their alcohol intake to improve their bone health and reduce the risk of fragility fractures. h For guidance on stopping smoking, see Smoking cessation p. 520. g Patients at risk of osteoporosis should also ensure an adequate intake of calcium and vitamin D, preferably through increasing dietary intake. Elderly patients, especially those who are housebound or live in residential or nursing homes, are at increased risk of calcium and vitamin D deficiency and can benefit from supplements. h Elderly patients also have an increased risk of falls (see Prescribing in the elderly p. 33). Drug treatment Postmenopausal osteoporosis The therapeutic options for the prevention and treatment of osteoporosis in postmenopausal women are the same. g Oral bisphosphonates, alendronic acid p. 766 and risedronate sodium p. 769 are considered as first-line choices for most patients with postmenopausal osteoporosis due to their broad spectrum of anti-fracture efficacy. Alendronic acid and risedronate sodium have been shown to reduce occurrence of vertebral, non-vertebral and hip fractures. Intravenous bisphosphonates (ibandronic acid p. 767 or zoledronic acid p. 771), denosumab p. 774, or raloxifene hydrochloride p. 796 are alternative options in women who are intolerant of oral bisphosphonates or in whom they are contra-indicated. Hormone replacement therapy (HRT) is an additional option. The use of HRT for osteoporosis is generally restricted to younger postmenopausal women with menopausal symptoms who are at high risk of fractures. This is due to the risk of adverse effects such as cardiovascular disease and cancer in older postmenopausal women and women on long-term HRT therapy. Teriparatide p. 773 is reserved for postmenopausal women with severe osteoporosis at very high risk for vertebral fractures. Its duration of treatment is limited to 24 months. h Glucocorticoid-induced osteoporosis Glucocorticoid therapy is associated with bone loss and increased risk of fractures. The greatest rate of bone loss occurs early after initiation of glucocorticoids and increases with dose and duration of therapy. g Bone-protection treatment should be started at the onset of therapy in patients who are at a high risk of fracture. If glucocorticoid therapy is stopped, the need to continue bone-protection treatment should be reviewed. However, bone-protection treatment should be continued with long- term glucocorticoid therapy. Complex cases of glucocorticoid-induced osteoporosis should be referred to a specialist. Women aged 70 years or over, or with a previous fragility fracture, or taking large doses of glucocorticoids (prednisolone 7.5 mg daily or equivalent) are at high risk of fractures and should be assessed for prophylactic bone- protection. Some younger patients, particularly those with a previous history of fracture or receiving high doses of glucocorticoids can also be considered for bone-protection treatment. The therapeutic options for prophylaxis and treatment of glucocorticoid-induced osteoporosis are the same; oral bisphosphonates, alendronic acid, or risedronate sodium are first-line options. Intravenous zoledronic acid or teriparatide are alternatives in patients intolerant of oral bisphosphonates or in whom they are contra-indicated. h Osteoporosis in men g Oral bisphosphonates, alendronic acid or risedronate sodium are recommended as first-line treatments for osteoporosis in men. Intravenous zoledronic acid or denosumab are alternatives in men who are intolerant of oral bisphosphonates or in whom they are contra-indicated; teriparatide is an additional option. h Men having long-term androgen deprivation therapy for prostate cancer have an increased fracture risk. g Fracture risk should be assessed when starting this therapy. A bisphosphonate can be offered to men with confirmed osteoporosis; denosumab is an alternative if bisphosphonates are contra-indicated or not tolerated. h Bisphosphonates: treatment duration g There is some evidence to suggest that patients can benefit from a bisphosphonate-free period as their therapeutic effects last for some time after cessation of treatment. Bisphosphonate treatment should be reviewed after 5 years of treatment with alendronic acid, risedronate sodium or ibandronic acid, and after 3 years of treatment with zoledronic acid. Patients over 75 years of age, or with a history of previous hip or vertebral fracture, or patients who have had one or more fragility fractures during treatment, or who are taking long-term glucocorticoid therapy can continue bisphosphonates beyond this period. h Useful Resources Compston, J. et al. The National Osteoporosis Guideline Group (NOGG). (2017) UK clinical guidelines for the prevention and treatment of osteoporosis. Arch Osteoporos 12(1): 43. doi.org/10.1007/s11657-017-0324-5 Other drugs used for Disorders of bone metabolism Calcitriol, p. 1144 Endocrine system ANABOLIC STEROIDS
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Initially 5 mg/kg daily in 2–3 divided doses,
First-line fragment. Read the complete Indications and Dose section above.
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