Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Antihypoglycemic, Antihypertensive
Original Date: 
March 2021
Revised Date: 
March 2022
  • Management of hypoglycemia related to hyperinsulinism
  • PO
  • Initial 10 mg/kg/day divided every 8 to 12 hours; usual range: 5 - 15 mg/kg/day divided every 8 to 12 hours
    • Lower initial doses (5 - 7.5 mg/kg/day) should be used for patients with congenital heart disease
  • Concurrent addition of Hydrochlorothiazide with the initiation of Diazoxide can be considered to minimize risk of fluid retention.  Hydrochlorothiazide should be started at 1 mg/kg/day divided daily or bid  
Side Effects: 
  • CVS: edema (due to antidiuretic effect which leads to a decrease in sodium and water excretion), pulmonary hypertension*
    • There have been postmarketing reports of pulmonary hypertension occuring in neonates and infants treated with diazoxide .  Risk is higher if infant has pre existing risk factors for pulmonary hypertension. The cases were reversible upon discontinuation of the drug. Monitor patients at risk for respiratory distress and discontinue diazoxide if pulmonary hypertension is suspected.
  • Endocrine and metabolic: hypertrichosis, hyperuricemia, sodium and water retention
  • Hematologic: neutropenia, thrombocytopenia
  • Hepatic: elevated liver enzymes
  • Renal: decreased creatinine clearance, decreased urinary output
Parameters to Monitor: 
  • Blood glucose
  • CBC with differential, platelets
  • Serum uric acid level
  • Electrolytes
  • BUN and serum creatinine
  • Liver function tests
  • BP/HR
Reconstitution and Stability: 





- Herrera A, Vajravelu ME, Givler S, Mitteer L, Avitabile CM, Lord K, De Leon, DD.  Prevalence of Adverse Events in Children with Congenital Hyperinsulinism Treated with Diazoxide.  J Clin Endocrinol Metab 2018; 103: 4365-4372

- Gray KD, Dudash K, Escobar C, Freel C, Harrison T, McMillan C et al. Prevalence and Safety of Diazoxide in the Neonatal Intensive Care Unit.  J Perinatol 2018; 38 (11): 1496-1502

- Welters A, Lerch C, Kummer S, et al. Long-term medical treatment in congenital hyperinsulinism: a descriptive analysis in a large cohort of patients from different clinical centers. Orphanet J Rare Dis. 2015;10:150. Published 2015 Nov 25. doi:10.1186/s13023-015-0367-x

- Taketomo CK, Hodding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

- Desai J, Key L, Swindall A, Gaston K, Talati AJ. The danger of diazoxide in the neonatal intensive care unit. Ther Adv Drug Saf. 2021 May 18;12:20420986211011338 *

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