Chemistry:Diazoxide

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Diazoxide, sold under the brand name Proglycem among others, is a medication used to treat low blood sugar due to a number of specific causes.[1] This includes islet cell tumors that cannot be removed and leucine sensitivity.[1] It can also be used in refractory cases of sulfonylurea toxicity.[2] It is taken by mouth.[1]

Diazoxide, used as the salt diazoxide choline, and sold under the brand name Vykat XR, is used for the treatment of hyperphagia in people with Prader–Willi syndrome.[3] It was approved for this use in the United States in March 2025.[4]

Common side effects include high blood sugar, fluid retention, low blood platelets, a fast heart rate, increased hair growth, and nausea.[1] Other severe side effects include pulmonary hypertension and heart failure.[1] It is chemically similar to thiazide diuretics.[1] It works by decreasing insulin release from the pancreas and increasing glucose release by the liver.[1]

Diazoxide was approved for medical use in the United States in 1973.[1] It is on the World Health Organization's List of Essential Medicines.[5] It is available as a generic medication.[6]

Medical uses

Diazoxide is used as a vasodilator in the treatment of acute hypertension or malignant hypertension.[7]

Diazoxide also inhibits the secretion of insulin by opening ATP-sensitive potassium channel of beta cells of the pancreas; thus, it is used to counter hypoglycemia in disease states such as insulinoma (a tumor producing insulin)[8] or congenital hyperinsulinism.

Diazoxide acts as a positive allosteric modulator of the AMPA and kainate receptors, suggesting potential application as a cognitive enhancer.[9]

Side effects

Diazoxide interferes with insulin release through its action on potassium channels.[10] Diazoxide is one of the most potent openers of the K+ ATP channels present on the insulin producing beta cells of the pancreas. Opening these channels leads to hyperpolarization of cell membrane, a decrease in calcium influx, and a subsequently reduced release of insulin.[2]

The US Food and Drug Administration (FDA) published a safety announcement in July 2015 highlighting the potential for development of pulmonary hypertension in newborns and infants treated with this drug.[11]

Diazoxide has been associated with development of hypertrichosis and stimulation of scalp hair growth.[12][13]

Research

Diazoxide, formulated as its choline salt diazoxide choline, is an experimental antiobesity drug being tested in people with Prader-Willi syndrome[14][15][16] and monogenic obesity caused by mutations in the SH2B1, PCSK1, or SIM1 genes.[17]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 "Diazoxide Monograph for Professionals". https://www.drugs.com/monograph/diazoxide.html. 
  2. ↑ 2.0 2.1 "Pharmacological agents that directly modulate insulin secretion". Pharmacological Reviews 55 (1): 105–131. March 2003. doi:10.1124/pr.55.1.7. PMID 12615955. 
  3. ↑ "Vykat XR- diazoxide choline tablet, film coated". 26 March 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e745e85-9512-e360-e063-6394a90aebf1. 
  4. ↑ "Soleno Therapeutics Announces U.S. FDA Approval of Vykat XR to Treat Hyperphagia in Prader-Willi Syndrome" (Press release). Soleno Therapeutics. 26 March 2025. Retrieved 28 March 2025 – via GlobeNewswire.
  5. ↑ The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. 2023. WHO/MHP/HPS/EML/2023.02. 
  6. ↑ British national formulary: BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 708. ISBN 978-0-85711-338-2. 
  7. ↑ "Oedema formation with the vasodilators nifedipine and diazoxide: direct local effect or sodium retention?". Journal of Hypertension 14 (8): 1041–1045. August 1996. doi:10.1097/00004872-199608000-00016. PMID 8884561. closed access
  8. ↑ "Diazoxide prevents diabetes through inhibiting pancreatic beta-cells from apoptosis via Bcl-2/Bax rate and p38-beta mitogen-activated protein kinase". Endocrinology 148 (1): 81–91. January 2007. doi:10.1210/en.2006-0738. PMID 17053028. open access
  9. ↑ "Allosteric potentiation by diazoxide of AMPA receptor currents and synaptic potentials". European Journal of Pharmacology 247 (3): 257–265. November 1993. doi:10.1016/0922-4106(93)90193-D. PMID 8307099. closed access
  10. ↑ "Control of insulin secretion by sulfonylureas, meglitinide and diazoxide in relation to their binding to the sulfonylurea receptor in pancreatic islets". Biochemical Pharmacology 38 (8): 1217–1229. April 1989. doi:10.1016/0006-2952(89)90327-4. PMID 2650685. 
  11. ↑ "FDA Drug Safety Communication: FDA warns about a serious lung condition in infants and newborns treated with Proglycem (diazoxide)" (Press release). U.S. Food and Drug Administration (FDA). 16 July 2015. Archived from the original on 19 July 2015. Retrieved 19 July 2015.
  12. ↑ "Minoxidil use in dermatology, side effects and recent patents". Recent Pat Inflamm Allergy Drug Discov 6 (2): 130–136. May 2012. doi:10.2174/187221312800166859. PMID 22409453. "Other potassium channel openers, like diazoxide [39, 40] and pinacidil [41] can cause hypertrichosis in humans as well as minoxidil. In balding macaques minoxidil, cromakalin and P-1075 (a pinacidil analogue) stimulate hair growth in about 20 weeks of topical treatment, whereas a fourth potassium channel opener, called RP49356, is not effective [42].". 
  13. ↑ "Potassium channel conductance as a control mechanism in hair follicles". J Invest Dermatol 101 (1 Suppl): 148S–152S. July 1993. doi:10.1111/1523-1747.ep12363290. PMID 8326149. "The evidence that [potassium channel openers (PCOs)] are active on hair growth is correlative. In humans three PCOs have been reported to affect hair growth. Minoxidil was reported to induce hypertrichosis during early clinical trials as an antihypertensive [12]. These side effects were characterized by increasingly visual facial hair, thickening of eyebrows, and diffuse hair growth across the upper back and limbs. Systemic minoxidil induced hypertrichosis in 80–100% of adults [13]. Clinical trials using topical minoxidil demonstrate increased scalp hair in about 39% of treated balding men. Oral diazoxide causes hypertrichosis in most hypoglycemic children and about 1% of adults, and induces some scalp hair in 25% of the balding patients [13–15]. Systemic pinacidil induces hypertrichosis in 2–13% of patients [13]. We are not aware of any topical hair growth trials using pinacidil.". 
  14. ↑ "Diazoxide choline extended-release tablet in people with Prader-Willi syndrome: results from long-term open-label study". Obesity 32 (2): 252–261. February 2024. doi:10.1002/oby.23928. PMID 37919617. 
  15. ↑ "A randomized pilot efficacy and safety trial of diazoxide choline controlled-release in patients with Prader-Willi syndrome". PLOS ONE 14 (9). 23 September 2019. doi:10.1371/journal.pone.0221615. PMID 31545799. Bibcode: 2019PLoSO..1421615K. 
  16. ↑ "Diazoxide Choline Extended-Release Tablet in People With Prader-Willi Syndrome: A Double-Blind, Placebo-Controlled Trial". The Journal of Clinical Endocrinology and Metabolism 108 (7): 1676–1685. June 2023. doi:10.1210/clinem/dgad014. PMID 36639249. 
  17. ↑ Clinical trial number NCT05532020 for "An Open-Label Study of Diazoxide Choline in Patients With Genetic Obesities" at ClinicalTrials.gov



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