BNF for Children (BNFC) 2018-2019

insulinoma.when used in the diagnosis of growth

hormone secretion, delayed hypoglycaemia may result—

deaths reported (ensure a meal is eaten before discharge)

lINTERACTIONS→Appendix 1 : glucagon

lSIDE-EFFECTS

▶Common or very commonNausea

▶UncommonVomiting

▶Rare or very rareAbdominal pain.hypertension.

hypotension.tachycardia

lDIRECTIONS FOR ADMINISTRATION

▶With intravenous useWhen administered bycontinuous

intravenous infusion, do not add to infusionfluids

containing calcium—precipitation may occur.

lPATIENT AND CARER ADVICE

Medicines for Children leaflet: Glucagon for

hypoglycaemiawww.medicinesforchildren.org.uk/glucagon-for-

hypoglycaemia

lEXCEPTIONS TO LEGAL CATEGORYPrescription-only

medicine restriction does not apply where administration

is for saving life in emergency.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Powder and solvent for solution for injection

▶GlucaGen Hypokit(Novo Nordisk Ltd)

Glucagon hydrochloride 1 mgGlucaGen Hypokit 1 mg powder and

solvent for solution for injection| 1 vialP£ 11. 52 DT = £ 11. 52

3.2a Chronic hypoglycaemia

Other drugs used for Chronic hypoglycaemia

Chlorothiazide, p. 111

GLYCOGENOLYTIC HORMONES

Diazoxide

lINDICATIONS AND DOSE

Resistant hypertension

▶BY MOUTH

▶Neonate:Initially 1. 7 mg/kg 3 times a day, adjusted

according to response; maximum 15 mg/kg per day.

▶Child:Initially 1. 7 mg/kg 3 times a day, adjusted

according to response; maximum 15 mg/kg per day

Chronic intractable hypoglycaemia

▶BY MOUTH

▶Neonate:Initially 5 mg/kg twice daily, adjusted

according to response, initial dose used to establish

response; maintenance 1. 5 – 3 mg/kg 2 – 3 times a day;

increased if necessary up to 7 mg/kg 3 times a day,

higher doses are unlikely to be beneficial, but may be

required in some cases.

▶Child:Initially 1. 7 mg/kg 3 times a day, adjusted

according to response; maintenance 1. 5 – 3 mg/kg

2 – 3 times a day, increased if necessary up to 5 mg/kg

3 times a day, doses up to 5 mg/kg may be required in

some cases, but higher doses are unlikely to be

beneficial

lUNLICENSED USENot licensed for resistant hypertension.

lCAUTIONSAortic coarctation.aortic stenosis.

arteriovenous shunt.heart failure.hyperuricaemia.

impaired cardiac circulation.impaired cerebral circulation

lINTERACTIONS→Appendix 1 : diazoxide

lSIDE-EFFECTSAbdominal pain.albuminuria.appetite

decreased (long term use).arrhythmia.azotaemia.

cardiomegaly.cataract.constipation.diabetic

hyperosmolar coma.diarrhoea.dizziness.dyspnoea.

eosinophilia.extrapyramidal symptoms.face abnormal.

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

lPREGNANCYUse only if essential; alopecia and

hypertrichosis reported in neonates with prolonged use;

may inhibit uterine activity during labour.

lBREAST FEEDINGManufacturer advises avoid—no

information available.

lRENAL IMPAIRMENT

Dose adjustmentsDose reduction may be required.

lMONITORING REQUIREMENTS

▶Monitor blood pressure.

▶Monitor white cell and platelet count during prolonged

use.

▶Regularly assess growth, bone, and psychological

development during prolonged use.

lMEDICINAL FORMS

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 mgEudemine 50 mg tablets| 100 tabletP£ 46. 45

Capsule

▶Diazoxide (Non-proprietary)

Diazoxide 25 mgProglycem 25 capsules| 100 capsulePs

PITUITARY AND HYPOTHALAMIC HORMONES

AND ANALOGUES›SOMATOSTATIN ANALOGUES

Somatostatin analogues f

lCAUTIONSDiabetes mellitus (antidiabetic requirements

may be reduced).insulinoma (increased depth and

duration of hypoglycaemia may occur—observe patients

and monitor blood glucose levels when initiating

treatment and changing doses)

lSIDE-EFFECTS

▶Common or very commonAdrenal insufficiency.alopecia.

appetite decreased.arrhythmias.arthralgia.asthenia.

biliary dilatation.cholelithiasis (following long term use).

constipation.diabetes mellitus.diarrhoea.dizziness.

dyspnoea.gallbladder disorders.gastrointestinal

discomfort.gastrointestinal disorders.glucose tolerance

impaired (following long term use).headache.hepatic

disorders.hyperbilirubinaemia.hyperglycaemia (long

term use).hypoglycaemia.hypotension.hypothyroidism.

lethargy.musculoskeletal pain.myalgia.nausea.QT

interval prolongation.skin reactions.thyroid disorder.

vomiting.weight decreased

▶UncommonAnaemia.dehydration.hotflush.insomnia

▶Frequency not knownPancreatitis.pancreatitis acute (after

administration)

lDIRECTIONS FOR ADMINISTRATIONInjection sites should

be rotated.

466 Diabetes mellitus and hypoglycaemia BNFC 2018 – 2019

Endocrine system

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