디아족사이드

직접 혈관 확장제 / 혈당 상승제

디아족사이드(Diazoxide)는 비이뇨성 티아지드 유도체로, 수의학에서는 주로 개와 페럿의 **인슐린종**(인슐린 분비 췌도 세포 종양)의 내과적 관리에 사용됩니다. 강력한 직접 혈관 확장 특성(인체에서는 고혈압 응급 상황에 정맥 투여됨)을 가지고 있지만, 동물에서의 경구 사용은 주로 그 강력한 **혈당 상승** 부작용을 활용합니다. 인슐린 방출을 길항함으로써 난치성 저혈당증 환자의 혈당 수치를 안정시키는 데 도움을 줍니다. **임상 요점:** - 식이 관리(소량씩 자주 급여)와 글루코코르티코이드(예: 프레드니손) 단독으로 저혈당 위기를 통제하지 못할 때 종종 병용하여 사용됩니다. - 티아지드 이뇨제와 구조적으로 유사하여 나트륨 및 수분 저류를 유발할 수 있으나, 이뇨 효과는 없습니다.

작용 기전: Diazoxide exerts its hyperglycemic and vasodilatory effects via multiple mechanisms: - **K+ ATP Channel Activation**: It binds to the sulfonylurea receptor 1 (SUR1) subunit of the **ATP-sensitive potassium (K+ ATP) channels** on pancreatic beta cells → channel opening → cellular hyperpolarization → decreased intracellular **calcium (Ca2+)** influx → **inhibition of insulin exocytosis** from secretory granules. - **Beta-Adrenergic Stimulation**: Stimulates the release of **epinephrine**, which promotes hepatic glycogenolysis and inhibits peripheral cellular glucose uptake. - **Vasodilation**: Directly relaxes arteriolar smooth muscle by opening K+ ATP channels in vascular smooth muscle cells → hyperpolarization → vasodilation → decreased peripheral vascular resistance and blood pressure.

동물 종별 용량

Cats

Hypoglycemia secondary to insulin secreting islet cell tumors · Initially, 5 mg/kg PO twice daily; increase to a maximum of 30 mg/kg PO twice daily to control clinical signs · PO · q12h · Insulinomas are very rare in cats; little experience with this drug in this species.

Ferrets

Hypoglycemia secondary to insulin secreting islet cell tumors · Begin at 5-10 mg/kg PO q12h. · PO · q12h · Add diazoxide when clinical signs cannot be controlled with prednisone alone. At same time prednisone dosage may be lowered.

Dogs

Hypoglycemia secondary to insulin secreting islet cell tumors · Initially, 5 mg/kg PO twice daily; increase to a maximum of 30 mg/kg PO twice daily to control clinical signs · PO · q12h
Hypoglycemia secondary to insulin secreting islet cell tumors (refractory) · Initially at 10 mg/kg divided twice a day. May gradually increase dosage to 60 mg/kg/day as tolerated and add hydrochlorothiazide (2-4 mg/kg/day). · PO · Divided twice a day · Used if frequent feedings and glucocorticoids fail or cause Cushingoid appearance.
Adjunctive therapy of hypoglycemia secondary to insulin secreting non-islet cell (extra-pancreatic) tumors · 5-13 mg/kg PO three times daily · PO · q8h · May add hydrochlorothiazide 2-4 mg/kg/day.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

POIV

금기

Functional hypoglycemia
Hypoglycemia secondary to insulin overdosage in diabetic patients
Hypersensitivity to thiazide diuretics (unless benefits outweigh risks)
Hypersensitivity to thiazides
Functional hypoglycemia (non-insulinoma)

이상반응

Anorexia
Vomiting
Diarrhea
Hypersalivation
Tachycardia
Agranulocytosis
Aplastic anemia
Thrombocytopenia
Diabetes mellitus
Cataracts
Sodium and water retention
Malaise (ferrets)
Bone marrow suppression (ferrets)
Gastrointestinal upset (anorexia, vomiting, diarrhea)
Hyperglycemia
Cataracts (rare)
Bone marrow suppression (rare)

약물 상호작용

Alpha-adrenergic agents (e.g., phenoxybenzamine) · May decrease the effectiveness of diazoxide in increasing glucose levels
Hypotensive agents (e.g., hydralazine, prazosin) · Diazoxide may enhance the hypotensive actions of other hypotensive agents
Phenothiazines (e.g., acepromazine, chlorpromazine) · May enhance the hyperglycemic effects of diazoxide
Phenytoin · Diazoxide may increase the metabolism, or decrease the protein binding of phenytoin
Thiazide diuretics (e.g., hydrochlorothiazide) · May potentiate the hyperglycemic effects of oral diazoxide. Can be used synergistically, but caution is advised as hypotension may occur
Thiazide diuretics · Potentiate hyperglycemic and hyperuricemic effects · moderate
Phenothiazines · May potentiate hyperglycemia · moderate
Alpha-adrenergic blockers · May antagonize the effects of diazoxide · moderate
Highly protein-bound drugs (e.g., NSAIDs, warfarin) · Diazoxide is highly protein-bound and may displace or be displaced by other drugs, altering free drug concentrations · moderate

모니터링

Blood (serum) glucose
CBC (at least every 3-4 months)
Physical exam (monitor for clinical signs of adverse effects like edema, cataracts, or tachycardia)
Blood glucose
Electrolytes (sodium, potassium)
Complete blood count (CBC) periodically
Signs of fluid retention/edema

과용량

Acute overdosage may result in severe **hyperglycemia** and **ketoacidosis**. - **Treatment**: Administer insulin, intravenous fluids, and correct electrolyte imbalances. - **Monitoring**: Intensive and prolonged monitoring of blood glucose and acid-base status is highly recommended.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.