Diazoxide is administered intravenously for the treatment of hypertensive emergencies, particularly malignant hypertension, hypertensive encephalopathy, and eclampsia. It is effective in 75 to 85% of the patients to whom it is administered and rarely reduces blood pressure below the normotensive range.
In patients with coronary insufficiency, a p-blocker can be given in conjunction with diazoxide to decrease the cardiac work associated with reflex increases in sympathetic stimulation of the heart. However, p-blockers potentiate the hypotensive effect of diazoxide, and therefore, the dose of the vasodilator should be lowered. The dose of diazoxide should also be lowered if the patient has recently been treated with guanethidine or another drug that depresses the action of the sympathetic nervous system. Such drugs permit a greater hy-potensive effect because they reduce the increase in cardiac output that normally partially counteracts the fall in pressure.
Diazoxide appears to have a direct antinatriuretic action. This direct action, coupled with the neuroendocrine reflexes that are activated by a decrease in pe ripheral vascular resistance, leads to severe retention of Na+ and water. Since tolerance to diazoxide can develop rapidly, it is frequently administered in conjunction with a diuretic.
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