ArticleCardiovascular diabetology. Endocrinology reports2025
Diazoxide as a bridging therapy in methadone-induced hypoglycemia- a case report and review of the literature.
Article in Cardiovascular diabetology. Endocrinology reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe objective of this report is to describe the successful use of diazoxide as a bridging therapy for a patient with opioid-induced hypoglycemia who was unable to immediately discontinue methadone treatment. CASE PRESENTATION: A 41-year-old male presented for an unrelated planned surgical procedure and was found to have symptomatic hyperinsulinemic hypoglycemia resulting from high-dose methadone prescribed for chronic pain in the setting of end stage renal disease requiring hemodialysis. Diazoxide was successfully used as a bridging therapy until he ultimately decided to discontinue methadone following a multidisciplinary discussion with endocrinology, internal medicine, and an addiction consultation team. During a 10-day admission for safety and observation of withdrawal, he was weaned from methadone and transitioned to buccal buprenorphine and eventually sub-lingual buprenorphine/naloxone. After methadone was decreased and then discontinued, he was able to discontinue dextrose infusion and eventually diazoxide. Several months after discharge, he reported fasting blood glucose levels between 110 and 130 mg/dL (6.11-7.22 mmol/L; reference range 75-115 mg/dL; 4.16-6.38 mmol/L) without symptoms of hypoglycemia.
conclusionsWhile diazoxide has been used as bridging therapy for insulinoma patients awaiting surgery, this report highlights the utility of the non-diuretic benzothiadiazine in opioid-induced hyperinsulinemic hypoglycemia. Patients with hyperinsulinemic hypoglycemia on high doses of tramadol or methadone should be transitioned off the offending agent; however, diazoxide is an effective, alternative option when the transition is not feasible or needs to be delayed.
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