| Route | Dose | Mode of action | Side effects |
---|---|---|---|---|
Conventional medicines | ||||
 Diazoxide | Oral | 5–20 mg/kg/day, in 3 divided doses | Bind to SUR1 subunit of KATPchannels, opens the channels and inhibits insulin secretion Requires an intact KATP channel activity to work properly | Common: Water and salt retention, hypertrichosis, loss of appetite Rare: Cardiac failure, hyperuricaemia, blood dyscrasias (bone marrow suppression, anaemia, eosinophilia etc.), paradoxical hypoglycaemia |
 Chlorothiazide | Oral | 7–10 mg/kg/day, in 2 divided doses | Prevents fluid retention, synergistic effects with diazoxide on KATP channels to inhibit insulin secretion | Hyponatraemia, hypokalaemia |
 Nifedipine | Oral | 0.25–2.5 mg/kg/day, in 2–3 divided doses | Inhibits Ca-channels of the β-cell membrane | Hypotension |
 Octreotide | s.c | 5–35 μg/kg/day, divided to 3–4 doses or continuous subcutaneous infusion | Activation of SSTR-2 and SSTR-5 inhibits calcium mobilization and acetylcholine activity, and decreases insulin gene promoter activity, reduces insulin biosynthesis and insulin secretion. | Acute: Anorexia, nausea, abdominal discomfort, diarrhoea, drug induced hepatitis, elevated liver enzyme, long QT syndrome, tachyphylaxis, necrotizing enterocolitis Long-term: Decreases intestinal motility, bile sludge and gallstone, suppression of pituitary hormones (Growth hormone, TSH) |
 Glucagon | s.c/i.m bolus or s.c/i.v infusion | 0.02 mg/kg/dose or 5–10 μg/kg/h infusion | G-protein coupled activation of adenylate cyclase, increases cAMP, Induces glycogenolysis and gluconeogenesis | Nausea, vomiting, skin rash and rebound hypoglycaemia in high doses (>20 μg/kg/h) due to paradoxical activation of insulin secretion |
New medicines | ||||
 Rapamycin (sirolimus, everolimus) | Oral | An initial dose of 1 mg/m2 per day may require dose adjustment according to blood sirolimus concentration usually to keep between 5 and 15 ng/ml | mTOR inhibitor. Inhibits insulin release and β-cell proliferation through different mechanism which have not been clarified yet | Immune suppression, mucositis, hyperlipidemia, elevation of liver enzyme, thrombocytosis, impaired immune response to BCG vaccine |
 Octreotide LAR/ Lanreotide | Deep s.c | Total 4 weekly dose of octreotide given every 4 weekly or 15–60 mg/every 4 weekly | These long acting somatostatin analogues have similar effects as daily multidose octreotide. | Similar to daily multiple injection octreotide. However, long-term follow up is not known yet |