Diazoxide (Proglycem)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Proglycem (diazoxide) oral suspension manages low blood sugar (hypoglycemia) caused by too much insulin (hyperinsulinism). In adults, the causes are an inoperable islet cell adenoma or carcinoma (a tumor of the insulin-making cells of the pancreas that cannot be removed by surgery) or a malignancy outside the pancreas. In infants and children, the causes are leucine sensitivity, islet cell hyperplasia, nesidioblastosis, extrapancreatic malignancy, islet cell adenoma, or adenomatosis. It may also be used before surgery as a temporary measure, and after surgery if the low blood sugar continues.

What it is for, in depth

Proglycem is a medicine for a specific and uncommon problem: blood sugar that stays dangerously low because the body makes too much insulin. In adults this usually comes from an insulin-producing tumor of the pancreas that cannot be removed with surgery, or from a cancer elsewhere in the body; in babies and children it comes from conditions present from birth, such as islet cell hyperplasia, nesidioblastosis, or leucine sensitivity. It is prescribed only after the cause has been confirmed and when surgery or other specific treatment has failed or is not possible, and it can also be used for a short time before surgery or after surgery if low blood sugar persists. Doses are based on body weight, are started under close supervision with frequent blood sugar checks, and are adjusted to the lowest dose that keeps blood sugar safe. It comes only as a chocolate-mint flavored oral suspension, 50 mg in each milliliter, taken by mouth two or three times a day.

How it works

Proglycem raises blood glucose in a dose-related way, mainly by inhibiting (stopping) the release of insulin from the pancreas, and also through an effect outside the pancreas. With less insulin released, blood sugar rises. The blood-sugar-raising effect begins within about an hour and generally lasts no more than 8 hours when kidney function is normal. Diazoxide also decreases the excretion of sodium and water, which is why fluid retention can occur.

How it is taken

Proglycem is an oral suspension (50 mg/mL) taken by mouth. Treatment is started under close clinical observation, with blood glucose and clinical response monitored until the patient's condition is stable, which usually takes several days; if it is not effective after 2 to 3 weeks, it should be discontinued. For adults and children, the recommended starting dose is 3 mg/kg/day, divided into 3 equal doses every 8 hours or 2 equal doses every 12 hours, and may be raised to a maximum of 8 mg/kg/day; patients with refractory hypoglycemia may need higher doses. For infants and newborns, the starting dose is 8 mg/kg/day in divided doses, up to a maximum of 15 mg/kg/day. Dosage accuracy is especially important in infants and young children. Urine glucose and ketones should be checked regularly, especially during illness or stress.

Common side effects

Sodium and fluid retention is the most common serious-type reaction, especially in young infants and adults. Other frequent reactions are hirsutism (excess hair growth of the fine lanugo type, mainly on the forehead, back, and limbs, most common in children and women; it goes away after the drug is stopped), hyperglycemia or glycosuria (high blood sugar or sugar in the urine), gastrointestinal intolerance (loss of appetite, nausea, vomiting, abdominal pain, ileus, diarrhea, temporary loss of taste), rapid heartbeat (tachycardia) and palpitations, increased serum uric acid, low platelet count (thrombocytopenia), transient low white cell count (neutropenia), skin rash, headache, weakness, and malaise.

Serious warnings

Fluid retention from Proglycem can precipitate congestive heart failure in patients with compromised cardiac reserve (a weak heart). Diabetic ketoacidosis and nonketotic hyperosmolar coma have been reported, usually during intercurrent illness; these can develop very rapidly and patients must be watched for up to 7 days because the drug has a long half-life of about 30 hours. Postmarketing reports include pulmonary hypertension in neonates and infants, which resolved after the drug was stopped, and necrotizing enterocolitis (severe bowel inflammation) in neonates and infants, including fatal cases. Pericardial effusion (fluid around the heart) has also been reported, mostly in children and infants. The development of abnormal facial features was reported in four children treated for more than 4 years.

Who should be careful

Proglycem must not be used for functional hypoglycemia, or by patients allergic (hypersensitive) to diazoxide, any of its excipients, or other thiazides. It should only be used after a diagnosis of hypoglycemia due to one of the labeled conditions has been definitely established, and when other specific medical therapy or surgery has been unsuccessful or is not feasible. Be careful with compromised cardiac reserve (fluid retention can cause heart failure), kidney impairment (the drug lasts longer, so a reduced dose should be considered), hyperuricemia or a history of gout, and during pregnancy - diazoxide crosses the placenta, safety in pregnancy has not been established, and use requires weighing the benefit to the mother against possible harm to the fetus. It is not known whether diazoxide passes into breast milk, so a decision should be made whether to discontinue nursing or discontinue the drug.

Major interactions

Giving thiazides or other diuretics with Proglycem may potentiate (strengthen) its hyperglycemic (blood-sugar-raising) and hyperuricemic (uric-acid-raising) actions, and occasional low blood pressure from diazoxide may be augmented by thiazide diuretics given at the same time. Taking Proglycem with diphenylhydantoin (phenytoin) may result in loss of seizure control. Because diazoxide is highly bound to serum proteins, it may displace other protein-bound substances such as coumarin anticoagulants (whose dose may need reducing) and bilirubin (important in newborns with increased bilirubin). The blood-pressure-lowering effect of other antihypertensive drugs may be enhanced by Proglycem.

Cost and saving notes

If this drug is covered under your Medicare Part D plan and the cost is high, you can ask your plan for a tier exception to pay a lower cost share. If you have limited income, Extra Help (the Part D Low-Income Subsidy) can lower your Part D premiums and drug costs. In 2027, your total yearly out-of-pocket spending on covered Part D drugs is capped at $2,400, and you can spread those costs out in monthly payments through the Medicare Prescription Payment Plan.

Why it is in its tier

Diazoxide (Proglycem) sits on Tier 4 in 56.45% of the plans that list it (3102 of 5495 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $3,897 per beneficiary for 2024 — a mid-cost drug, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• PROGLYCEM (DIAZOXIDE) SUSPENSION [TEVA PHARMACEUTICALS USA, INC.] — DailyMed

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 7.34415 per unit (DIAZOXIDE 50 MG/ML ORAL SUSP) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Diazoxide (Proglycem) — 100% of plans. Most of those plans put it on Tier 4: 3,102 plans, 56.5% of the plans that list it. Other plans place it on Tier 5 (2,019 plans), Tier 2 (200 plans) or Tier 1 (124 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 4; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 4; Aetna Medicare Value Plus (PPO) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.