Pharm
Symlin
search
Symlin
, Pramlintide, Amylinomimetic, Amylin Analogue
See Also
Type II Diabetes Medications
Indications
Type I and II
Diabetes Mellitus
Adjunct to
Insulin
therapy
Third-line measure due to
Hypoglycemia
risk and cost
Contraindications
Gastroparesis
Mechanism
Pramlintide is a synthetic analogue of human Amylin
Amylin is secreted with
Insulin
from
Pancreas
Amylin lowers post-prandial
Blood Sugar
s
Delays gastric emptying
Inhibits glucago release
Dosing
Protocol
Reduce short and mixed-acting
Insulin
dose by 50%
Use 100 unit 0.3 ml syringe
Take with at least 250 calories (>30 g
Carbohydrate
)
Type I Diabetes Mellitus
Start: 15 mcg (2.5 U) SQ tid immediately before meals
Titrated in 15 mcg increments q3-7 days
Target: 30-60 mcg (5-10 units) SQ tid before meals
Discontinue if significant
Nausea
Type II Diabetes Mellitus
Start: 60 mcg (10 U) SQ tid immediately before meals
Target: 60-120 mcg (10-20 units) SQ tid before meals
Discontinue if significant
Nausea
Precautions
Switch to new pen device which replaces the vials and prevents dosing errors
Warning: Pen concentration is different than vial concentration
Dosing errors are common with the vials
Dosing is typically listed in mcg, but is drawn up in
Insulin
syringes marked with units
A patient who mistakes their 30 mcg dose for 30 units is accidentally taking 180 mcg
Adverse effects
Nausea
(28%) or
Vomiting
(8%): Especically Type I DM (related to
Delayed Gastric Emptying
)
Contraindicated in
Gastroparesis
Headache
(13%)
Anorexia
(9%)
Abdominal Pain
(8%)
Severe
Hypoglycemia
(4.7%)
Occurs 3 hours after
Insulin
and Pramlintide dose
FDA Black box warning (decrease
Insulin
dose before starting)
Advantages
Lowers weight 3 lb or 1.4 kg (
Placebo
: 0.6 kg gained)
Disadvantages
Nausea
Severe
Hypoglycemia
(FDA black box warning)
No good longterm outcome data (other agents with better longterm efficacy are preferred)
Expensive (>$1000)
Efficacy
Drops A1C 0.5 to 0.6% (contrast with
Placebo
: 0.25% )
References
Jones (2007) Am Fam Physician 75:1831-5 [PubMed]
Kruger (2004) Drugs 64: 1419-32 [PubMed]
Kleppinger (2003) Ann Pharmacother 37:1082-9 [PubMed]
Ryan (2005) Clin Ther 27:1500-12 [PubMed]
Steinberg (2019) Am Fam Physician 99(4): 237-43 [PubMed]
Type your search phrase here