Tag Archives: Symlin

Brief Drug Review: Pramlintide

Pramlintide is sold in the U.S. as Symlin.  It’s only used in patients already taking meal-time rapid-acting insulin.  Pramlintide may have a role in treatment of overweight type 2 diabetics inadequately controlled on insulin, or who experience weight gain refractory to diet and exercise.

Remember that drug names vary by country and manufacturer.  This is a brief review; consult your physician or pharmacist for details.

Class:  amylin analogue

How does it work?

Amylin is a hormone stored in pancreas beta cells and is secreted along with insulin.  It affects glucose levels by several mechanisms, including slowed stomach emptying, regulation of glucagon secretion after meals, and by reducing food intake.  Amylin and insulin levels rise and fall together,working jointly to control blood sugar levels.   Amylin is relatively deficient in many cases of type 2 diabetes.

Pramlintide is a chemical similar in structure to amylin, and causes similar effects.  It allows insulin therapy to more easily match the body’s needs in the after-meal period.  It also promotes modest weight loss in obese patients. 

Pramlintide therapy reduces hemoglobin A1c by 0.5 to 1% (absolute decrease, not relative).

We have no data on long-term outcomes with this drug.


Pramlintide is FDA-approved for use in both type 1 diabetes and insulin-requiring type 2 diabetes.  It can be used with metformin and/or sulfonylureas as long as insulin is also part of the regimen.  It’s probably best not to use it with exenatide and other GLP-1-based therapies.


It’s injected subcutaneously just before meals, starting with 60 mcg in type 2 diabetics.  To avoid hypoglycemia at the start of treatment, the pre-meal rapid-acting injected insulin dose is usually reduced by half.  Pramlintide should only be administered before meals that contain at least 30 grams of carbohydrate or 250 calories.  The maximum dose is 120 mcg with each meal. 

Side effects

Nausea is the most common side effect but clears up in a few weeks.  Pramlintide by itself does not cause hypoglycemia, but since it is always used with injectable insulin, hypoglycemia may occur—usually within three hours.

Don’t use if you have . . .

. . . gastroparesis or hypoglycemia unawareness.

Steve Parker, M.D.

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