Endocrinology Book

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Symlin

Aka: Symlin, Pramlintide, Amylinomimetic
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  1. Indications
    1. Type I and II Diabetes Mellitus
      1. Adjunct to Insulin therapy
      2. Third-line measure due to Hypoglycemia risk and cost
  2. Mechanism
    1. Pramlintide is a synthetic analogue of human Amylin
    2. Amylin is secreted with Insulin from Pancreas
    3. Amylin lowers post-prandial Blood Sugars
      1. Delays gastric emptying
      2. Inhibits glucago release
  3. Dosing
    1. Protocol
      1. Reduce short and mixed-acting Insulin dose by 50%
      2. Use 100 unit 0.3 ml syringe
      3. Take with at least 250 calories (>30 g Carbohydrate)
    2. Type I Diabetes Mellitus
      1. Start: 15 mcg (2.5 U) SQ tid immediately before meals
      2. Titrated in 15 mcg increments q3-7 days
      3. Target: 30-60 mcg (5-10 units) SQ tid before meals
      4. Discontinue if significant Nausea
    3. Type II Diabetes Mellitus
      1. Start: 60 mcg (10 U) SQ tid immediately before meals
      2. Target: 60-120 mcg (10-20 units) SQ tid before meals
      3. Discontinue if significant Nausea
  4. Precautions
    1. Switch to new pen device which replaces the vials and prevents dosing errors
      1. Warning: Pen concentration is different than vial concentration
    2. Dosing errors are common with the vials
      1. Dosing is typically listed in mcg, but is drawn up in Insulin syringes marked with units
      2. A patient who mistakes their 30 mcg dose for 30 units is accidentally taking 180 mcg
  5. Adverse effects
    1. Nausea (28%) or Vomiting (8%): Especically Type I DM
    2. Headache (13%)
    3. Anorexia (9%)
    4. Abdominal Pain (8%)
    5. Severe Hypoglycemia (4.7%)
      1. Occurs 3 hours after Insulin and Pramlintide dose
  6. Advantages
    1. Lowers weight 3 lb or 1.4 kg (Placebo: 0.6 kg gained)
  7. Disadvantages
    1. Nausea and Severe Hypoglycemia
    2. Expensive (Almost $400 for 1 month at 120 mcg tid)
  8. Efficacy
    1. Drops A1C 0.5 to 0.6% (contrast with Placebo: 0.25% )
  9. References
    1. Jones (2007) Am Fam Physician 75:1831-5
    2. Kruger (2004) Drugs 64: 1419-32
    3. Kleppinger (2003) Ann Pharmacother 37:1082-9
    4. Ryan (2005) Clin Ther 27:1500-12
Medication Costs
SymlinPen 120 (on 2/9/2012 at DrugStore.com)
SymlinPen 120 1000mcg/ml Solution Two 2.7ml Syringes Per Box. #1 for $461.64 ($461.64/unit)
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Pramlintide (C0537551)

Definition (NCI) A synthetic analogue of the hormone amylin with antidiabetic activities. Upon administration, pramlintide mimics the actions of the naturally occurring amylin (islet amyloid polypeptide), a hormone that is produced by the beta cells of the pancreas and helps regulate blood glucose levels by 1) Inhibiting glucagon secretion; 2) Decreasing the rate of gastric emptying and 3) Suppressing appetite. Production of amylin is absent or decreased in patients with diabetes type I or II, respectively.
Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSH C105254
SnomedCT 416392006, 416425000
English pramlintide, PRAMLINTIDE, Pramlintide, pramlintide [Chemical/Ingredient], Pramlintide (product), Pramlintide (substance)
Spanish pramlintida (producto), pramlintida (sustancia), pramlintida
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Symlin (C1174780)

Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSH C105254
English Symlin, Amylin Pharmaceuticals brand of pramlintide acetate
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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