Endocrinology Book



Aka: Symlin, Pramlintide, Amylinomimetic, Amylin Analogue
  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. Contraindications
    1. Gastroparesis
  3. 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
  4. 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
  5. 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
  6. Adverse effects
    1. Nausea (28%) or Vomiting (8%): Especically Type I DM (related to Delayed Gastric Emptying)
      1. Contraindicated in Gastroparesis
    2. Headache (13%)
    3. Anorexia (9%)
    4. Abdominal Pain (8%)
    5. Severe Hypoglycemia (4.7%)
      1. Occurs 3 hours after Insulin and Pramlintide dose
      2. FDA Black box warning (decrease Insulin dose before starting)
  7. Advantages
    1. Lowers weight 3 lb or 1.4 kg (Placebo: 0.6 kg gained)
  8. Disadvantages
    1. Nausea
    2. Severe Hypoglycemia (FDA black box warning)
    3. No good longterm outcome data (other agents with better longterm efficacy are preferred)
    4. Expensive (>$1000)
  9. Efficacy
    1. Drops A1C 0.5 to 0.6% (contrast with Placebo: 0.25% )
  10. References
    1. Jones (2007) Am Fam Physician 75:1831-5 [PubMed]
    2. Kruger (2004) Drugs 64: 1419-32 [PubMed]
    3. Kleppinger (2003) Ann Pharmacother 37:1082-9 [PubMed]
    4. Ryan (2005) Clin Ther 27:1500-12 [PubMed]
    5. Steinberg (2019) Am Fam Physician 99(4): 237-43 [PubMed]
Medication Costs
symlin (on 1/1/2017 at Medicaid.Gov Pharmacy Drug pricing)
SYMLINPEN 120 PEN INJECTOR $172.13 per ml
SYMLINPEN 60 PEN INJECTOR $261.39 per ml
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 peptide analogue of human amylin with 3 proline substitutions at positions 25, 28 and 29, with antihyperglycemic activity. By mimicking amylin, pramlintide slows gastric emptying, inhibits digestive secretions (gastric acid, pancreatic enzymes, and bile), reduces glucagon secretion, and increases satiety; all of these actions are mediated mostly by glucose-sensitive areas in the brain stem. The overall result is a decrease in blood glucose levels. The use of pramlintide may cause an increased risk of insulin-induced hypoglycemia.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH C105254
SnomedCT 416392006, 416425000
English pramlintide, PRAMLINTIDE, Pramlintide, pramlintide [Chemical/Ingredient], Triproamylin, Pramlintide (product), Pramlintide (substance)
Spanish pramlintida (producto), pramlintida (sustancia), pramlintida
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
Derived from the NIH UMLS (Unified Medical Language System)

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