Pramlintide
SYMLIN
What it isAmylin analogue slowing gastric emptying and suppressing glucagon; diabetes with mealtime insulin.
Why this oneIt addresses postprandial glucagon excess, which insulin alone does not.
What limits itSevere hypoglycemia with insulin unless the insulin dose is cut by half first. Nausea; a separate injection at every meal.
FDA-approved for
- diabetes (adjunct to insulin) (2005)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 1 diabetes (with mealtime insulin) | Adults | 15 mcg SC before major meals | Titrate by 15 mcg | 30–60 mcg premeal |
| Type 2 diabetes (with mealtime insulin) | Adults | 60 mcg SC before major meals | 120 mcg premeal | 120 mcg premeal |
Titration Wait ≥3 days between dose increases (to minimize nausea)
Renal Undefined
Hepatic Undefined
Reduce mealtime insulin by 50% when initiating
Instructions
- Inject SC immediately before major meals
- Reduce mealtime insulin dose by 50% at initiation
- Administer as a separate injection — do not mix with insulin
- Give oral drugs needing rapid onset ≥1 h before or 2 h after
Contraindications
- Hypoglycemia unawareness
- Confirmed gastroparesis
Cautions
- Severe hypoglycemia (with insulin)
- Never share a SymlinPen between patients
- Do not mix with insulin
- Slows gastric emptying (affects oral drug absorption)
Adverse reactions
- Nausea
- Vomiting
- Anorexia
- Headache
Pregnancy Insufficient data; low placental transfer in ex-vivo studies
Lactation No data on presence in human milk
⚠ BOXED WARNING
- Severe hypoglycemia with insulin
Cost, est. cash$300–$1,000/month
Generic entryNo US generic
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityAgent-specific hypoglycemia, ketoacidosis, volume, renal or gastrointestinal toxicity.
Mechanism of action: Pramlintide ballicule
