Pramlintide

SYMLIN

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Pronunciation: PRAM-lin-tide (SIM-lin)

Pramlintide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Pramlintide ballicule

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.

Pramlintide molecular structure (skeletal formula) — Molecular structure: Pramlintide

FDA-approved for

diabetes (adjunct to insulin) (2005)

FDA label

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BOXED WARNING Severe hypoglycemia with insulin (esp. type 1 diabetes), typically within 3 h of injection; reduce insulin, monitor glucose, select patients carefully

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

Available strengths

inj 1000 mcg/mL

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

Cost

Pramlintide (SYMLIN)

Strength		#/mo	generic $/unit	CostPlus
1000 mcg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Pramlintide is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entryNo US generic

⚠ BOXED WARNING

Severe hypoglycemia with insulin

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent

Defining liabilityAgent-specific hypoglycemia, ketoacidosis, volume, renal or gastrointestinal toxicity.

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