pramlintide (Symlin)

Indications

• backup agent to reduce insulin requirements in patients with
  • diabetes mellitus type 1
  • diabetes mellitus type 2
• may help with weight reduction

Dosage

• type 1 diabetes:
  • start 15 ug before meals*
  • titrate# to 15-60 ug
• type 2 diabetes:
  • start 60 ug before meals
  • reduce short-acting preprandial insulin 50% when starting Symlin
  • titrate# to 60-120 ug
• administration is SC in thigh or abdomen
• pen is calibrated to give correct dose in ug

* meal is 250 kcal or more, or 30 g of carbohydrates or more

# titrate to nausea or maximum dose adjust insulin to achieve glycemic control after maintenance dose of Symlin has been reached

5 mL vials 0.6 mg/mL

refrigerate & protect unopened vials from light

Adverse effects

• hypoglycemia (may be severe)
• nausea/vomiting

• drug adverse effects of hypoglycemic agents

Mechanism of action

• synthetic amylin
• slows gastric emptying
• supresses glucagon secretion
• increases satiety
• reduces insulin requirements

Clinical trials

• no long term outcome studies

Notes

• Cost: $100 for 5 mL vial (2005)

More general terms

• amylin
• parenteral hypoglycemic agent