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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 [3]
Dosage:
1) type 1 diabetes:
a) start 15 ug before meals*
b) titrate# to 15-60 ug
2) type 2 diabetes:
a) start 60 ug before meals
b) reduce short-acting preprandial insulin 50% when starting Symlin
c) titrate# to 60-120 ug
3) administration is SC in thigh or abdomen
4) pen is calibrated to give correct dose in ug [2]
* 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:
1) hypoglycemia (may be severe)
2) nausea/vomiting
Mechanism of action:
1) synthetic amylin
2) slows gastric emptying [3]
3) supresses glucagon secretion
4) increases satiety [3]
5) reduces insulin requirements
Clinical trials:
- no long term outcome studies [3]
Notes:
- Cost: $100 for 5 mL vial (2005)
Interactions
drug adverse effects of hypoglycemic agents
monitor with insulin-response enhancers
General
amylin; islet amyloid polypeptide; diabetes-associated peptide; DAP; insulinoma amyloid peptide (IAPP)
parenteral hypoglycemic agent
References
- Prescriber's Letter 12(6):32 2005
New Drug: Pramlintide (Symlin)
Detail-Document#: 210603
(subscription needed) http://www.prescribersletter.com
- Prescriber's Letter 15(1): 2008
Symlin (Pramlintide) Pen
Detail-Document#: 240105
(subscription needed) http://www.prescribersletter.com
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015