Synthetic version of amylin, a hormone the pancreas releases together with insulin. Used with mealtime insulin in type 1 and type 2 diabetes.
Regulatory status
Approved (FDA / EMA)
Family
Amylin analog
Scientific evidence
Moderate
Number of findings
2
Where it acts
Hormones and metabolism · Digestive and weight
Also known as
pramlintide, Symlin, SymlinPen, amylin analog
Regulatory status
FDA (US): Approved (2005, Symlin) as an add-on to mealtime insulin in type 1 and type 2 diabetes.
EMA (EU): Not approved: the European application (2001) was withdrawn in 2002 because more data were needed; it is not marketed in the EU.
Dose
Type 1: 15 µg subcutaneously before main meals, increasing in 15 µg steps to 30–60 µg; type 2: 60 µg, increasing to 120 µg. When starting, mealtime insulin is reduced by 50% (FDA Symlin label).
Safety
FDA boxed warning for risk of severe hypoglycemia, especially in type 1 diabetes, within 3 hours after injection. Nausea very common at the start, vomiting, loss of appetite. Contraindicated in gastroparesis or hypoglycemia unawareness. Only with a prescription and close medical monitoring.
Interactions
Slows absorption of oral drugs: those needing a rapid effect should be taken 1 hour before or 2 hours after. Avoid with drugs that slow intestinal transit (anticholinergics) or with alpha-glucosidase inhibitors.
Effect by goal · level of evidence
HbA1c and weight in type 1 diabetes
improvesModerateRCT (AA)in people
−0.3 points HbA1c
52-week RCT with 651 patients: HbA1c −0.29/−0.34 points with 60 µg 3–4 times daily versus −0.04 with placebo; weight −0.4 kg versus +0.8 kg. Mild, transient nausea was the most common effect.
29-week RCT with 296 patients: HbA1c fell equally in both groups (−0.5), but weight fell 1.3 kg with pramlintide and rose 1.2 kg with placebo. More nausea (63% vs 36%) and severe hypoglycemia (0.57 vs 0.30 episodes/year).
It mimics amylin, which is missing in type 1 diabetes and reduced in type 2. It slows stomach emptying, suppresses glucagon after eating, and increases satiety. This reduces glucose spikes after meals and helps people eat less.
What the evidence says
In people
HbA1c and weight in type 1 diabetes. 52-week RCT with 651 patients: HbA1c −0.29/−0.34 points with 60 µg 3–4 times a day versus −0.04 with placebo; weight −0.4 kg versus +0.8 kg. Mild, transient nausea was the most common effect. PubMed 15498087
Weight with intensive insulin in type 1. 29-week RCT with 296 patients: HbA1c fell equally in both groups (−0.5), but weight fell 1.3 kg with pramlintide and rose 1.2 kg with placebo. More nausea (63% vs 36%) and severe hypoglycemia (0.57 vs 0.30 episodes/year). PubMed 17003291