Pramlintide

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Pramlintide Brand Names- Symlin | SymlinPen

What is Pramlintide

Pramlintide is a synthetic analog of amylin, a hormone co-secreted with insulin from pancreatic beta cells.

Pramlintide is used as an adjunct to insulin therapy in patients with type 1 and type 2 diabetes mellitus (DM).

Pramlintide is synthesized from a chemical modification of amylin with proline substituted for 3 amino acid residues at positions 25, 28, and 29; amylin itself cannot be injected as it is too viscous, unstable in solution, and tends to aggregate.

Amylin secretion is absent in patients with type 1 DM and decreased in patients with type 2 DM; decreased amylin concentrations contribute to persistent postprandial hyperglycemia and weight gain; accordingly, amylin replacement therapy with pramlintide complements insulin’s effects in achieving glycemic control, especially in controlling postprandial hyperglycemia.

Specifically, pramlintide slows gastric emptying, reduces postprandial glucagon secretion, and modulates appetite leading to decreased caloric intake. When used in combination with insulin, pramlintide further reduces A1C by up to 0.3% while not increasing the overall incidence of hypoglycemia.

Unlike the weight gain that is experienced with insulin monotherapy, modest weight reductions of 0.5 to 2 kg occur during combination therapy. Both the effects on glycemic control and weight have been maintained in clinical trials lasting 12 months.

In the treatment of type 1 DM, insulin therapy may be initiated with a basal-bolus regimen of insulin and then further individualized to achieve treatment goals; the addition of pramlintide may be beneficial in these patients.

In the treatment of type 2 DM, insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents.

If A1C remains above target, the addition of pramlintide may be considered.

Indications

  • type 1 diabetes mellitus
  • type 2 diabetes mellitus

For the treatment of type 1 diabetes mellitus and type 2 diabetes mellitus

for the adjunct treatment of type 1 diabetes mellitus in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy

Side Effects

  1. abdominal pain
  2. anorexia
  3. arthralgia
  4. cough
  5. dizziness
  6. fatigue
  7. headache
  8. hypoglycemia
  9. injection site reaction
  10. lipodystrophy
  11. nausea
  12. pancreatitis
  13. pharyngitis
  14. pruritus
  15. vomiting

Monitoring Parameters

  • blood glucose
  • glycosylated hemoglobin A1c (HbA1c)

Contraindications

  • breast-feeding
  • children
  • cresol hypersensitivity
  • dialysis
  • diarrhea
  • driving or operating machinery
  • fever
  • gastroparesis
  • geriatric
  • hypoglycemia
  • infection
  • osteoporosis
  • pregnancy
  • renal failure
  • surgery
  • thyroid disease
  • tobacco smoking
  • trauma
  • vomiting

Interactions

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