Monograph Details
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Endocrine System
> Diabetes
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SYMLIN |
| Manufacturer |
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Amylin Pharmaceuticals, Inc. |
| Legal Classification |
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Rx
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| Pharmacological Class |
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Amylin analogue/amylinomimetic. |
| Generic Name |
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Pramlintide (as acetate) 0.6mg/mL; soln for SC inj; contains m-cresol, mannitol. |
| Indications |
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Type 1 diabetes as adjunct to mealtime insulin, or type 2 diabetes as adjunct to mealtime insulin with or without sulfonylurea and/or metformin, in patients without optimal blood glucose control despite optimal insulin therapy. |
| Children |
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Not recommended. |
| Adults |
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Do not mix with insulin. Reduce preprandial, short/rapid-acting insulin dose by 50% when starting pramlintide. Monitor blood glucose frequently (pre- and post-meals, and at bedtime). Adjust insulin dose after target pramlintide dose is achieved and any nausea subsides. Give by SC inj into abdomen or thigh immediately before major meals (≥250 kcal or ≥30g carbohydrates); rotate inj sites (use different site for insulin). Type 1: initially 15micrograms; titrate in 15microgram increments if no significant nausea occurs for at least 3 days; maintenance: 60micrograms (30 micrograms only if 60micrograms is not tolerated). If nausea occurs at 45 or 60 microgram dose, reduce to 30micrograms; if not tolerated, consider discontinuing therapy. Type 2: initially 60micrograms; may increase to 120micrograms if no significant nausea occurs for 3–7days; if nausea occurs at 120micrograms reduce to 60micrograms. |
| Contraindications |
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Gastroparesis. Hypoglycemia unawareness. Do not use in patients with poor compliance, HbA1c >9%, recurrent hypoglycemia needing assistance in the past 6 months, or if on prokinetic drugs. |
| Precautions |
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Dialysis. Pregnancy (Cat.C). Nursing mothers. |
| Interactions |
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Drugs that alter GI motility (eg, anticholinergics) and those that slow intestinal absorption (eg, α-glucosidase inhibitors): not recommended. May delay absorption of oral drugs (give these 1 hr before or 2 hrs after pramlintide). |
| Adverse Reactions |
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GI upset, anorexia, headache, allergy, insulin-dependent hypoglycemia (may be severe). |
| How Supplied |
Vials (5mL)—1
SymlinPen 60—1 (pre-filled inj device)
SymlinPen 120—1 (pre-filled inj device) |
| Additional Resources |
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• Related Prescribing Note |
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