Pramlintide
Approved synthetic amylin analog used as adjunct mealtime therapy in insulin-treated diabetes. Slows gastric emptying and suppresses glucagon, with modest weight loss.
01 Overview
Pramlintide (Symlin) is a synthetic analog of the pancreatic hormone amylin, approved as an adjunct to mealtime insulin in type 1 and type 2 diabetes. It complements insulin by controlling post-meal glucose through mechanisms insulin does not address.
By slowing gastric emptying, suppressing glucagon and promoting satiety, it modestly reduces weight and mealtime glucose excursions. Its main risk is severe hypoglycaemia when combined with insulin, and it requires separate injection from insulin. Amylin analogs like pramlintide underpin the current wave of amylin-based weight-loss drugs.
02 Mechanism
Synthetic amylin analog that slows gastric emptying, suppresses postprandial glucagon secretion, and enhances satiety via central amylin receptors.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Type 1 diabetes | 15–60 mcg | SubQ | Titrated from 15 mcg before meals |
| Type 2 diabetes | 60–120 mcg | SubQ | Before major meals |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Reduced postprandial glucoseBlunts after-meal glucose spikes as insulin adjunct. | Marked | Clinical | |
| Modest weight lossSmall weight reduction through satiety and slowed emptying. | ~1-2 kg | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Severe hypoglycaemia (with insulin)Insulin-associated severe hypoglycaemia, carries a boxed warning. | Severe | Common | Clinical | |
| NauseaCommon early nausea from slowed gastric emptying. | Moderate | Very common | Clinical |