Indications for SYMLIN:
Adjunctive treatment in patients with type 1 or type 2 diabetes who use mealtime insulin and who have failed to achieve blood glucose control despite optimal insulin therapy.
Do not mix with insulin. Reduce preprandial, short/rapid-acting insulin dose by 50% when starting pramlintide. 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 15mcg; titrate in 15mcg increments (max 60mcg) if no significant nausea occurs for ≥3 days. If nausea occurs at 45 or 60mcg dose, reduce to 30mcg; if not tolerated, consider discontinuing therapy. Type 2: initially 60mcg; may increase to 120mcg if no significant nausea occurs for ≥3 days; if nausea occurs at 120mcg reduce to 60mcg.
Gastroparesis. Hypoglycemia unawareness.
Increased risk of severe hypoglycemia with insulin (esp. type 1 diabetics). Do not use in patients with poor compliance, HbA1c >9%, recurrent hypoglycemia needing assistance in the past 6 months, or if on prokinetic drugs. Discontinue if persistent severe nausea occurs. Visual or dexterity impairment. Monitor blood glucose frequently (pre- and post-meals, and at bedtime). Do not share pens between patients, even if the needle is changed. Hepatic impairment, ESRD: not studied. Pregnancy. Nursing mothers.
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). Increased risk of hypoglycemia with other antidiabetics (eg, sulfonylurea), ACEIs, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, salicylates, somatostatin analogs, sulfonamide antibiotics; caution.
Nausea, vomiting, anorexia, headache, local allergy; insulin-dependent hypoglycemia.
SymlinPen 60, 120—2 (multidose pen-injectors)