Generic Name and Formulations:
Pramlintide (as acetate) 1000mcg/mL; soln for SC inj; contains m-cresol, mannitol.
Indications for SYMLIN:
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.
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 if no significant nausea occurs for at least 3 days; maintenance: 60mcg (30mcg only if 60mcg is not tolerated). 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 3–7days; if nausea occurs at 120mcg reduce to 60mcg.
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. Monitor blood glucose frequently (pre- and post-meals, and at bedtime). Visual or dexterity impairment. ESRD. Pregnancy (Cat.C). 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, propoxyphene, salicylates, somatostatin analogs, sulfonamide antibiotics; caution.
Nausea, vomiting, anorexia, headache, allergy; insulin-dependent hypoglycemia (may be severe, esp. in type 1 diabetes).
SymlinPen 60, 120—2 (pre-filled inj device)
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