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. Visual or dexterity impairment. Increased risk of severe hypoglycemia (esp. type 1 diabetics). Monitor blood glucose frequently (pre- and post-meals, and at bedtime). Do not share pens between patients, even if the needle is changed. 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)