What to Know About Symlin (Pramlintide Injection)

An Injectable Drug for Treating Diabetes

Symlin (pramlintide injection) is a medication used to help manage type 1 diabetes as well as type 2 diabetes in people who take insulin. It is a synthetic form of amylin, a hormone produced in the pancreas along with insulin that helps to control the levels of glucose (sugar) in the bloodstream. In type 1 diabetes, amylin and insulin production stops altogether; in type 2 diabetes, amylin production can be impaired, so that not enough is released. In both cases, the use of Symlin alongside supplemental insulin can help keep blood glucose at normal levels. Symlin works by slowing the rate at which food is emptied from the stomach, which has several benefits for people with diabetes: It prevents blood sugar levels from rising too high after meals and also prolongs the feeling of fullness after eating, which can decrease appetite and lead to weight loss. It also reduces glucose production by the liver by suppressing the release of a hormone called glucagon. Symlin belongs to a class of medications called antihyperglycemics and is taken by injection.

Uses

Symlin is approved by the U.S. Food and Drug Administration (FDA) to work alongside supplemental insulin in adults. It's prescribed for people for whom taking insulin falls to adequately control blood glucose levels.

Before Taking

Your doctor may prescribe Symlin for you if insulin alone (or, if you have type 2 diabetes, insulin plus an oral diabetes drug) isn't adequately controlling your blood glucose. Goal levels for blood glucose vary from person to person.

Precautions and Contraindications

In some people, especially those with type 1 diabetes, Symlin can cause blood sugar levels to fall dangerously low—a condition called hypoglycemia. This is most likely to happen within three hours of taking it. The drug carries a boxed warning about this possibility, as severe hypoglycemia can interfere with the ability to think clearly, increasing the risk of getting hurt (or harming someone else) while doing any activity that requires you to be alert such as driving a car.

For this reason, there are certain people who should not take Symlin. They are those who:

  • Have had diabetes for a long time
  • Aren't able to recognize when their blood sugar levels are low (known as hypoglycemia unawareness)
  • Have been treated for hypoglycemia several times in the past 6 months
  • Have gastroparesis (slowed movement of food from the stomach to the small intestine)

If you are taking Symlin, there are certain circumstances under which the risk of a precipitous drop in glucose levels is especially high.

Do not take Symlin without first talking to your doctor if you:

  • Plan to skip a meal
  • Plan to eat a meal that has fewer than 250 calories or 30 grams of carbohydrates
  • Cannot eat because you're sick or scheduled for surgery or a medical test
  • Have very low blood sugar levels before a meal

Also, if you plan to be more active than usual, let your doctor know, as exercise can lower blood sugar levels temporarily.

Dosage

The dose of Symlin your doctor prescribes for you will depend on whether you have type 1 or type 2 diabetes. Either way, you'll start with a low dose and increase it every three days to find the best dose for you. (This is called titration.)

How to Titrate Symlin
For Type 1 Diabetes For Type 2 Diabetes
Starting with 15 mcg before major meals, increase dose in increments of 15 mcg to either 30 mcg or 60 mcg. If 45 mcg or 60 mcg aren't tolerable, reduce the dose back to 30 mcg. Start with 60 mcg before  major meals. After three days, increase to 120 mcg.
All listed doses are according to the drug manufacturer, Astra Zeneca. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

How to Take and Store

Symlin comes as a solution in a prefilled pen-injector. There are two available devices:

  • SymlinPen 60, which can be calibrated to deliver doses of 15 mcg, 30 mcg, 45 mcg, and 60 mcg
  • SymlinPen 120, which can be calibrated for 60-mcg and 120-mcg doses

The pens do not come with needles; you'll purchase those separately. (Your doctor will tell you which gauge needle is best for you.) You'll also need a sharps container in which to dispose of each needle after you've used it.

The pen will deliver the medication subcutaneously—that is, into the fatty tissue just beneath your skin. Choose an injection site on your abdomen or one of your upper legs, at least two inches away from your insulin injection site. Never inject insulin and Symlin in the same spot on your body, or mix the two medications together.

IMPORTANT

When you start taking Symlin, you will need to lower your insulin dose by 50 percent to prevent hypoglycemia.

Symlin typically is injected several times a day, before each meal that includes at least 250 calories or 30 grams of carbohydrates.

When you first start taking Symlin, check your blood glucose levels often—ideally before each meal and two hours after, or whenever you feel as if your blood glucose may be low. o see how the pramlintide dose works for you. You should also test whenever you feel like your blood glucose may be low.

Side Effects

As described above, a potential and dangerous side effect of Symlin is hypoglycemia.

A less serious side effect is nausea, caused by the slower rate at which food is emptied from your stomach. This may persist until your body adjusts to the medication. However, in rare cases, a person isn't able to tolerate nausea caused by Symlin; if lowering the dose doesn't help, it may be wise to stop taking it.

Other potential side effects of Symlin include:

  • redness, swelling, bruising, or itching at the injection site
  • appetite loss
  • stomach pain
  • excessive fatigue
  • dizziness
  • cough
  • sore throat
  • joint pain

These symptoms usually are mild, but if they become severe or don't go away, let your doctor know.

Warnings and Interactions

Symlin can interact with a wide variety of other medications, including but not limited to, angiotensin-converting enzyme (ACE) inhibitors, beta blockers, monoamine oxidase (MAO) inhibitors, fluoxetine (Prozac), aspirin, and certain antibiotics. If your doctor suggests Symlin for you, it's vital to make sure he or she knows about every other medication you take.

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