Pramlintide (Symlin)
Symlin
Synthetic amylin analog used at mealtimes to slow gastric emptying and aid glycemic/weight control.
Key takeaways
- Amylin analog injected before major meals as an adjunct to insulin in type 1 and type 2 diabetes.
- Short half-life, roughly 45–50 minutes; dosing is tied to meals, not a weekly depot.
- FDA-approved with RCT evidence; main risks are nausea and insulin-stacked hypoglycemia.
- Preprandial insulin is typically reduced (often 50%) when pramlintide is added, per the label.
Reported dosing protocols
Protocols reported in research literature and clinic/community use — informational context, not a dosing recommendation.
| Use case | Dose | Route | Frequency | Duration |
|---|---|---|---|---|
| Type 1 diabetes, with mealtime insulin (label) | 15 mcg start, titrate to 30–60 mcg | SubQ | Before each major meal | Chronic |
| Type 2 diabetes, with mealtime insulin (label) | 60 mcg start, titrate to 120 mcg | SubQ | Before each major meal | Chronic |
Pharmacokinetic summary
- Model tier
- Simple (t½ + F, Tmax estimated)
- Half-life
- 43 min
- Bioavailability
- 40%
- Typical dose
- 0.015–0.12 mg
Frequently asked questions
Does pramlintide replace insulin?
No. It's an add-on to mealtime insulin, not a replacement. Amylin handles what insulin doesn't: slowing gastric emptying and suppressing glucagon after meals. The label requires reducing insulin doses when it's added, to lower hypoglycemia risk.
Can pramlintide be used for weight loss?
It's been studied for weight management and does reduce food intake, but it's only approved as a diabetes adjunct. The multi-injection daily burden and nausea have limited interest in it as a standalone weight-loss drug; newer amylin analogs like cagrilintide are in development for that.
Why does pramlintide cause hypoglycemia?
It doesn't cause it directly — the risk comes from stacking it on insulin while it slows gastric emptying. Food arrives in the bloodstream later than the insulin peak, so the label cuts preprandial insulin at initiation and carries a severe-hypoglycemia warning.
References
- Estimated — Short half-life (~50 min); meal-time injection.
- FDA Symlin prescribing information — Label dosing for T1D/T2D, roughly 50-minute half-life, and the hypoglycemia boxed warning.
Related compounds
Cagrilintide
Long-acting calcitonin/amylin analog used with semaglutide (CagriSema) for obesity; weekly injection.
Semaglutide Injection (Ozempic/Wegovy)
Long-acting GLP-1 receptor agonist for type 2 diabetes and weight loss; weekly injection.
Semaglutide Oral (Rybelsus)
Oral semaglutide with very low bioavailability; taken fasting.
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