Amylin Analog

Question 1

Pramlintide MOA

Answer 1

Amylin works in concert with insulin to regulate post-prandial hyperglycemia
● Slows gastric emptying
● Suppression of post-prandial glucagon secretion
● Centrally mediated modulation of appetite

Question 2

Amylin Analog Agent

Answer 2

• Symlin® (pramlintide)
• Synthetic analog of amylin
• Amylin is a hormone co-secreted with insulin from pancreatic beta cells
• Amylin production is absent in type 1 and inadequate in type 2

Question 3

Pramlintide: Dosing

Answer 3

•Available as 0.6mg/ml or 1mg/mL

•Dosing (T1DM):
• Start: 15μg SC immediately prior to each meal
• Target dose of 60μg SC immediately prior to each meal

•Dosing (T2DM):
• Start: 60mcg SC immediately prior to each meal
• Target dose of 120mcg QAC

Question 4

Pramlintide: Side effects

Answer 4

● HYPOGLYCEMIA (severe)***
● Nausea
● Headache
● Vomiting
● Fatigue
● Arthralgia

Question 5

Pramlintide: Drug interactions

Answer 5

● Potassium Salts: pramlintide can delay absorption which could be detrimental for thyroid

● Anticholinergics: additive effect and delayed gastric emptying/slow GI transit

Question 6

Pramlintide: BBW

Answer 6

• Co-administration with insulin
- 50% reduction due to hypoglycamia

Question 7

Pramlintide: Contraindications

Answer 7

• Hypoglycemia unawareness
• Gastroparesis
• Hypersensitivity

Question 8

Pramlintide: Precautions

Answer 8

• Bariatric surgery
• Conditions or medications that impair
gastric motility
● Other IR medications
● A1C > 9%
● Non-compliant patients

Question 9

Pramlintide: Counseling points

Answer 9

● SC administration
● Do not mix with insulin
● Best if given immediately prior to eating
● If you skip a meal and skip a bolus, skip your injection
● May cause upset stomach; should decrease over time
● Can keep in fridge or room temperature; discard after 28 days once open
● Ask about: post-prandial readings at every refill

Question 10

Pramlintide: Monitoring

Answer 10

● PPG
● GI intolerance
● Injection technique