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Metabolic & weight

Pramlintide

Also called Symlin, SymlinPen, pramlintide acetate, AC-137

Pramlintide is a lab-made version of amylin, a hormone released with insulin after meals. It is added to mealtime insulin in type 1 or type 2 diabetes to help control blood sugar after eating.

FDA-approvedApproved by the FDA for at least one use after large human trials.

All printable flashcards

Drawn from its published sequence: 37 residues, one bead each. Dashed arcs are ring bonds.

Overview

Pramlintide is a lab-made version of amylin, a hormone released with insulin after meals. It is added to mealtime insulin in type 1 or type 2 diabetes to help control blood sugar after eating.

How it works

Established: like natural amylin, pramlintide slows stomach emptying, lowers the rise in glucagon after meals (so the liver releases less sugar), and increases fullness, which reduces food intake.

What research shows

  • Type 1 diabetes trials (30/60 mcg three times daily with insulin): nausea 48% vs 17% placebo, anorexia 17% vs 2% (FDA label, RCTs).
  • Type 2 diabetes trials (120 mcg twice daily with insulin): nausea 28% vs 12%, headache 13% vs 7% (FDA label, RCTs).

Doses studied in people

Study or labelDose usedSource
FDA label, type 1 diabetes (with mealtime insulin)Start 15 mcg subcutaneously before major meals; increase in 15 mcg steps to 30–60 mcg as tolerated1
FDA label, type 2 diabetes (with mealtime insulin)Start 60 mcg before major meals; increase to 120 mcg if tolerated1

Label requires cutting mealtime insulin by 50% when starting.

Read this first: these are the amounts given to participants in published studies or written on official prescribing labels, reported for reference. They are not recommendations. Trial doses were chosen for specific patients under medical supervision, and a dose that is safe in one person can be harmful in another.

Weekly protocol

How the schedule looks week by week. Each chart says where it comes from: a prescribing label, a clinical trial, or a protocol commonly reported online.

Symlin label: type 2 diabetes

Prescribing label

One week

D1D2D3D4D5D6D7

Immediately before each major meal · Subcutaneous injection

Dose by week

60 mcg per mealStarting · wk 1
120 mcg per mealMaintenance · wk 2+
Course
Ongoing
Note
Cut mealtime insulin by 50% when starting. Increase once there has been no significant nausea for at least 3 days; return to 60 mcg if nausea persists at 120 mcg.
Source
SYMLIN (pramlintide) prescribing information (revised 12/2019)

Symlin label: type 1 diabetes

Prescribing label

One week

D1D2D3D4D5D6D7

Immediately before each major meal · Subcutaneous injection

Dose by week

15 mcg per mealStarting · wk 1
30 mcg per mealwk 2
45 mcg per mealwk 3
60 mcg per mealMaintenance · wk 4+
Course
Ongoing
Note
Cut mealtime insulin by 50% when starting. Each 15 mcg step needs at least 3 days without significant nausea (weeks shown are approximate); maintenance is 30 or 60 mcg, reduced to 30 mcg if 45–60 mcg is not tolerated.
Source
SYMLIN (pramlintide) prescribing information (revised 12/2019)

Reference only, not a recommendation. Label and trial schedules were set for specific patients under medical supervision. Use the calculator only to understand the arithmetic.

Safety

  • Boxed warning: severe hypoglycemia when used with insulin, especially in type 1 diabetes, usually within 3 hours of injection (label).
  • Contraindicated with hypoglycemia unawareness, confirmed gastroparesis, or serious hypersensitivity (label).
  • Common: nausea (usually early and fading), anorexia, vomiting, headache, fatigue, dizziness (label).

Report side effects of any drug or product to the FDA through MedWatch. For a possible poisoning in the US, call Poison Control at 1-800-222-1222.

History

Developed by Amylin Pharmaceuticals (now part of AstraZeneca) and approved by the FDA on March 16, 2005.

Common questions

Is pramlintide FDA-approved?

Yes. It was approved as Symlin in 2005 as an add-on to mealtime insulin in type 1 and type 2 diabetes 12.

How does pramlintide work?

It works like the natural hormone amylin. It slows stomach emptying, lowers the after-meal rise in glucagon and increases fullness 1.

What doses are on the FDA label?

The label starts at 15 mcg before major meals in type 1 diabetes, rising to 30 to 60 mcg, and 60 mcg rising to 120 mcg in type 2 1. It also says mealtime insulin should be cut by half when starting 1. These are label figures, not advice.

What is the biggest safety concern?

A boxed warning flags severe low blood sugar when used with insulin, especially in type 1 diabetes, usually within 3 hours of the injection 1. It is not for people with hypoglycemia unawareness or confirmed gastroparesis (slow stomach emptying) 1.

What side effects were seen in trials?

In type 1 trials, nausea affected 48% vs 17% on placebo 1. In type 2 trials, nausea affected 28% vs 12% and headache 13% vs 7% 1.

Is pramlintide banned in sport?

It is not named on WADA's 2026 Prohibited List 3.

Related compounds

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Insulin (human insulin and analogs)

regular human insulin · Humulin R

Insulin is the hormone the pancreas makes to move sugar from the blood into the body's cells.

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Exenatide

exendin-4 (synthetic) · Byetta

Exenatide was the first GLP-1 drug, a lab-made copy of a peptide found in Gila monster venom.

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Glucagon

Glucagon Emergency Kit · GlucaGen

Glucagon is a pancreatic hormone that does the opposite of insulin: it tells the liver to release stored sugar.

Sources

  1. SYMLIN (pramlintide acetate) prescribing information FDA label
  2. Pramlintide — Wikipedia (CAS, approval date, substitutions) Reference
  3. WADA 2026 Prohibited List Regulatory

Last reviewed 2026-10-25 · How we research · Found an error? See our corrections policy.