pramlintide (Rx)

Brand and Other Names:Symlin, SymlinPen 120, more...SymlinPen 60
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 0.6mg/mL

pen-injector

  • 15mcg/dose
  • 30mcg/dose
  • 45mcg/dose
  • 60mcg/dose
  • 120mcg/dose

Type 1 Diabetes

Initial: 15 mcg SC immediately prior to major meals

Increase by 15 mcg q3Days (if not significant nausea occur)

Reduce postprandial short-acting insulin dose by 50%

Maintenance: 30-60 mcg SC

Type 2 Diabetes

Initial: 60 mcg SC immediately prior to major meals

After 3-7 days increase to 120 mcg prior to meals (if not significant nausea occurs)

Reduce postprandial short-acting insulin dose by 50%

Maintenance: 60-120 mcg SC

Renal Impairment

No adjustments necessary

Monitor

Blood glucose AC, PC & HS

Safety and efficacy not established

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Interactions

Interaction Checker

and pramlintide

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (7)

            • insulin aspart

              insulin aspart, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            • insulin detemir

              insulin detemir, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            • insulin glargine

              insulin glargine, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            • insulin glulisine

              insulin glulisine, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            • insulin lispro

              insulin lispro, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            • insulin NPH

              insulin NPH, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            • insulin regular human

              insulin regular human, pramlintide. Mechanism: unspecified interaction mechanism. Contraindicated. Must be administered separately.

            Serious - Use Alternative (42)

            • acarbose

              pramlintide, acarbose. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI nutrient absorption.

            • aclidinium

              pramlintide, aclidinium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • anticholinergic/sedative combos

              pramlintide, anticholinergic/sedative combos. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • atracurium

              pramlintide, atracurium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • atropine

              pramlintide, atropine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • atropine IV/IM

              pramlintide, atropine IV/IM. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • belladonna alkaloids

              pramlintide, belladonna alkaloids. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • belladonna and opium

              pramlintide, belladonna and opium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • cisatracurium

              pramlintide, cisatracurium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • cyclizine

              pramlintide, cyclizine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • cyclobenzaprine

              pramlintide, cyclobenzaprine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • darifenacin

              pramlintide, darifenacin. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • dicyclomine

              pramlintide, dicyclomine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • diphenhydramine

              pramlintide, diphenhydramine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • fesoterodine

              pramlintide, fesoterodine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • flavoxate

              pramlintide, flavoxate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • glycopyrrolate

              pramlintide, glycopyrrolate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • glycopyrrolate inhaled

              pramlintide, glycopyrrolate inhaled. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • henbane

              pramlintide, henbane. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • homatropine

              pramlintide, homatropine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • hyoscyamine

              pramlintide, hyoscyamine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • hyoscyamine spray

              pramlintide, hyoscyamine spray. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • incobotulinumtoxinA

              pramlintide, incobotulinumtoxinA. pharmacodynamic synergism. Avoid or Use Alternate Drug. Synergistic inhibition of GI motility.

            • ipratropium

              pramlintide, ipratropium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • meclizine

              pramlintide, meclizine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • methscopolamine

              pramlintide, methscopolamine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • miglitol

              pramlintide, miglitol. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI nutrient absorption.

            • onabotulinumtoxinA

              pramlintide, onabotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • oxybutynin

              pramlintide, oxybutynin. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • oxybutynin topical

              pramlintide, oxybutynin topical. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • oxybutynin transdermal

              pramlintide, oxybutynin transdermal. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • pancuronium

              pramlintide, pancuronium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • pralidoxime

              pramlintide, pralidoxime. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • propantheline

              pramlintide, propantheline. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • rapacuronium

              pramlintide, rapacuronium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • rocuronium

              pramlintide, rocuronium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • scopolamine

              pramlintide, scopolamine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • solifenacin

              pramlintide, solifenacin. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • tiotropium

              pramlintide, tiotropium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • tolterodine

              pramlintide, tolterodine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • trospium chloride

              pramlintide, trospium chloride. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • vecuronium

              pramlintide, vecuronium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            Monitor Closely (27)

            • albiglutide

              albiglutide, pramlintide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Concurrent use may increase risk of hypoglycemia; monitor glucose levels.

            • aripiprazole

              aripiprazole, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • asenapine

              asenapine, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • atazanavir

              atazanavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • benztropine

              pramlintide, benztropine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Synergistic inhibition of GI motility.

            • darunavir

              darunavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • dulaglutide

              dulaglutide, pramlintide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

            • fosamprenavir

              fosamprenavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • iloperidone

              iloperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • indinavir

              indinavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • insulin degludec

              pramlintide, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Pramlintide is indicated to be used in combination with insulin; however, pamlintide increases risk of insulin-induced hypoglycemia; reduce prandial insulin dose when initiating pramlintide.

            • insulin degludec/insulin aspart

              pramlintide, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Pramlintide is indicated to be used in combination with insulin; however, pamlintide increases risk of insulin-induced hypoglycemia; reduce prandial insulin dose when initiating pramlintide.

            • insulin inhaled

              pramlintide, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Pramlintide is indicated to be used in combination with insulin; however, pamlintide increases risk of insulin-induced hypoglycemia; reduce prandial insulin dose when initiating pramlintide.

            • liraglutide

              liraglutide, pramlintide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Concurrent use may increase risk of hypoglycemia; monitor glucose levels.

            • lopinavir

              lopinavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • lurasidone

              lurasidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • nelfinavir

              nelfinavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • olanzapine

              olanzapine, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • paliperidone

              paliperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • quetiapine

              quetiapine, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • risperidone

              risperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • ritonavir

              ritonavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • saquinavir

              saquinavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • somapacitan

              somapacitan decreases effects of pramlintide by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone products may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating somapacitan. .

            • tipranavir

              tipranavir decreases effects of pramlintide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

            • trihexyphenidyl

              pramlintide, trihexyphenidyl. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Synergistic inhibition of GI motility.

            • ziprasidone

              ziprasidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            Minor (0)

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              Adverse Effects

              >10%

              Nausea

              Headache

              Vomiting

              Anorexia

              Severe hypoglycemia

              Inflicted injury

              1-10%

              Dizziness

              Fatigue

              Abdominal pain

              Pharyngitis

              Cough

              Arthralgia

              Allergic reaction

              Postmarketing Reports

              Injection site reactions

              Pancreatitis

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              Warnings

              Black Box Warnings

              Pramlintide is used with insulin and has been associated with an increased risk of insulin-induced severe hypoglycemia, particularly in patients with type 1 diabetes

              When severe hypoglycemia associated with pramlintide use occurs, it is seen within 3 hours following injection

              If severe hypoglycemia occurs while operating a motor vehicle or heavy machinery, or while engaging in other high-risk activities, serious injuries may occur. Appropriate patient selection, careful patient instruction, and insulin dose adjustments are critical elements for reducing this risk

              Contraindications

              Hypersensitivity

              Gastroparesis

              Hypoglycemia unawareness

              Cautions

              Risk of severe insulin-induced hypoglycemia; pramlintide alone does not cause hypoglycemia; however, since it is indicated to be coadministered with mealtime insulin therapy, and in this setting there is an increased risk of severe hypoglycemia

              Do not mix with insulin - administer the two separately

              Slows gastric emptying, which may delay the absorption of concomitantly administered oral medications; administer the concomitant oral medication at least 1 hr prior or 2 hr after pramlintide

              Slows gastric emptying; not recommended if taking other medications that alter gastrointestinal motility

              Never share pen between patients even if needle is changed

              Erythema, edema, or pruritus at site of injection reported; may be related to other factors, such as irritants in a skin cleansing agent or improper injection technique

              Proper patient selection

              • Proper patient selection is essential to safe and effective use
              • For use only in patients with type 1 or type 2 diabetes using mealtime insulin who fulfill the following criteria:
              • -failed to achieve adequate glycemic control despite individualized insulin management
              • -receiving ongoing care under the guidance of a healthcare professional skilled in the use of insulin and supported by the services of diabetes educator
              • Not for use in patients with ANY of the following criteria:
              • -poor compliance with current insulin regimen
              • -poor compliance with prescribed self blood glucose monitoring
              • -have a HbA1c >9%
              • -recurrent severe hypoglycemia requiring assistance during the past 6 months
              • -presence of hypoglycemia unawareness
              • -confirmed diagnosis of gastroparesis
              • -require the use of drugs that stimulate gastrointestinal motility
              • -pediatric patients
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              Pregnancy & Lactation

              Pregnancy

              Available data from a small number of reports in manufacturer’s safety database on use in pregnant women are not sufficient to determine a drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes; there are risks to mother and fetus associated with poorly controlled diabetes in pregnancy

              Ex-vivo studies using term perfused human, rabbit, and rat placentas indicate that drug has low potential to cross maternal/fetal placental barrier

              Poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, and delivery complications; poorly controlled diabetes increases fetal risk for major birth defects, stillbirth, and macrosomia related morbidity

              Animal data

              • In animal reproduction studies, congenital abnormalities were observed in fetuses of pregnant rats but not in fetuses of pregnant rabbits exposed during organogenesis to drug at 10 times clinical dose of 360 mcg/day, based on exposure

              Lactation

              There is no data on presence in human milk, effects on breastfed infant, or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Synthetic analog of the polypeptide pancreatic hormone amylin, which slows gastric emptying, supresses glucagon, and regulate appetite

              Pharmacokinetics

              Half-Life: 48 min

              Bioavailability: 30-40%

              Metabolism: kidneys

              Excretion: Primarily urine

              Duration: 3 hr

              Protein binding: 60%

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              SymlinPen 60 subcutaneous
              -
              1,500 mcg/1.5 mL injection
              SymlinPen 120 subcutaneous
              -
              2,700 mcg/2.7 mL injection

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              pramlintide subcutaneous

              PRAMLINTIDE INJECTOR - INJECTION

              (PRAM-lin-tide)

              COMMON BRAND NAME(S): Symlinpen

              WARNING: Pramlintide may increase the risk of very low blood sugar when used with insulin, particularly in patients with type 1 diabetes. This reaction is most likely to occur within 3 hours after an injection. Your doctor may decrease your insulin dose when you start pramlintide. Low blood sugar makes it hard to think clearly, drive a car, use heavy machinery, or safely participate in other activities that include a risk of hurting yourself or others. (See also Side Effects and Precautions sections.)

              USES: Pramlintide is used with mealtime insulin and a proper diet and exercise program to control high blood sugar in people with type 1 and type 2 diabetes. It is used when patients who are already using insulin need better blood sugar control. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke.Pramlintide acts like a certain natural substance called amyrin, which lowers blood sugar. This drug works by slowing the movement of food through your stomach. It also decreases your appetite and the amount of sugar your liver makes. Pramlintide does not replace insulin, but it may lower the amount of insulin you need.

              HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using pramlintide and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Inject this medication under the skin of the thigh or abdomen just before each main meal. Do not use pramlintide if your blood sugar is too low, if you are planning to eat a small meal (less than 250 calories or 30 grams of carbohydrate), or if you are skipping a meal.The liquid in the pre-filled injector is stronger than the liquid in the vial. Make sure you are using the correct product. Do not switch between products unless directed by your doctor.Make sure you learn from your health care professional how to measure your dose and inject this drug. Always use a new needle for each injection. Consult your doctor or pharmacist if you have any questions. If you are storing this drug in the refrigerator, remove it and allow it to come to room temperature before injecting. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Before injecting each dose, clean the injection site with rubbing alcohol. It is important to change the location of the injection site daily to avoid problems under the skin. Never mix pramlintide and insulin in the same syringe or at the same injection site. Inject pramlintide in an area that is at least 2 inches (5 centimeters) away from your insulin injection site.Your dosage is based on your medical condition, use of other medications, and response to treatment. To reduce the risk of nausea, your doctor may direct you to start at a low dose of pramlintide and gradually increase the dose. Your doctor may also direct you to lower your insulin dose and to check you blood sugar more often. Do not change your dosage without consulting your doctor. Use this medication regularly in order to get the most benefit from it.Do not share your pen device with another person, even if the needle is changed. You may give other people a serious infection, or get a serious infection from them. Learn how to store and discard medical supplies safely.

              SIDE EFFECTS: Nausea, vomiting, tiredness, and upset stomach may occur as your body adjusts to the medication. Nausea can be reduced by starting at a low dose and increasing the dose slowly. Redness, swelling and itching at the injection site may occur and usually go away in a few days. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Though pramlintide does not cause low blood sugar (hypoglycemia) by itself, this effect can occur because it is used with insulin. This may also occur if you do not consume enough calories from food or if you do unusually heavy exercise. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your dosage may need to be increased.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using pramlintide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as the preservative metacresol), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medication, consult your doctor or pharmacist if you have: stomach/intestinal disorders (for example, digestion problems such as gastroparesis).This medication should not be used by people who are unable to tell when they have symptoms of low blood sugar (e.g., children).Before using pramlintide, tell your doctor or pharmacist your medical history, especially of: attacks of low blood sugar (hypoglycemia) that required treatment.You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages because alcohol can affect your blood sugar.It may be harder to control your blood sugar when your body is stressed (e.g., due to fever, infection, injury, or surgery). Consult your doctor because this may require a change in your treatment plan, medications, or blood sugar testing.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known if pramlintide passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: diabetes drugs (including alpha glucosidase inhibitors such as acarbose/miglitol), darifenacin, drugs for high blood pressure that may make it harder to notice symptoms of low blood sugar (e.g., clonidine, guanethidine), drugs that slow down or speed up movement of food through your stomach (causing constipation or diarrhea; drugs such as atropine, exenatide, metoclopramide), solifenacin.Some other medications may not work as well if used at the same time as pramlintide. If you are using any of the following drugs, use them at least 1 hour before or 2 hours after your injection: antibiotics, birth control pills, pain relievers (e.g., acetaminophen).If you have any questions about when to take your other medications, ask your pharmacist.If you are using a medication that needs to be taken with food, take it with a small meal or snack (less than 250 calories or 30 grams of carbohydrate) at a time when you do not normally inject pramlintide.Beta blocker medications (e.g., metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar such as dizziness, hunger, or sweating are unaffected by these drugs.Many drugs can affect your blood sugar, making it harder to control. Before you start, stop, or change any medication, talk with your doctor or pharmacist about how the medication may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high or low blood sugar. (See also Side Effects section.) Your doctor may need to adjust your diabetes medication, exercise program, or diet.This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe nausea, vomiting, diarrhea, flushing, dizziness.

              NOTES: Do not share this medication, syringes, or needles with others.Attend a diabetes education program to learn more about how to manage your diabetes with medications, diet, exercise, and regular medical exams.Lab and/or medical tests (such as fasting blood glucose, hemoglobin A1c) should be done while you are using this medication. Keep all medical and lab appointments. Check your blood sugar regularly as directed (usually before and after meals and at bedtime) and share the results with your doctor.

              MISSED DOSE: If you miss a dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store injectors you are not currently using in the refrigerator at 36-46 degrees F (2-8 degrees C). Protect from light. Do not freeze. Discard injectors that have been frozen or overheated. The injector you are currently using can be stored in the refrigerator or at room temperature for up to 30 days as long as the temperature is not higher than 86 degrees F (30 degrees C). Discard the injector 30 days after first use whether or not it has been refrigerated, even if some drug remains in the injector. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.