A mealtime amylin analog (Symlin) approved in 2005 for insulin users with diabetes. Every US strength is now discontinued.
Also called Symlin, SymlinPen, SymlinPen 60, SymlinPen 120, pramlintide acetate, amylin analog
When Pramlintide's status or evidence changes, it's in the next morning's email.
Pramlintide is a synthetic version of amylin, a hormone that beta cells in the pancreas release together with insulin after a meal. People with type 1 diabetes lack amylin as well as insulin. Pramlintide differs from human amylin at three positions, where it carries proline. It was sold as Symlin, injected before each main meal alongside insulin, and approved by FDA in 2005 for type 1 and type 2 diabetes.
The effect is modest. In a 52-week trial of 651 people with type 1 diabetes, HbA1c fell 0.29 to 0.34 points more than placebo, and weight fell 0.4 kg while the placebo group gained 0.8 kg. In 656 people with insulin-treated type 2 diabetes, 120 mcg twice daily cut HbA1c 0.62 points at 52 weeks and weight by 1.4 kg. The main risk is severe low blood sugar within 3 hours of the shot, which is why the label carries a boxed warning and tells people to cut mealtime insulin by half when starting.
Pramlintide matters today mostly as the first amylin drug. Its 48-minute half-life meant a shot before every main meal, and it never became a weight-loss drug. Newer long-acting amylin analogs such as cagrilintide, eloralintide and petrelintide are built on the same idea. Drugs@FDA lists every Symlin strength as discontinued, and drug references say it is no longer available in the United States.
What it binds to, and what happens inside the body after that, step by step.
Amylin is stored with insulin in beta cells and released with it after eating. Pramlintide copies three of its effects: it slows stomach emptying, lowers the glucagon rise after meals so the liver releases less glucose, and acts on the brain to reduce food intake.
Human results and animal results are kept apart below. A result in rats tells you a mechanism is plausible. It does not tell you what happens in a person.
Pramlintide was an FDA-approved drug backed by several 6- to 12-month placebo-controlled trials in type 1 and type 2 diabetes. It lowered HbA1c by about 0.3 to 0.7 points and body weight by 1 to 2 kg compared with placebo. A 16-week phase 2 trial in obesity without insulin found about 3.7% placebo-adjusted weight loss, but it was never approved for weight management.
651 adults with type 1 diabetes
HbA1c fell 0.29 to 0.34 points on pramlintide 60 mcg three or four times daily vs 0.04 on placebo at 52 weeks; weight fell 0.4 kg vs a 0.8 kg gain.
Read the study656 adults with insulin-treated type 2 diabetes
HbA1c fell 0.62 points on 120 mcg twice daily at 52 weeks, more than placebo, with weight change of -1.4 kg vs +0.7 kg.
Read the study204 adults with obesity, with or without type 2 diabetes, not on insulin
Placebo-adjusted weight loss was 3.7% at 16 weeks on up to 240 mcg three times daily; 31% lost at least 5% vs 2% on placebo.
Read the studyNo preclinical studies are listed as key studies here. The human data above carries the evidence.
When a new Pramlintide study in people is published, the daily email covers it.
These are questions the published research has not answered.
Approved by FDA on March 16, 2005 (NDA 021332, now held by AstraZeneca). Drugs@FDA lists all three Symlin strengths as discontinued, and Davis's Drug Guide states it is no longer available in the United States. We could not find the exact date or an official reason for the discontinuation. Not named on the WADA Prohibited List; because WADA's S0 class covers discontinued drugs with no current approval, athletes should check with their anti-doping organization.
When the FDA or WADA changes Pramlintide's status, it's in the next morning's email.
How much of Pramlintide is left after a single dose
Simple first-order model from the published half-life. Real clearance varies with dose, route, kidney and liver function and formulation. This is not a dosing schedule.
This table records the doses that trials and approved labels used, with the source for each row. It is a record of research, not a recommendation, and it is open to free members.
Which symptoms are expected and which mean stop and get help: side effects and red flags.
Tap a claim to see what the studies found.
It was approved only as an add-on to mealtime insulin. Weight loss in the diabetes trials was 1 to 2 kg versus placebo, and the 16-week obesity trial (3.7% placebo-adjusted) never led to a weight indication.
It was only approved for people already using mealtime insulin and does not lower glucose enough on its own. Insulin doses are reduced, not stopped.
Long-acting amylin analogs such as cagrilintide are in late-stage trials, alone and with semaglutide. Pramlintide itself was too short-acting to be used that way.
These pairings come up often. Almost none have been tested together in a trial, and the evidence note on each says so plainly.
The approved use: replacing amylin alongside insulin in people who make little or none.
EvidenceShown in 52-week RCTs to lower HbA1c by about 0.3 to 0.6 points and weight by 1 to 2 kg, at the cost of more nausea and early severe lows.
Amylin and GLP-1 cut appetite through different brain circuits, so combining them was designed to add weight loss.
EvidenceTested with cagrilintide plus semaglutide (CagriSema), not with pramlintide. See the cagrisema profile.
Not applicable: Symlin was supplied as a ready-to-use solution in pens.
Unopened pens: refrigerate at 36 to 46 F (2 to 8 C), protect from light and do not freeze. Pens in use: refrigerated or up to 86 F (30 C) for 30 days.
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