pramlintide


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Related to pramlintide: Colesevelam, Exenatide, Symlin

pramlintide

(pram-lin-tide) ,

Symlin

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: hormones
Pregnancy Category: C

Indications

Used with mealtime insulin in the management of diabetics whose blood sugar cannot be controlled by optimal insulin therapy; can be used with other agents (sulfonylureas, metformin).

Action

Acts as a synthetic analogue of amylin, an endogenous pancreatic hormone that helps to control postprandial hyperglycemia; effects include slowed gastric emptying, suppression of glucagon secretion and regulation of food intake.

Therapeutic effects

Improved control of postprandial hyperglycemia.

Pharmacokinetics

Absorption: 30–40% absorbed following subcutaneous administration.
Distribution: Does not appear to significantly cross the placenta.
Metabolism and Excretion: Metabolized by the kidneys; major metabolite has pharmacologic properties similar to the parent compound.
Half-life: 48 min.

Time/action profile (effect on blood sugar*)

ROUTEONSETPEAKDURATION
Subcutrapid20 min3 hr
*Blood level

Contraindications/Precautions

Contraindicated in: Hypersensitivty;Inability to identify hypoglycemia;Gastroparesis or need for medications to stimulate gastric motility;Poor compliance with current insulin regimen or self-monitoring;HbA1c >9%;Recurring severe hypoglycemia within the last 6 mo, requiring treatment; Obstetric: Insulin is the drug of choice for blood glucose control during pregnancy; Pediatric: Safety not established.
Use Cautiously in: Lactation: Lactation.

Adverse Reactions/Side Effects

Noted for concurrent use with insulin

Central nervous system

  • dizziness
  • fatigue
  • headache

Respiratory

  • cough

Gastrointestinal

  • nausea (most frequent)
  • abdominal pain
  • anorexia
  • vomiting

Endocrinologic

  • hypoglycemia (life-threatening)

Dermatologic

  • local allergy

Musculoskeletal

  • arthralgia

Miscellaneous

  • injection site reactions
  • systemic allergic reactions

Interactions

Drug-Drug interaction

↑ likelihood of hypoglycemia with short-acting insulin ; ↓ dose of short-acting pre-meal insulin by 50%.Avoid concurrent use with other agents that ↓ GI motility, including atropine and other anticholinergics.Avoid concurrent use with other agents that ↓ GI absorption of nutrients, including α-glucosidase inhibitors including acarbose and miglitol.May delay oral absorption of concurrently administered drugs; if prompt absorption is desired, administer 1 hr before or 2 hr after pramlintide.

Route/Dosage

Insulin-using Type 2 Diabetes

Subcutaneous (Adults) 60 mcg, immediately prior to major meals initially, if no significant nausea occurs, dose may be ↑ to 120 mcg.

Type 1 Diabetes

Subcutaneous (Adults) 15 mcg, immediately prior to major meals initially, if no significant nausea occurs, dose may be ↑ by 15 mcg every 3 days up to 60 mcg.

Availability

Pen-injector: 1000 mcg/mL
Solution for injection: 600 mcg/mL

Nursing implications

Nursing assessment

  • Assess hemoglobin A1c, recent blood glucose monitoring data, history of insulin-induced hypoglycemia, current insulin regimen, and body weight prior to initiation of therapy.
  • Assess for signs and symptoms of hypoglycemia (hunger, headache, sweating, tremor, irritability, difficulty concentrating, loss of consciousness, coma, seizure), occurs within 3 hr of injection. Pramlintide alone does not cause hypoglycemia, may increase risk when administered with insulin.
  • Lab Test Considerations: Monitor blood glucose frequently, including pre- and post-meals and at bedtime.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)

Implementation

  • high alert: Dose errors are a potential problem with administration of pramlintide. Pramlintide is available in a concentration of 0.6 mg/mL, dosing is in mcg, and insulin syringe for administration is in units. Carefully review dosing and conversion table prior to administration.
  • Administer pramlintide and insulin as separate injections; do not mix.
    • Adjust insulin doses to optimize glycemic control once target dose of pramlintide is achieved and nausea has subsided.
  • Subcutaneous: Administer immediately prior to major meals ≥250 kcal or containing ≥30 g of carbohydrate. Reduce preprandial rapid-acting, short-acting, and fixed-mix insulin doses by 50%. Use a U-100 syringe (preferably a 0.3 mL size) for optimal accuracy. Administer into abdomen or thigh, rotating injection sites. Do not administer solutions that are cloudy. Store unopened vials in refrigerator. Opened vials may be refrigerated or kept at room temperature for up to 28 days.

Patient/Family Teaching

  • Instruct patient in proper use of pramlintide (injection technique, timing of doses, storage, and disposal of equipment). Make sure patient understands dosing and preparation of correct dose. Emphasize importance of adherence to meal planning, physical activity, recognition and management of hypoglycemia and hyperglycemia, and assessment of diabetes complications. Advise patient to read the Medication Guide before use and with each refill for new information.
  • Review with patient how to handle illness or stress, inadequate or omitted insulin dose, inadvertent administration of increased dose of insulin or pramlintide, inadequate food intake or missed meals. If a dose is missed, wait until the next meal and take usual dose; do not give an additional injection.
  • Instruct patient to contact health care professional at least once a week until target dose of pramlintide is achieved, pramlintide is well-tolerated, and blood glucose concentrations are stable.
  • May cause difficulty concentrating. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Inform patient that signs of local allergy (redness, swelling, itching at site of injection) usually resolve within a few days to a few weeks; may be related to pramlintide, irritants in skin cleansing agent or improper injection technique.
  • Advise patient to contact health care professional if recurrent nausea or hypoglycemia occur; may lead to increased risk of severe hypoglycemia. Discontinue pramlintide therapy if recurrent unexplained hypoglycemia requiring medical assistance, persistent clinically significant nausea, or noncompliance with self-monitoring of blood glucose concentrations, insulin dose adjustments, or scheduled health care professional contacts or recommended clinic visits occur.
  • Advise patient to contact health care professional before taking other Rx, OTC, vitamins, or herbal products with pramlintide and to avoid concurrent alcohol use.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Reduction in postprandial glucose concentrations.

pramlintide

(prăm′lĭn-tīd′)
n.
An injectable drug that is a synthetic analog of the hormone amylin, used in the form of its acetate salt to treat type 1 and type 2 diabetes.

pramlintide

an antidiabetic that modulates and slows stomach emptying, prevents postprandial rise in plasma glucagon, decreases appetite, and leads to decreased caloric intake and weight loss.
indications This drug is used as an adjunct to insulin therapy to treat uncontrolled type 1 or type 2 diabetes.
contraindications Gastroparesis and known hypersensitivity to this drug or to metacresol prohibit its use.
adverse effects Adverse effects of this drug include headache, fatigue, dizziness, nausea, vomiting, anorexia, abdominal pain, injection site reactions, hypoglycemia (while used with insulin), arthralgia, cough, pharyngitis, and systemic allergy.

pramlintide

Endocrinology An amylin analogue of possible use in ↑ glucose control in Pts with DM. See Diabetes mellitus.
References in periodicals archive ?
glucagon-like peptide-1 receptor agonists (GLP1RA) and pramlintide.
Amylin replacement with Pramlintide in type 1 and type 2 diabetes: A physiological approach to overcome a barrier with insulin therapy.
3 kg (anticonvulsant) (400 mg/d) greater than diet and lifestyle intervention; safety and efficacy beyond 1 year is undetermined (33) Pramlintide Types 1 and 2 [down arrow] 2.
After a 1-week placebo lead-in period, the subjects were randomized to twice-daily therapy with eight regimens: (i) placebo + placebo, (ii) pramlintide 360gg + placebo, (iii) metreleptin 5mg + placebo, (iv) pramlintide 180gg + metreleptin 2.
Scientists from Boston University School of Medicine (BUSM) also found that pramlintide improves learning and memory and AD patients have a lower level of amylin in blood compared to those without this disease.
Further, the person with Type 1 diabetes must check their blood glucose level frequently (up to seven times per day) and then provide adequate and appropriate treatment by receiving injections of pramlintide (insulin), or wearing an insulin pump (Childs, 2005).
Injectable medicines, as exenatide and pramlintide, can lower glycaemia levels.
A stable analog, pramlintide, which has actions and pharmacokinetic and pharmacodynamic properties similar to the native peptide, has been developed.
Amylin analogues: Pramlintide (Symlin) was developed in New Zealand.
There is no human pregnancy experience with pramlintide (Symlin), a synthetic analogue of human amylin given by subcutaneous injection, but the animal data suggest moderate risk (structural anomalies in rats).
have selected the combination treatment of pramlintide (an analog of the natural hormone amylin) and metreleptin (an analog of the natural hormone leptin) for advancement toward Phase III development of a potential obesity treatment.
Pramlintide (Symlin), a daily injectable, decreases the speed at which sugar enters the blood after a meal by slowing digestion.