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SymlinPen

pramlintide
Used for Diabetes Type 2, Diabetes Type 1
Used for Diabetes Type 2, Diabetes Type 1

Pramlintide, also known by the brand name SymlinPen, helps lower blood sugar in adults with Type 1 diabetes or Type 2 diabetes when fast-acting or mealtime insulin isn't enough. It's an amylin analog that's given as an injection under the skin before meals. This medication works by slowing down your digestion and preventing the release of a hormone that causes your blood sugar to go up. Though it's used at the same time as your mealtime insulin, it shouldn't be mixed and must be injected separately. Potential side effects include nausea, low appetite, and headache.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Daisy Chau, PharmD
Last reviewed on November 18, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsLatest newsReferencesPricesMedicare
basics-icon

What is SymlinPen (pramlintide)?

What is SymlinPen (pramlintide) used for?

How SymlinPen (pramlintide) works

SymlinPen (pramlintide) is an amylin analog. It's a man-made version of human amylin, a natural hormone made in our body. The medication helps to lower blood sugar by:

  • Slowing your digestion, which can affect how your body absorbs nutrients

  • Blocking a hormone called glucagon, which stops your liver from releasing more sugar

  • Making you feel full for longer, which reduces the number of calories your consume

Drug Facts

Common BrandsSymlinPen
Drug ClassAmylin analog
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Avg retail price
$1190.27(save 12.26%)
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$1044.33
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What are the side effects of SymlinPen (pramlintide)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea (28-48%)
  • Loss of appetite (9-17%)
  • Headache (up to 13%)
  • Vomiting (8-11%)
  • Stomach pain (up to 8%)
  • Tiredness (7%)
  • Joint pain (up to 7%)
  • Allergic reaction (up to 6%)
  • Dizziness (5-6%)

Other Side Effects

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Dangerously low blood sugar: shaking, dizziness, sweating, fast heartbeat, feeling irritable

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Anxiety

blurred vision

chills

cold sweats

coma

confusion

cool pale skin

cough

depression

difficulty with swallowing

dizziness

fast heartbeat

headache

hives, itching, or skin rash

increased hunger

nausea

nightmares

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

seizures

shakiness

slurred speech

tightness in the chest

unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Difficulty with moving

inflicted injury

loss of appetite

muscle pain or stiffness

pain in the joints

stomach pain

vomiting

weight loss

Less common

Body aches or pain

congestion

dryness or soreness of the throat

fever

hoarseness

runny nose

tender, swollen glands in the neck

voice changes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of SymlinPen (pramlintide)

thumbs-up

Pros

Doesn't cause weight gain like insulin can

Can reduce daily insulin requirements

Safe for people with kidney and liver problems

thumbs-down

Cons

Need to use with each major meal

Only available as an injection

Can interact with certain medications taken by mouth

pharmacist-tips

Pharmacist tips for SymlinPen (pramlintide)

pharmacist

  • Before using SymlinPen (pramlintide), you should receive training from a healthcare professional on how to use it safely and correctly. If you have any questions, contact your care team.

    • Allow your SymlinPen (pramlintide) to come to room temperature before injecting it. This will lessen pain and discomfort from the injection.

      • Inject SymlinPen (pramlintide) right before a meal. If you skip the meal, don't take a dose. Instead, wait until your next meal before taking your usual dose.

        • Change the site of where you give yourself SymlinPen (pramlintide) injection each time to prevent skin irritation.

          • SymlinPen (pramlintide) can affect the way some medications get absorbed into your body. You might need to take certain medications (like birth control pills, antibiotics, or pain medicines) 1 hour before or 2 hours after SymlinPen (pramlintide). Talk with your pharmacist about the best times to take your medications.

            • Use a new needle each time you inject SymlinPen (pramlintide) to prevent contamination. Don't share your SymlinPen (pramlintide) with anyone, even if the needle is changed. This can put you and others at risk for infections.

              • Never mix SymlinPen (pramlintide) with insulin in the same syringe. They should be given as separate injections, and at least 2 inches away from each other.

                • SymlinPen (pramlintide) is almost empty when the tip of the plunger is near the thickest line on the cartridge. Make sure to refill your medication before you run out.

                  • Store unopened SymlinPen (pramlintide) pens in the refrigerator up until the expiration date. Open pens can be kept at room temperature or in the refrigerator for 30 days.

                    How to use SymlinPen (pramlintide):

                    • Check your SymlinPen (pramlintide) to make sure it isn't expired, and pull the cap off. Then, attach a new pen needle.

                      • If you're using SymlinPen (pramlintide) for the first time, you'll need to prime your pen. To do this, turn the dial to 15 mcg and pull the knob out as far as it'll go. Hold the pen with the needle pointing up and push the knob until it stops. You should see a stream of liquid. If you don’t see the stream, repeat this process up to 6 times.

                        • Once you're ready to inject, turn the dial to your correct dose. You should see a line, arrow, and number of your dose. If not, you don't have enough medication in your pen.

                          • Insert the needle into your skin and push the knob in all the way. Hold for 10 seconds, then pull the needle out.

                            • Replace the needle cover and carefully unscrew the needle from the pen. Place it into a sharps container. Then replace the pen cap.

                              faqs

                              Frequently asked questions about SymlinPen (pramlintide)

                              Where do you inject SymlinPen (pramlintide)?
                              You can inject SymlinPen (pramlintide) under the skin of your stomach area (not within 2 inches of your belly button) or thigh. But be sure to inject it at least 2 inches away from your insulin injection. Make sure to first wipe the area clean with an alcohol swab and let it dry before injecting your dose.
                              How many doses are in a SymlinPen (pramlintide)?
                              Each SymlinPen (pramlintide) carton comes with two multi-dose pen injectors. How many doses each pen will last you depends on your specific dose. SymlinPen 60 can be used if your dose is 15 mcg, 30 mcg, 45 mcg, or 60 mcg. It contains a total of 1,500 mcg in each pen. This means if your dose is 60 mcg and you're using it 3 times a day, each pen will last you about 8 days. SymlinPen 120 can be used if your dose is 60 mcg or 120 mcg. Each pen contains a total of 2,700 mcg. This means if your dose is 120 mcg and you're using it 3 times a day, each pen will last you about 7 days. Follow up with your prescriber to learn how long each SymlinPen (pramlintide) pen will last you and when to request a refill from the pharmacy.
                              Can you take SymlinPen (pramlintide) without insulin?
                              No, don't take SymlinPen (pramlintide) without insulin. It's only FDA approved as an add-on treatment to your mealtime insulin. This medication doesn't replace your daily insulin, but it might lower how much insulin you need before meals.
                              Does SymlinPen (pramlintide) cause weight loss?
                              SymlinPen (pramlintide) isn't FDA-approved as a weight loss medication. But because it can make you feel fuller and reduce the calories your body absorbs from meals, it's possible that you might experience some weight loss. In studies lasting up to 1 year, people taking SymlinPen (pramlintide) lost about 2 to 4 lbs of body weight. Speak with your prescriber if you have questions about this medication and weight loss.
                              Does SymlinPen (pramlintide) come with needles?
                              No, the pen needles that you need to attach to your SymlinPen (pramlintide) aren't included. You'll need to get 29, 30, or 31 gauge pen needles separately.
                              Can SymlinPen (pramlintide) and metformin be taken together?
                              Yes, you can take SymlinPen (pramlintide) with metformin (Glumetza). There aren't any known interactions between these medications. Be sure to attend your follow-up appointments so your prescriber can review how well your diabetes medications are working for you and adjust them as needed.
                              How many times a day should you take SymlinPen (pramlintide)?
                              There isn't a specific amount of times per day that you should take SymlinPen (pramlintide). It should be taken just before each major meal, or one that's at least 250 calories or 30 grams of carbohydrates. Work with your prescriber to plan how often you should be using this medication.
                              Is SymlinPen (pramlintide) safe in pregnancy?
                              It's not known whether SymlinPen (pramlintide) is safe in pregnancy as there haven't been enough studies. But it's typically not a first-choice option to control blood sugar or diabetes during pregnancy. If you are planning to or have become pregnant, speak with your OB-GYN provider about medication options that are best during pregnancy.
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                              What are the risks and warnings for SymlinPen (pramlintide)?

                              SymlinPen (pramlintide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                              risk-warning

                              Low blood sugar

                              • Risk factors: Taking other diabetes medications that can lower blood sugar | Use more SymlinPen (pramlintide) or insulin than prescribed | Eating less food or smaller meals than normal | More physically active | Drink alcohol

                                Though SymlinPen (pramlintide) on its own doesn't cause low blood sugar (hypoglycemia), taking it with other diabetes medications (e.g., insulin, sulfonylureas) or drinking alcohol can raise your risk. This usually happens within 2-3 hours after injecting this medication. Your insulin dose will be lowered when you first start using SymlinPen (pramlintide). You might need to check your blood sugar levels more often to avoid this potentially life-threatening side effect. Talk to your prescriber about the symptoms of low blood sugar and how to treat it. Until you know how SymlinPen (pramlintide) affects you, don't drive, use heavy machinery, or participate in dangerous activities.

                                risk-warning

                                Injection site reactions

                                SymlinPen (pramlintide) can cause injection site reactions on the skin. These reactions include redness, swelling, itching, or bruising. They usually go away on their own in a few days to a few weeks. Speak to your prescriber if your symptoms don't go away or if they become bothersome.

                                risk-warning

                                Stomach emptying problems

                                • Risk factors: History of stomach problems | Medications that affect stomach emptying

                                  Because SymlinPen (pramlintide) slows your digestion, it's not recommended if you have stomach emptying problems or are taking medication that can affect how food moves through your gut. Tell your prescriber about all the medications you're currently taking or if you have a history of stomach problems.

                                  risk-warning

                                  Medication interactions

                                  SymlinPen (pramlintide) can interact with other medications. Some medications (e.g., birth control pills, antibiotics, or pain medicines) should be taken 1 hour before you inject SymlinPen (pramlintide) or 2 hours after. It's important to let members of your care team know about all the prescription and non-prescription medications you're taking.

                                  dosage

                                  SymlinPen (pramlintide) dosage forms

                                  The average cost for 1 carton of 2 pens of 1.5ml of SymlinPen (pramlintide) is $1044.33 with a free GoodRx coupon. This is 12.26% off the average retail price of $1190.27.
                                  carton
                                  Carton
                                  DosageQuantityPrice as low asPrice per unit
                                  2 pens of 1.5ml1 carton$1044.33$1044.33
                                  2 pens of 2.7ml1 carton$1235.72$1235.72

                                  Typical dosing for SymlinPen (pramlintide)

                                  • Type 1 diabetes: The typical starting dose is 15 mcg injected under the skin before major meals. If you don't feel nauseous for at least three days, the dose is raised (usually around 30 mcg to 60 mcg).

                                  • Type 2 diabetes: The typical starting dose is 60 mcg injected under the skin before major meals. If you don't feel nauseous for at least three days, the dose is raised to 120 mcg.

                                  interactions

                                  Interactions between SymlinPen (pramlintide) and other drugs

                                  SymlinPen (pramlintide) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with SymlinPen (pramlintide). Please note that only the generic name of each medication is listed below.

                                  Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                                  Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                                  How much does SymlinPen (pramlintide) cost?

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                                  SymlinPen (brand)
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                                  contraindications-icon

                                  SymlinPen (pramlintide) contraindications

                                  Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because SymlinPen (pramlintide) will not be safe for you to take.

                                  • Not familiar with signs and symptoms of low blood sugar

                                  • Gastroparesis

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                                  References

                                  Best studies we found

                                  Adeghate, E., et al. (2011). Amylin analogues in the treatment of diabetes mellitus: Medicinal chemistry and structural basis of its function. The Open Medicinal Chemistry Journal.

                                  American Diabetes Association Professional Practice Committee. (2023). 15. Management of diabetes in pregnancy: Standards of Care in Diabetes–2024. Diabetes Care.

                                  AstraZeneca Pharmaceuticals LP. (2019). Symlinpen- pamlintide acetate injection [package insert]. DailyMed.

                                  View All References (2)

                                  Lee, N. J., et al. (2010). Efficacy and harms of the hypoglycemic agent pramlintide in diabetes mellitus. Annals of Family Medicine.

                                  You and Your Hormones. (2021). Glucagon.

                                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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