Pramlintide, a synthetic analog of amylin, is an injectable antihy-perglycemic agent that modulates postprandial glucose levels and is approved for preprandial use in persons with type 1 and type 2 diabetes. It is administered in addition to insulin in those who are unable to achieve their target postprandial blood sugar levels. Pramlintide suppresses glucagon release via undetermined mecha-nisms, delays gastric emptying, and has central nervous system-mediated anorectic effects. It is rapidly absorbed after subcutaneous administration; levels peak within 20 minutes, and the duration of action is not more than 150 minutes. Pramlintide is renally metab-olized and excreted, but even at low creatinine clearance there is no significant change in bioavailability. It has not been evaluated in dialysis patients. The most reliable absorption is from the abdomen and thigh; arm administration is less reliable.
Pramlintide should be injected immediately before eating; doses range from 15 to 60 mcg subcutaneously for individuals with type 1 diabetes and from 60 to 120 mcg subcutaneously for individuals with type 2 diabetes. Therapy with this agent should be initiated with the lowest dose and titrated upward. Because of the risk of hypoglycemia, concurrent rapid- or short-acting mealtime insulin doses should be decreased by 50% or more. Concurrent insulin secretagogue doses also may need to be decreased in persons with type 2 diabetes. Pramlintide should always be injected by itself with a separate syringe; it cannot be mixed with insulin. The major adverse effects of pramlintide arehypoglycemia and gastrointestinal symptoms, including nausea, vomiting, and anorexia.