Overview
Pramlintide (brand: Symlin) is a synthetic analog of human amylin, a hormone co-secreted with insulin by pancreatic beta cells. FDA-approved in 2005 as an adjunct to mealtime insulin for type 1 and type 2 diabetes, it reduces post-meal glucose spikes and promotes satiety. Off-label interest exists for weight management independent of diabetes management.
Mechanism of action
Pramlintide mimics the physiological actions of endogenous amylin at amylin receptors, which are calcitonin receptor/RAMP heterodimers expressed in the area postrema and nucleus tractus solitarius. Activation produces three coordinated effects: slowing of gastric emptying to blunt post-prandial glucose excursions, suppression of inappropriate glucagon secretion from pancreatic alpha cells, and satiety signaling through hypothalamic pathways distinct from those activated by GLP-1 receptor agonists. The dual amylin-and-satiety mechanism complements insulin's glucose-lowering action without increasing hypoglycemia risk on its own, though severe hypoglycemia can occur when mealtime insulin is not reduced appropriately.
Dosing protocols
| Purpose | Route | Dosage | Frequency | Notes |
|---|---|---|---|---|
| Type 1 diabetes glucose control | subcutaneous | 15–60 mcg | before each major meal | Start at 15 mcg before each meal. Increase by 15 mcg increments every 3 days as tolerated. Target dose 60 mcg per meal. Reduce mealtime insulin by 50% at initiation. |
| Type 2 diabetes glucose control | subcutaneous | 60–120 mcg | before each major meal | Start at 60 mcg before meals. Increase to 120 mcg when no significant nausea for 3–7 days. Reduce mealtime insulin by 50% at initiation. |
Dosing information is for educational purposes only. Consult a qualified healthcare professional before using any peptide.
Research summary
Multiple randomized controlled trials demonstrate pramlintide lowers HbA1c by 0.4–0.7% and reduces body weight by 1.7 kg (T1D) to 3.7 kg (T2D) versus placebo over 16–52 weeks. It was the first non-insulin therapy approved for type 1 diabetes. Nausea is the primary tolerability hurdle, typically resolving within weeks of titration. Pramlintide was voluntarily discontinued from US commerce by AstraZeneca in 2020; its mechanistic relevance persists as the amylin pathway underpins next-generation agents including cagrilintide and CagriSema.
Side effects
Side effects vary by individual. This is not an exhaustive list. Report unusual symptoms to a healthcare professional.
Common stacks
Peptides commonly paired with Pramlintide for synergistic effects.
Legal status
FDA-approved (NDA 021332) for subcutaneous use as an adjunct to mealtime insulin in T1D and T2D. Voluntarily withdrawn from the US market by AstraZeneca circa 2020; no longer commercially available in the US as of 2026. Compounding pharmacy availability varies by jurisdiction.
Where to get it
Prescription required
Pramlintide is a prescription medication. Consult your healthcare provider or a licensed telehealth platform for access.