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Pramlintide

Also known as: Symlin, AC-137, 25,28,29-triprolyl-amylin (human), pramlintide acetate

Synthetic amylin analog; pancreatic hormone replacement; antihyperglycemic agent

Research chemicalLast updated: October 10, 2026Based on 7 peer-reviewed studies
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What it is

Pramlintide (sold as Symlin) is an FDA-approved synthetic version of amylin, a hormone the pancreas co-releases with insulin after meals. It slows stomach emptying, blocks a post-meal glucagon surge, and signals the brain to curb appetite — effects insulin alone cannot replicate. Symlin is a prescription-only injection approved since 2005 for adults with type 1 or type 2 diabetes on mealtime insulin.

The scientific side

Pramlintide is a synthetic analog of human amylin — a 37-amino acid peptide co-secreted with insulin by pancreatic beta cells in response to meals. In both type 1 and type 2 diabetes, amylin secretion is severely deficient or absent, leaving several key post-meal regulatory actions unaddressed by insulin replacement alone. Pramlintide restores these actions through three primary mechanisms. First, it potently slows gastric emptying: in humans, pramlintide extends gastric half-emptying time from approximately 112 minutes (placebo) to 169–177 minutes (PMID 10859225), blunting the rapid postprandial rise in circulating glucose. This effect operates via vagal inhibitory pathways and requires an intact vagus nerve. Second, pramlintide suppresses meal-stimulated glucagon secretion, which is paradoxically elevated after meals in both types of diabetes. In RCTs, glucagon AUC was reduced from 35 ± 9 pg·h/mL on placebo to 5 ± 7 pg·h/mL with pramlintide 30 µg in adolescents (PMID 19464026), and complete glucagon suppression during meals was observed in adult type 1 trials (PMID 11979398, 10421239). Third, pramlintide acts centrally on hypothalamic and area-postrema satiety circuits to reduce meal size and energy intake. Chronic administration reduces chow intake primarily by decreasing meal size and duration in rodent models (PMID 38493922), and 16-week trials in obese non-diabetic subjects showed 3.6 kg placebo-corrected weight loss (PMID 17504894). Pharmacologically, pramlintide is a non-selective agonist at calcitonin receptor family receptors including amylin receptor subtypes (AMYR1–3) and the calcitonin receptor (CTR). Receptor activation in the area postrema is required for its anorectic effects. Its three proline substitutions (at positions 25, 28, and 29) prevent beta-sheet aggregation that limits solubility of native human amylin at pharmacologic concentrations, making subcutaneous delivery feasible. Together these actions collectively reduce postprandial glucose excursions, lower HbA1c by 0.3–0.7%, decrease insulin requirements by up to 28%, and produce modest but sustained reductions in body weight.

Class: Synthetic amylin analog; pancreatic hormone replacement; antihyperglycemic agent

Administration & storage

Administration
Subcutaneous injection into the abdomen or thigh using a separate syringe from insulinIntravenous infusion (used in pharmacokinetic and mechanistic clinical studies only — not for clinical use)Sites should be rotated; do not inject into the same site as mealtime insulin
Storage
Unopened vials: refrigerate at 2–8°C (36–46°F). Opened (in-use) vials: may be stored at room temperature (<25°C/77°F) or refrigerated; use within 28 days. Do not freeze. Protect from light.
Cautions
BOXED WARNING (FDA): Pramlintide used with insulin can cause severe hypoglycemia, particularly in type 1 diabetes. Onset within 3 hours of injection. Monitor blood glucose closely.,CONTRAINDICATED in patients with confirmed gastroparesis — gastric emptying delay effect may worsen gastroparesis and cause unpredictable glucose excursions.,CONTRAINDICATED in patients with hypoglycemia unawareness.,Nausea reported in approximately 63% of pramlintide-treated type 1 patients in pivotal trials (PMID 17003291); generally mild-to-moderate and transient (first 4–8 weeks); dose-titration approach reduces severity.,May cause migraine-like attacks: randomized crossover trial showed 41% of migraineurs developed migraine-like attacks after pramlintide infusion via amylin receptor agonism (PMID 33772845).,Reduce mealtime insulin dose by 50% at initiation to minimize severe hypoglycemia risk; closely monitor glucose pre-meal, post-meal, and at bedtime.,Pramlintide can delay absorption of orally co-administered drugs — take oral medications requiring rapid absorption at least 1 hour before or 2 hours after pramlintide injection.

Legal & regulatory status

US FDA

FDA-approved (NDA) as Symlin (pramlintide acetate) injection for adults with type 1 diabetes and insulin-using adults with type 2 diabetes as an adjunct to mealtime insulin therapy. Approved March 2005. Available as 5…

WADA

Pramlintide is not listed on the current WADA Prohibited List. It is a therapeutic hormone used exclusively under medical supervision for diabetes management and has no known performance-enhancing application in sport.

Health Canada

Not identified as separately approved in Canada under a distinct brand as of available literature. Amylin physiology and pramlintide pharmacology are reviewed in Canadian endocrinology literature, but no distinct Health…