Pramlintide Injection
Pramlintide Injection is an amylin-based mealtime injection used alongside mealtime insulin in adults with type 1 or type 2 diabetes who haven't reached their glucose goals with insulin alone.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 1 clinical label set within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Pramlintide (SymlinPen) is a man-made form of amylin, a hormone released with insulin at meals, used as a specialist add-on to mealtime insulin for type 1 or type 2 diabetes when insulin alone falls short; it slows stomach emptying and curbs appetite, and has been on the market for more than a decade without a generic. Nausea is the side effect most people notice, usually worst early on and easing with time. The danger is the boxed warning for severe low blood sugar with insulin, especially in type 1 diabetes and within about 3 hours of a dose, so your mealtime insulin is cut at the start and glucose is checked often.
Clinical pearls
- Inject it right before major meals only, meaning at least 250 calories or 30 grams of carbohydrate, not before snacks.
- Inject it separately from insulin, never mixed in one syringe, using the abdomen or thigh, not the arm.
- Take pain relievers, antibiotics or birth control at least 1 hour before or 2 hours after pramlintide.
- Beta-blockers and clonidine can blunt early low blood sugar warning signs, so lean on glucose readings rather than how you feel.
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾
Using pramlintide with insulin raises the risk of severe low blood sugar, especially in people with type 1 diabetes. Severe lows usually happen within about 3 hours after an injection.
A severe low while driving, using heavy machinery or doing other risky activities can cause serious injury. Careful patient selection, good instruction and lowering your insulin dose at the start help reduce this risk. Check your glucose often and follow your care team's plan.
Patient information guide A plain-language walkthrough of Pramlintide Injection, written from its FDA label.
What Pramlintide Injection is used for
▾
Pramlintide Injection is an add-on to mealtime insulin. It is used in:
- Type 1 diabetes, for people using mealtime insulin who haven't reached their glucose goals despite optimal insulin therapy (SymlinPen)
- Type 2 diabetes, for people using mealtime insulin who haven't reached their glucose goals despite optimal insulin therapy (SymlinPen)
How Pramlintide Injection works
▾
Pramlintide is a man-made version of amylin, a hormone released with insulin by the pancreas when you eat. In diabetes, less insulin and amylin are released after meals.
Pramlintide slows how quickly food leaves your stomach, reduces the after-meal rise in glucagon (which lowers sugar released by the liver), and helps you feel full so you eat less.
Pramlintide Injection dosage
▾
SymlinPen is injected under the skin right before each major meal (at least 250 calories or 30 grams of carbohydrate). Doses are started low and raised gradually, no faster than every 3 days, to limit nausea. Your dose differs for type 1 and type 2 diabetes.
- Your mealtime insulin is reduced when you start, then adjusted by your care team.
- Inject into the abdomen or thigh, not the arm, and rotate sites.
- Use a different site from your insulin, and never mix the two.
- If you miss a dose, wait for the next scheduled dose and take your usual amount.
Follow your prescriber's directions and the label.
Dosing details from the FDA-approved label
From the Pramlintide Injection prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Type 2 Diabetes (patients using mealtime insulin)
- Reduce mealtime insulin doses (including premixed insulins) by 50%, then initiate SYMLIN at 60 mcg subcutaneously, injecting immediately prior to each major meal
- Increase from 60 to 120 mcg prior to each major meal when no clinically significant nausea has occurred for at least 3 days
- If significant nausea persists at the 120 mcg dose, decrease to 60 mcg
- Maximum: 120 mcg before meals
- Wait at least 3 days between dose titrations to reduce the risk of nausea
- Type 1 Diabetes
- Reduce mealtime insulin doses by 50%, then initiate SYMLIN at 15 mcg subcutaneously, injecting immediately prior to each major meal
- Increase to the next increment (30, 45, or 60 mcg) when no clinically significant nausea has occurred for at least 3 days
- If significant nausea persists at the 45 or 60 mcg dose level, decrease to 30 mcg
- If the 30 mcg dose is
- Maximum: 30 or 60 mcg premeal dose
- Wait at least 3 days between dose titrations to reduce the risk of nausea
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION • Upon initiation of SYMLIN, reduce mealtime insulin dose by 50%. Monitor glucoses frequently and individualize subsequent insulin dose adjustments (2.1) . • Type 1 Diabetes: Start at 15 mcg subcutaneously before major meals. Increase in 15 mcg increments to a maximum premeal dose of 30 or 60 mcg; if not tolerated, reduce to 30 mcg, as tolerated (2.2) . • Type 2 Diabetes: Start at 60 mcg subcutaneously before major meals then increase to 120 mcg before meals, as tolerated (2.2) . • Wait at least 3 days between dose titrations to minimize nausea (2.1) . 2.1 Important Considerations Pertaining to SYMLIN and Insulin Dose Adjustments SYMLIN dosage differs depending on whether the patient has type 1 or type 2 diabetes [see Dosage and Administration (2.2 , 2.3) ]. SYMLIN should be used only in patients who can fully understand and adhere to proper insulin adjustments and glucose monitoring. Insulin and SYMLIN dose adjustments should be made only as directed by a healthcare professional skilled in the use of insulin. When initiating SYMLIN, reduce mealtime insulin doses, including premixed insulins, by 50% to reduce the risk of hypoglycemia. To reduce the risk of nausea, wait at least 3 days before titrating SYMLIN to the next dose increment. Monitor blood glucoses frequently, including pre- and post-meals and at bedtime, particularly when initiating SYMLIN or increasing the SYMLIN dose. After the initial 50% reduction in mealtime insulin dose, individualize insulin dose adjustments based on glycemic control and tolerability (e.g., if nausea occurs it may affect the dose of insulin required). An increased frequency of mild-to-moderate hypoglycemia should be viewed as a warning sign of increased risk for severe hypoglycemia. If SYMLIN therapy is discontinued for any reason (e.g., surgery or illnesses), the same initiation protocol should be followed when SYMLIN therapy is reinstituted [see Dosage and Administration (2.2) ]. 2.2 Patients with Type 2 Diabetes Using Mealtime Insulin Reduce mealtime insulin doses (including premixed insulins) by 50%, then initiate SYMLIN at 60 mcg subcutaneously, injecting immediately prior to each major meal. Increase the SYMLIN dose from 60 to 120 mcg prior to each major meal when no clinically significant nausea has occurred for at least 3 days.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Pramlintide Injection side effects
▾
Most side effects involve the stomach, and nausea is most common early in treatment, then fades for most people.
Common side effects
- Nausea (the most common, usually worst early on)
- Vomiting
- Loss of appetite
- Headache
- Fatigue
- Dizziness
- Stomach pain
- Redness, swelling or itching at the injection site
- Joint pain, cough and sore throat were also reported
When to get medical help
- Get help right away for severe low blood sugar (hypoglycemia), especially within about 3 hours after an injection. It can mean needing help from someone else or emergency care.
- Call your doctor if you have more frequent mild-to-moderate low blood sugar. It is a warning sign that severe lows may be coming.
- Call your doctor if nausea is strong or doesn't go away.
- Seek care for signs of a serious allergic reaction.
- Report any unexplained low blood sugar that needs medical help.
- Pancreatitis (inflammation of the pancreas) has been reported after approval, so tell your doctor about any new, concerning stomach symptoms.
Pramlintide Injection warnings and precautions
▾
- Severe hypoglycemia: The biggest risk when used with mealtime insulin, especially in type 1 diabetes. It usually appears within 2 to 3 hours after an injection.
- Warning signs can be dulled: Long-standing diabetes, nerve damage, beta-blockers, clonidine, guanethidine, reserpine or tight glucose control can make early symptoms less noticeable.
- Never share a pen: Sharing risks spreading blood-borne infections.
- Never mix with insulin: Mixing changes how both work.
- Slows stomach emptying: This can delay other oral medicines.
- Stopping: Your doctor may stop it for repeated unexplained lows, persistent nausea, or not following monitoring and insulin plans.
Pramlintide Injection interactions
▾
Pramlintide can affect how other medicines work or raise low blood sugar risk.
- Insulin: mixing in one syringe changes how both act.
- Oral medicines like pain relievers, antibiotics and birth control pills: take them at least 1 hour before or 2 hours after pramlintide if fast action matters, because it slows the stomach.
- Anticholinergics such as atropine and alpha-glucosidase inhibitors: not recommended due to effects on digestion.
- Other diabetes medicines, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAO inhibitors, pentoxifylline, salicylates, somatostatin analogs and sulfonamide antibiotics: may raise low blood sugar risk, so use with caution.
Interactions listed in the FDA-approved label
From the Pramlintide Injection prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- Insulin: The pharmacokinetic parameters of pramlintide are altered when SYMLIN is mixed in the same syringe with regular, NPH, and 70/30 premixed formulations of recombinant human insulin. SYMLIN and insulin must not be mixed and must be administered as separate injections.
- Oral medications (e.g., analgesics, antibiotics, oral contraceptives): SYMLIN has the potential to delay the absorption of concomitantly administered oral medications. When rapid onset or threshold concentration of the oral medication is critical to effectiveness, administer it at least 1 hour prior to SYMLIN injection or 2 hours after SYMLIN injection.
- Medications that alter gastrointestinal motility (e.g., anticholinergic agents such as atropine) or slow intestinal nutrient absorption (e.g., alpha-glucosidase inhibitors): Due to its effects on gastric emptying, patients using these medications have not been studied in SYMLIN clinical trials. SYMLIN should not be considered for patients taking these medications.
- Drugs affecting glucose metabolism (anti-diabetic products, ACE inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, salicylates, somatostatin analogs, sulfonamide antibiotics): These medications may increase the susceptibility to hypoglycemia when administered with SYMLIN. SYMLIN and these drugs should be coadministered with caution.
Read the label’s full interactions text
7 DRUG INTERACTIONS 7.1 Insulin The pharmacokinetic parameters of pramlintide are altered when SYMLIN is mixed in the same syringe with regular, NPH, and 70/30 premixed formulations of recombinant human insulin. SYMLIN and insulin must not be mixed and must be administered as separate injections [see Dosage and Administration (2.4) , Warnings and Precautions (5.4) , and Clinical Pharmacology (12.3) ]. 7.2 Oral Medications SYMLIN has the potential to delay the absorption of concomitantly administered oral medications. When the rapid onset or threshold concentration of a concomitant orally administered medication is a critical determinant of effectiveness (such as with analgesics, antibiotics, and oral contraceptives), the medication should be administered at least 1 hour prior to SYMLIN injection or 2 hours after SYMLIN injection [see Warnings and Precautions (5.5) and Clinical Pharmacology (12.3) ]. 7.3 Drugs Affecting Gastrointestinal Motility Due to its effects on gastric emptying, SYMLIN should not be considered for patients taking medications that alter gastrointestinal motility (e.g., anticholinergic agents such as atropine) or medications that slow the intestinal absorption of nutrients (e.g., alpha-glucosidase inhibitors). Patients using these medications have not been studied in SYMLIN clinical trials [see Warnings and Precautions (5.6) ]. 7.4 Drugs Affecting Glucose Metabolism The following are examples of medications that may increase the susceptibility to hypoglycemia when administered with SYMLIN: anti-diabetic products, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, salicylates, somatostatin analogs, and sulfonamide antibiotics. SYMLIN and these drugs should be coadministered with caution.
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Pramlintide Injection
▾
- Do not use with hypoglycemia unawareness or confirmed gastroparesis.
- Do not use after a serious allergic reaction to it.
- Not for people with poor adherence to insulin or glucose monitoring, A1c above 9%, or recurrent severe lows in the past 6 months.
- Use caution with vision or dexterity problems.
- Not recommended in children.
- Pregnancy: data are insufficient to determine risk; poorly controlled diabetes in pregnancy carries its own risks.
- Breastfeeding: no data on milk or infant effects.
- Older adults: manage insulin and pramlintide carefully to avoid severe lows.
- Kidney: dosing doesn't change for mild to severe kidney impairment; it hasn't been studied in end-stage kidney disease.
- Liver: not studied in people with liver impairment.
Pramlintide Injection overdose
▾
In a study, healthy volunteers who received a single dose far above the maximum recommended dose had severe nausea with vomiting, diarrhea, blood vessel widening and dizziness. No low blood sugar was reported. Treatment is supportive care, and pramlintide leaves the body fairly quickly.
What Pramlintide Injection does in the body
▾
In people with type 1 or type 2 diabetes using mealtime insulin, pramlintide lowered after-meal glucose, reduced glucose swings across the day, and reduced food intake. It did not change the body's hormone response to low blood sugar or the ability to feel low-sugar symptoms.
How your body processes Pramlintide Injection
▾
About 30% to 40% of an injected dose reaches the bloodstream. Peak levels occur in roughly 20 minutes, and the half-life is about 48 minutes in healthy people. It does not build up with repeated dosing. Arm injections give more variable absorption than the abdomen or thigh.
How to store Pramlintide Injection
▾
Refrigerate (2°C to 8°C; 36°F to 46°F), and protect from light. Do not freeze. refrigerate or keep at a temperature not greater than 86°F (30°C) for 30 days.
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Pramlintide Injection
239 supplements and herbal products have documented interactions with Pramlintide Injection in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 1
- Moderate · 208
- Minor · 30
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Nutrient depletion considerations
Pramlintide Injection has been associated with lower levels of 1 nutrient in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.
Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.
Pramlintide Injection: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Pramlintide Injection — the kind of thing our pharmacy team would talk through with you at the counter.
What is this medicine for?
▾
How do I use it?
▾
Why is my insulin dose being lowered?
▾
Will it make me sick to my stomach?
▾
Can I take my other pills with it?
▾
What should I do if I think my blood sugar is dropping?
▾
Is Pramlintide Injection available over the counter?
▾
When was Pramlintide Injection first available?
▾
Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Pramlintide Injection on HelloPharmacist
Pramlintide Injection forms and strengths (how it comes)
Pramlintide Injection is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Injection
How this form is used
- SymlinPen is used with mealtime insulin in people with type 1 or type 2 diabetes who haven't reached their glucose goals with optimal insulin therapy.
- SymlinPen is injected under the skin right before each major meal, in the abdomen or thigh.
- SymlinPen must never be shared between people, even if the needle is changed.
- SymlinPen should be at room temperature before injecting, and injected separately from insulin, never mixed.
- SymlinPen injection sites should be rotated and kept apart from your insulin injection site.
Pramlintide Injection on the U.S. market: products, makers and brands
How Pramlintide Injection appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
1 company lists 2 Pramlintide Injection product records with the FDA, mostly as injection; the earliest marketing or approval year on record is 2005. Brand names on the directory include Symlin Pen, Symlin, SymlinPen; the rest are generics.
How widely Pramlintide Injection is used (Medicaid data)
A general measure of how commonly Pramlintide Injection is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Pramlintide Injection is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Pramlintide Injection prescribed? Of the 1,601 medications we measure, Pramlintide Injection ranks #1,531 by Medicaid prescriptions — more than 4% of them.
Utilization by Pramlintide Injection product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
1.5 ML pramlintide acetate 1 MG/ML Pen Injector
Summed across the 1 of 1 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 861044
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Pramlintide Injection, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 1 of 1 listed Pramlintide Injection NDCs with Medicaid activity.
Compare Pramlintide Injection products
A representative set of FDA-listed product records for Pramlintide Injection — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Injection | ||||
| 1000 mcg/mL | Subcutaneous | AstraZeneca Pharmaceuticals LP × 2 listings | NDA | View NDC → |
Showing 2 of 2 products — FDA National Drug Code Directory. See every product, package size and price: browse all 2 Pramlintide Injection NDCs →
Pramlintide Injection side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Pramlintide Injection — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Pramlintide Injection in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Pramlintide Injection FDA approval history
How Pramlintide Injection went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Pramlintide Injection recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Pramlintide recalls since July 2021.
✅No Pramlintide recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 139953 1 dose form · 2 strengths
-
Dose form (SCDF) Pen Injector RxCUI 1657563In current FDA listingsClinical drug / strength (SCD) 1.5 ML pramlintide acetate 1 MG/MLRxCUI 8610442.7 ML pramlintide acetate 1 MG/MLRxCUI 861042
Look up RxCUI 139953 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Pramlintide Injection supply and shortage status
Whether Pramlintide Injection is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
💵 What Pramlintide Injection costs pharmacies (NADAC benchmark)
The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Jun 10, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.
| Form | Strength | Pharmacy acquisition benchmark | |
|---|---|---|---|
| Injection · Subcutaneous | 1000 mcg/mL | $330.95 per mL | NDC details & price history |
Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.
Pramlintide Injection brand names
Pramlintide Injection is sold under 3 brand names in the FDA directory — Symlin Pen, Symlin, SymlinPen. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Pramlintide Injection: manufacturers and labelers
One company lists Pramlintide Injection products with the FDA. By number of product records, the largest are AstraZeneca Pharmaceuticals LP. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Pramlintide Injection drug class (RxNorm)
Pramlintide Injection belongs to the Amylin Analog class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Pramlintide Injection page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. AstraZeneca Pharmaceuticals LP is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →