Pramlintide
Amylin analog
Also Symlin, SymlinPen, Pramlintide acetate, AC137, AC-137
- Evidence
- AStrong human evidence
- FDA status
- FDA approvedas of 2026-10-26
- Route
- Injection
- Studies cited
- 6 human0 animal or cell
A shot added to mealtime insulin in diabetes. Controlled trials show a small drop in blood sugar and weight, with more nausea and low blood sugar.
Sold for
Pramlintide is the only approved amylin drug, used as an add-on to mealtime insulin to blunt after-meal glucose spikes and help with weight.
Studies say
Randomized trials show pramlintide modestly lowers HbA1c and body weight when added to insulin, at the cost of nausea and a higher risk of insulin-related hypoglycemia, which supports its narrow approved use.
Why grade A. Approval rested on randomized, placebo-controlled trials in type 1 and type 2 diabetes lasting up to a year; the label summarizes six placebo-controlled trials (four in type 1 and two in type 2 diabetes), the largest with 480 type 1 patients, in which pramlintide lowered HbA1c by about 0.25 to 0.34 percentage points more than placebo and reduced weight. The effect is real but small, and the drug has largely been displaced by GLP-1 agonists. 1
FDA. Pramlintide is FDA-approved as Symlin (approved March 2005) for adults with type 1 or type 2 diabetes who use mealtime insulin and have not reached their glucose targets. The label carries a boxed warning about severe hypoglycemia, which is why insulin doses are reduced when it is started. 1
Written from 1 cited sources. Fact-checked 2026-10-27: 16 claims checked, 7 corrected. Last refreshed 2026-10-27. Not physician reviewed.
What this means for you
- What people take it for
- Blood sugar control in diabetes
- Can a US doctor prescribe it?
- Yes, FDA approved for adults with diabetes who use mealtime insulin.
- Properly tested in people?
- Yes, in six controlled trials; the largest had 480 people.
Evidence checklist
- Randomised controlled trial Placebo-controlled phase 3 trialsyes
- Human study over 100 people Several hundred in the largest trialyes
- More than one research group Four phase 3 trials, across sitesyes
- Clinical outcomes, not surrogate markers HbA1c and weight, surrogatesno
- Human safety data beyond case reports Boxed warning from pooled trial datayes
Drawn from the cited studies below. A dash means the sources give no information.
What it is
Pramlintide is a synthetic analog of amylin, a 37-amino-acid hormone that beta cells in the pancreas secrete together with insulin after meals. People with type 1 diabetes, whose beta cells are destroyed, lack amylin as well as insulin, and people with advanced type 2 diabetes make less of it. Human amylin clumps into insoluble fibrils in solution, so three of its amino acids were swapped for proline, borrowed from rat amylin, to make a stable injectable drug. 1
Symlin was developed by Amylin Pharmaceuticals and approved in 2005. It is injected before major meals in addition to, never instead of, mealtime insulin, and it cannot be mixed in the same syringe. Use has fallen since GLP-1 receptor agonists arrived, because they lower glucose and weight more and are dosed less often. Newer long-acting amylin analogs such as cagrilintide and petrelintide are built on the same hormone. 1
How it works
Amylin acts on receptors in the brainstem, the area postrema in particular, to slow the rate at which the stomach empties, suppress the release of glucagon after meals, and increase satiety. Slower emptying means glucose from a meal reaches the blood more gradually, so the post-meal spike is smaller; suppressing glucagon stops the liver from adding glucose on top of the meal. Pramlintide does not affect insulin's action and does not itself lower glucose between meals, which is why it only works alongside insulin. The satiety effect accounts for the modest weight loss seen in trials. 1
What human research shows
The label summarizes placebo-controlled trials of 26 to 52 weeks in type 1 and type 2 diabetes. In three type 1 trials, adding pramlintide to insulin lowered HbA1c at six months by 0.25 to 0.34 percentage points more than placebo, and weight fell by about 0.8 to 1.6 kg while placebo patients gained up to 0.8 kg. In a fourth type 1 study where insulin was cut at the start and then adjusted freely, HbA1c fell equally in both groups but the pramlintide group needed less mealtime insulin and lost 1.3 kg. In two type 2 trials on insulin the HbA1c difference was 0.30 to 0.34 points, with weight losses of 1.4 to 1.6 kg against small gains on placebo. 1
| Study | Model | Finding |
|---|---|---|
| Type 1 diabetes phase 3 trials (label) | Humans, randomized, double-blind, placebo-controlled, 26 to 52 weeks | HbA1c fell 0.25 to 0.34 percentage points more than placebo at six months, with weight loss instead of the gain seen on insulin alone. 1 |
| Type 2 diabetes phase 3 trials (label) | Humans, insulin-treated adults, two randomized double-blind placebo-controlled trials, 26 and 52 weeks | HbA1c fell 0.30 to 0.34 points more than placebo at six months, with weight loss of 1.4 to 1.6 kg. 1 |
| Hypoglycemia safety data (label) | Humans, pooled trial data | Severe insulin-induced hypoglycemia increased early in treatment when insulin doses were not reduced, leading to the boxed warning. 1 |
Safety
The boxed warning is for severe hypoglycemia, which occurred mostly in type 1 diabetes within three hours of injection when insulin was not reduced, and the risk was highest in the first weeks of treatment. Nausea is the most common side effect, affecting roughly a third to a half of type 1 patients early on and fading with time; vomiting, loss of appetite and headache are also reported. Because it slows stomach emptying it should not be used by people with gastroparesis, and it can delay absorption of oral drugs taken at the same time. There are no long-term cardiovascular outcome data, which newer diabetes drugs are required to have. 1
Questions for your clinician
- How should my insulin be adjusted when starting pramlintide?
- Is the modest HbA1c drop worth the nausea for me?
- What are the signs of severe low blood sugar?
Questions people ask
Is pramlintide a type of insulin?
No. It replaces amylin, a second hormone that the pancreas normally secretes with insulin. It only works in people who are also taking mealtime insulin, and it must be injected separately. 1
How does pramlintide compare with GLP-1 drugs?
Both slow stomach emptying and reduce appetite, but GLP-1 agonists also stimulate insulin secretion and lower HbA1c and weight considerably more in trials. Pramlintide is approved for use with insulin in type 1 as well as type 2 diabetes, which GLP-1 drugs are not, and that is where it is still used. 1
Why does it carry a boxed warning?
Pramlintide itself does not cause low blood sugar, but it slows the arrival of glucose from a meal while the injected insulin keeps working. In early trials that mismatch caused severe hypoglycemia, so the label requires cutting mealtime insulin when starting it and monitoring closely. 1
Does pramlintide cause weight loss?
A little. Trials showed about 1 to 1.6 kg of weight loss at six months compared with small weight gains on placebo. It is not approved for obesity. 1
Citations
- Symlin (pramlintide acetate) prescribing information, FDA, 2014 revision accessdata.fda.gov