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Metabolic

Pramlintide

Also known as: Symlin, SymlinPen, Pramlintide acetate

FDA Approved
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Key Facts: Pramlintide

Category
Metabolic
FDA Status
FDA Approved
Clinical Status
FDA Approved (March 2005) as Symlin for type 1 and type 2 diabetes with mealtime insulin, but now discontinued in the US by AstraZeneca (MedlinePlus, March 2026), so no pramlintide product remains on the US market.
Banned in Sport (WADA)
Not on the WADA Prohibited List (2026).
Administration
Subcutaneous injection immediately before each major meal (never mixed with insulin in the same syringe)
Typical Dose
Type 2: 120 mcg before major meals; Type 1: 30-60 mcg before major meals
Frequency
Before each major meal (2-3 times daily)
Duration
Long-term adjunct to insulin therapy
Also Known As
Symlin, SymlinPen, Pramlintide acetate

How does Pramlintide work?

Human amylin clumps into fibrils, which makes it useless as a drug. Pramlintide fixes that by swapping three amino acids (positions 25, 28 and 29) for proline, giving a stable 37-amino-acid analog. It acts on amylin receptors in the brainstem to slow stomach emptying, blunt the glucagon spike after meals, and make you feel full sooner. The result is a smaller blood sugar rise after eating and modestly lower food intake. It is very short-acting (half-life about 48 minutes), so it has to be injected before each major meal. Because it lowers post-meal glucose on top of insulin, the label requires cutting mealtime insulin by 50% when starting.

What does the research show?

Approval came in March 2005 after a rocky path that included a negative FDA advisory vote in 2001 and approvable letters requiring more trials. It is approved as an adjunct for type 1 or type 2 diabetes in people using mealtime insulin who are not at goal despite optimal insulin. Benefits in trials were modest: small HbA1c reductions and some weight loss, rather than the big effects of modern incretin drugs. Side effects are the main story. In type 1 diabetes, nausea hit 48% versus 17% on placebo and anorexia 17% versus 2%; in type 2, nausea was 28% versus 12%. The label carries a boxed warning for severe insulin-induced hypoglycemia, usually within 3 hours of injection, especially in type 1 diabetes. AstraZeneca discontinued SymlinPen in the US, and MedlinePlus (March 2026) states pramlintide injection has been discontinued in the US. Its lasting legacy is scientific: it showed amylin is a real target, which is why the field is now testing long-acting amylin analogs for obesity.

Trial Progress:FDA Approved
Pre
I
II
III
IV
FDA

What doses have been studied?

FDA Approved·FDA approved in 2005 for type 1 and type 2 diabetes; now discontinued in the US

Typical Dosingⓘ

Community experience

Common Dose

Type 2: 120 mcg before major meals; Type 1: 30-60 mcg before major meals

Range

15-120 mcg per meal depending on diabetes type

Frequency

Before each major meal (2-3 times daily)

Labeled doses, titrated no faster than every 3 days to limit nausea, with a 50% cut in mealtime insulin at the start. Not approved for weight loss, and the product is no longer marketed in the US.

Research Dosingⓘ

Scientific studies

FDA-approved labeled dosing (prescription only, product now discontinued in the US)

Duration

Long-term adjunct to insulin therapy

Administration

Subcutaneous injection immediately before each major meal (never mixed with insulin in the same syringe)

When and how is Pramlintide taken?

Best Time to Take

Immediately before each major meal

Before each major meal, typically 2-3 times daily

Food Recommendation

Take with food

Why This Timing?

Short half-life (about 48 minutes) means it only covers the meal it is given with. The label ties each dose to a major meal, so no meal means no dose.

What are the side effects of Pramlintide?

Not everyone experiences these effects. Individual responses vary based on dosage, duration, and personal factors.

  • ●Severe hypoglycemia with insulin (boxed warning), usually within 3 hours of a dose
  • ●Nausea (48% in type 1, 28% in type 2)
  • ●Anorexia and reduced appetite
  • ●Vomiting
  • ●Headache
  • ●Injection site reactions
  • ●Contraindicated with gastroparesis or hypoglycemia unawareness
  • ●Slows absorption of oral drugs taken near meals

References

Research This Peptide Further

Frequently Asked Questions

What does Pramlintide do?

Pramlintide (Symlin) is a synthetic version of amylin, the hormone your pancreas releases alongside insulin, and it was the first amylin drug ever approved (FDA, March 2005). It was used as a mealtime add-on for type 1 and type 2 diabetes in people already on mealtime insulin. It never sold well because it meant up to three extra injections a day and a serious hypoglycemia warning, and AstraZeneca has discontinued it in the US. Today it matters mostly as the proof of concept behind newer weekly amylin drugs like cagrilintide and petrelintide.

How does Pramlintide work?

Human amylin clumps into fibrils, which makes it useless as a drug. Pramlintide fixes that by swapping three amino acids (positions 25, 28 and 29) for proline, giving a stable 37-amino-acid analog. It acts on amylin receptors in the brainstem to slow stomach emptying, blunt the glucagon spike after meals, and make you feel full sooner. The result is a smaller blood sugar rise after eating and modestly lower food intake. It is very short-acting (half-life about 48 minutes), so it has to be injected before each major meal. Because it lowers post-meal glucose on top of insulin, the label requires cutting mealtime insulin by 50% when starting.

Is Pramlintide FDA approved?

Yes, Pramlintide is FDA approved. FDA Approved (March 2005) as Symlin for type 1 and type 2 diabetes with mealtime insulin, but now discontinued in the US by AstraZeneca (MedlinePlus, March 2026), so no pramlintide product remains on the US market.

Is Pramlintide banned in sport?

Not on the WADA Prohibited List (2026).

What are the side effects of Pramlintide?

Reported side effects include: Severe hypoglycemia with insulin (boxed warning), usually within 3 hours of a dose, Nausea (48% in type 1, 28% in type 2), Anorexia and reduced appetite, Vomiting, Headache. Individual responses vary based on dosage, duration, and personal health factors.

What is the typical dose of Pramlintide?

Community-reported common dose: Type 2: 120 mcg before major meals; Type 1: 30-60 mcg before major meals (Before each major meal (2-3 times daily)). Range: 15-120 mcg per meal depending on diabetes type. Administration: Subcutaneous injection immediately before each major meal (never mixed with insulin in the same syringe). Prescription drug. Dose set by prescriber per label. Not medical advice.

Related Peptides

Peptides commonly compared with Pramlintide or used in similar applications.

Lixisenatide

FDA

Lixisenatide is a short-acting, once-daily GLP-1 agonist for type 2 diabetes, discovered by Zealand Pharma and sold by Sanofi as Adlyxin (US) and Lyxumia (EU). It never caught on against weekly GLP-1 drugs, and it has mostly left the market: standalone Adlyxin was discontinued in the US with last availability around January 2023, and the EU authorisation for Lyxumia was withdrawn in December 2025. It lives on in Soliqua 100/33, a fixed combination with insulin glargine.

Metabolic

Pancragen

Clinical Trials

Pancragen is a synthetic tetrapeptide bioregulator, Lys-Glu-Asp-Trp (KEDW), from the Khavinson group, designed to target pancreatic tissue. It is studied for supporting blood-sugar control and the insulin-producing endocrine pancreas, especially in aging. It is a research compound with no approval and no published human clinical trials. The notable evidence comes from aged primates, not people.

Metabolic

AICAR

Clinical Trials

AICAR is not a peptide at all. It is a small nucleoside (a building block related to the purine pathway) that cells convert into ZMP, a molecule that mimics AMP and switches on AMPK, the cell's energy sensor. It became famous in 2008 when a Salk Institute study showed sedentary mice on AICAR ran 44% further, earning it the "exercise in a pill" label. Human data tell a much less exciting story: it was tested as an intravenous drug (acadesine) for heart surgery and leukemia, the big heart trial failed, and nothing is approved.

Metabolic

Pemvidutide

Clinical Trials

Pemvidutide is Altimmune's once-weekly GLP-1/glucagon dual agonist, now being developed mainly for MASH (fatty liver disease with inflammation, formerly called NASH). It cleared fat out of the liver fast in trials and earned FDA Breakthrough Therapy designation, and its phase 3 trial (PERFORMA) started in August 2026. It also produced decent weight loss in an obesity trial, but it is not approved anywhere and its biggest phase 2 MASH trial missed on the fibrosis endpoint at 24 weeks.

Metabolic

Dasiglucagon

FDA

Dasiglucagon is a 29-amino-acid glucagon analog sold as Zegalogue, a ready-to-inject rescue pen for severe low blood sugar in people with diabetes. Its whole point is practical: old-school glucagon kits had to be mixed from a powder in the middle of an emergency, while dasiglucagon stays stable as a liquid, so a caregiver just presses an autoinjector. The FDA approved it in March 2021. It is a real, well-tested emergency drug, not a wellness peptide, and there is no sensible reason to use it outside of a hypoglycemia emergency.

Metabolic

SLU-PP-332

Preclinical

SLU-PP-332 is a small synthetic molecule, not a peptide, that turns on the estrogen-related receptors (ERRalpha, beta and gamma), the master switches behind much of the body's response to endurance exercise. Researchers call it an 'exercise mimetic' because in mice it boosts mitochondria, shifts muscle toward fatigue-resistant fibers, improves stamina and trims fat without the animal moving more. It was made as a lab tool to study exercise biology. There are no human trials.

Metabolic

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