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|Pramlintide

PRAMLINTIDE (Systemic)†

Some commonly used brand names are:

In the U.S.—

• Symlin

† Not commercially available in Canada.

Category

• Antidiabetic agent

Description

Pramlintide (PRAM-lin-tide) is used to control blood sugar in patients with type 1 and type 2 diabetes. It is always used with insulin.

This medicine is available only with your doctor"s prescription, in the following dosage forms:

• Parenteral
• Injection (U.S.)

Before Using This Medicine

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For pramlintide, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to pramlintide. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Pramlintide has not been studied in pregnant women. However studies in animals have shown that pramlintide may cause birth defects and other problems. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding—It is not known whether pramlintide passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of pramlintide in children with use in other age groups.

Older adults—This medicine has been tested and has not been shown to cause different side effects or problems in older people than it does in younger adults. However, some elderly people may be especially sensitive to the effects of low blood sugar. The doctor should manage pramlintide and insulin treatment to prevent an increased risk of severely low blood sugar.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking pramlintide, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Alpha-glucosidase inhibitors (type 2 diabetes medicines) (acarbose [e.g., Precose], miglitol [e.g., Glyset]) or
• Anticholinergic agents (medicines for abdominal or stomach spasms or cramps) or
• Other medicines that slow absorption of nutrient or alter movement through the intestines—These medicines should not be used together with pramlintide because they may effect the way food empties from the stomach.

Other medical problems—The presence of other medical problems may affect the use of pramlintide. Make sure you tell your doctor if you have any other medical problems, especially:

• Gastroparesis (a condition where the stomach takes too long to empty its contents) or
• HbA1c>9% (lab test that shows too high or low amount of sugar in the blood) or
• Hypoglycemia unawareness (unable to recognize symptoms of low blood sugar until it becomes severe) or
• Severe hypoglycemia (severe low blood sugar that comes back and has required assistance from medical personnel in the past 6 months)—If you have any of these conditions, you should NOT take pramlintide.

• Hypoglycemia, insulin-induced, history of (low blood sugar brought on by using insulin in the past)—May increase risk of severe hypoglycemia occurring again

Proper Use of This Medicine

Dosing—It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body.

You should never mix your insulin and pramlintide injections. These injections should be done separately. If you have questions about this, ask your doctor or pharmacist.

The dose of pramlintide will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of pramlintide. If your dose is different, do not change it unless your doctor tells you to do so.

The number of injections that you receive each day depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you receive the medicine depend on the amount of sugar in your blood

• For injection dosage form:
  • Diabetes, type 1 or type 2
    • Adults—The dose is based on your blood sugar and how well your body adjusts to the medicine. This must be determined by your doctor. The medicine is injected under the skin in your abdomen or thigh right before major meals. Also, your doctor will reduce your insulin dose by half before you begin receiving pramlintide.
    • Children—Use and dose must be determined by your doctor.

Missed dose—If you miss a dose of this medicine, check with your doctor. Do not double doses.

Storage—To store this medicine:

• Unopened vials should be refrigerated until needed and may be used until the printed expiration date on the label. Pramlintide should never be frozen.
• A pramlintide vial in use may be kept in the refrigerator or at room temperature for up to 28 days. An open vial of pramlintide that has been kept in the refrigerator or at room temperature for longer than 28 days should be thrown away.
• Storing prefilled syringes in the refrigerator with the needle pointed up reduces problems that can occur, such as crystals forming in the needle and blocking it up.
• Do not expose pramlintide to extremely hot temperatures or to sunlight. If pramlintide has been frozen or overheated, throw it away.

Precautions While Using This Medicine

It is very important that your doctor check your progress at regular visits , especially during the first few weeks of pramlintide treatment.

It is very important to follow carefully any instructions from your health care team about :

• Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
• Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes, especially teenagers, may need special counseling about pramlintide dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in women with diabetes who become pregnant.
• Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones, keep your meal times as close as possible to your usual meal times, and store pramlintide properly.

In case of emergency —There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:

• Wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and lists all of your medicines.
• Keep an extra supply of insulin and syringes with needles on hand in case high blood sugar occurs.
• Keep some kind of quick-acting sugar handy to treat low blood sugar.
• Have a glucagon kit available in case severe low blood sugar occurs. Check and replace any expired kits regularly.

Too much insulin can cause low blood sugar (also called hypoglycemia or insulin reaction). Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out) . Different people may feel different symptoms of low blood sugar. It is important that you learn what symptoms of low blood sugar you usually have so that you can treat it quickly .

• Symptoms of low blood sugar can include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.
• The symptoms of low blood sugar may develop quickly and may result from:
  • delaying or missing a scheduled meal or snack.
  • exercising more than usual.
  • drinking a significant amount of alcohol.
  • taking certain medicines.
  • using too much insulin.
  • sickness (especially with vomiting or diarrhea).
• Know what to do if symptoms of low blood sugar occur. Eating some form of quick-acting sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse. Good sources of sugar include:
  • Glucose tablets or gel, fruit juice or nondiet soft drink (4 to 6 ounces [one-half cup]), corn syrup or honey (1 tablespoon), sugar cubes (six one-half inch size), or table sugar (dissolved in water).
    • If a snack is not scheduled for an hour or more you should also eat a light snack, such as cheese and crackers, half a sandwich, or drink an 8-ounce glass of milk.
    • Do not use chocolate because its fat slows down the sugar entering into the blood stream.
  • Glucagon is used in emergency situations such as unconsciousness. Have a glucagon kit available and know how to prepare and use it. Members of your household also should know how and when to use it.

High blood sugar (hyperglycemia) is another problem related to uncontrolled diabetes. If you have any symptoms of high blood sugar, contact your health care team right away . If high blood sugar is not treated, severe hyperglycemia can occur, leading to ketoacidosis (diabetic coma) and death.

• The symptoms of mild high blood sugar appear more slowly than those of low blood sugar. Symptoms can include: blurred vision; drowsiness; dry mouth; flushed and dry skin; fruit-like breath odor; increased urination (frequency and volume); loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); and unusual thirst.
• Symptoms of severe high blood sugar (called ketoacidosis or diabetic coma) that need immediate hospitalization include: flushed and dry skin, fruit-like breath odor, ketones in urine, passing out, and troubled breathing (rapid and deep).
• High blood sugar symptoms may occur if you:
  • have diarrhea, a fever, or an infection.
  • do not take enough insulin or skip a dose of insulin.
  • do not exercise as much as usual.
  • overeat or do not follow your meal plan.
• Know what to do if high blood sugar occurs. Your doctor may recommend changes in your pramlintide and/or insulin dose or meal plan to avoid high blood sugar. Symptoms of high blood sugar must be corrected before they progress to more serious conditions. Check with your doctor often to make sure you are controlling your blood sugar. Your doctor might discuss the following with you:
  • Increasing your insulin dose when you plan to eat an unusually large dinner, such as on holidays. This type of increase is called an anticipatory dose.
  • Decreasing your dose for a short time for special needs, such as when you cannot exercise as you normally do. Changing only one type of insulin dose (usually the first dose) and anticipating how the change may affect other doses during the day. Contacting your doctor if you need a permanent change in dose.
  • Delaying a meal if your blood glucose is over 200 mg/dL to allow time for your blood sugar to go down. An extra insulin dose may be needed if your blood sugar does not come down shortly.
  • Not exercising if your blood glucose is over 240 mg/dL and reporting this to your doctor immediately.
  • Being hospitalized if ketoacidosis or diabetic coma occurs.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Developed: 08/03/2005

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