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Drug Side Effects
Side Effects of Pramlintide Acetate (Amylin Analogues)
Nov 25, 2016Introduction
Pramlintide Acetate or Amylin Analog (injectable) are chemicals that help insulin in doing its job to control post-meal glucose levels.
Pramlintide is used with mealtime insulin to govern blood sugar level in people with diabetes. Pramlintide is most effectively used to treat diabetics whose blood sugar cannot be managed through either insulin alone or when combined with an oral medicine.
Pramlintide belongs to a class of medicines called antihyperglycemics. It works by slowing the motion of meals through the belly. This prevents blood sugar from growing too excessive after a meal. It may decrease appetite and cause weight loss. Pramlintide is a synthetic drug that resembles the human hormone amylin. Amylin is produced by beta cells of the pancreas (the same cells that produce the hormone insulin) and it contributes to glucose control after consumption of a meal (the postprandial period).
Pramlintide comes as an injectable drug for adults with type-2 and type-1 diabetes. It regulates the rate at which sugar enters your blood after consuming food. Pramlintide is continually used by the body along with insulin to help decrease blood sugar all through the three hours after food.
Mechanism of Action
Under normal circumstances, both amylin and insulin are secreted together from pancreatic beta cells in response to the intake of food. Amylin slows anathe rate at which food passes from the stomach to the small intestines. It is also capable of suppressing the secretion of another pancreatic hormone called glucagon that in turn suppresses secretion of glucose from the liver. Amylin also regulates appetite.
In case of people with diabetes, the secretion of both insulin and amylin is reduced. Hence, to compensate for this reduced secretion, an amylin analog is given along with insulin to mimic the natural action of these two important hormones.
Pramlintide, a synthetic amylin analog shows actions similar to naturally found amylin and has been effective in controlling blood sugar along with insulin.
How Should This Medicine be Used?
- You should use pramlintide exactly as has been prescribed. Its dosage will depend on whether you have type-2 or type-1 diabetes. It is up to your doctor to determine whether you could use pramlintide.
- It is important to thoroughly and carefully read Patient Information Leaflet that comes together with this medicinal product.
- Pramlintide is available in vials and two Pramlintide pen-injectors. Your doctor will prescribe the form of pramlintide that is right for you.
- Learn how to properly inject pramlintide into your body. It is similar to injecting insulin. So if you are already on insulin, you will know how to inject pramlintide as well (beneath the skin (subcutaneously) of your belly region (abdomen) or upper leg (thigh)).
- Inject pramlintide at a site that is more than 2 inches away from your insulin injection. Do not inject pramlintide and insulin at the same site.
- Use a new needle for every pramlintide injection.
- By no means mix pramlintide and insulin. Insulin can have an impact on pramlintide activity, while the two are blended together.
- Do not use pramlintide, if the liquid appears cloudy.
Most Prescribed Names In This Category of Drugs
The usually prescribed drug in this category is Symlin.
Side Effects That Could Happen as Soon as You Start Taking the Medication
Digestive Issues
Digestive Issues are common side-effects of Pramlintide Acetate (Amylin Analogues)
The most common side effects include:
- Diarrhea
- Decreased appetite
- Stomach ache
- Nausea
- Vomiting
Low Blood Sugar or Hypoglycemia
Amylin is an amino acid that inhibits glucagon, a hormone that is responsible for releasing glucose from the liver into the blood stream. Amylin analogs are used alongside insulin to support it. Excess reduction in blood sugar levels can produce classic hypoglycemic symptoms like nausea, vomiting and increased hunger. Mental confusion, nervousness, shakiness, dizziness, fast heart rate, light-headedness, confusion, depression, irritability, crying spells and nightmares could also be symptoms of your blood sugar falling dangerously low.
Other Common Symptoms
Some people may suffer from headaches and allergic reactions (swelling, redness, itching) at the site of injection. In rare cases, allergic reactions may be severe, like trouble breathing and swelling on face, lips, throat or tongue.
What Can You Do?
These side effects can often be handled by your doctor by starting low dosage and increasing it over a period of time. The ratio of combined use with insulin can also be fine-tuned.
Should You Be Using Amylin Analogs for a Long Term?
Amylin analogs are effective when used along with insulin. However; research shows that they can create adverse effects such as hypoglycemia due to combination therapy. Many drugs cause depletion of nutrients from the body with long term use, but amylin analogs have not been studied for this.
It is noted that dietary supplements can also help you reduce the burden of prescription drugs and their side effects, by helping you manage your blood sugar better.
What Special Precautions Should I Follow?
Before using pramlintide injection, do take care of the following:
- Tell your physician and pharmacist in case you are allergic to pramlintide or any other substances that make up the medicine.
- Tell your physician and pharmacist what prescription and nonprescription medicinal drugs, vitamins, dietary supplements, and herbal products you are taking.
- Inform your doctor in case you are pregnant, plan to become pregnant, or are breastfeeding. If you get pregnant while on pramlintide, consult your health practitioner immediately.
What Should I Do if I Forget a Dose?
Skip the missed dose and take the usual dose of pramlintide acetate before your next major meal. Do not take a double dose to compensate for a missed one.
What Should I Know About Storage and Disposal of this Medication?
Pramlintide acetate pen-injectors which are not in use:
- Refrigerate (2°C to 8°C; 36°F to 46°F), and protect from light. Do not freeze. Do not use if the product has been frozen.
- Unused Pramlintide acetate pen injectors (opened or unopened) should not be used after the expiration date printed on the carton/ label.
Pramlintide acetate pen-injectors which are in use:
- After the first use, refrigerate or store at a temperature lower than 86°F (30°C) for 30 days. Use within 30 days, irrespective of refrigeration.
Dietary Considerations, While Taking Medicine
Your healthcare practitioner, dietitian, or pharmacist will help you create a diet plan that works for you. Follow the diet plan carefully. You should be eating atleast 30 grams (250 calories) of carbohydrates daily if you are taking pramlintide. Alcohol consumption also reduces blood sugar, hence should be avoided while you are on insulin and pramlintide.
Drug Interactions
Insulin
The concentration of pramlintide in blood is altered, when it is administered from the same syringe already containing premixed formulations of recombinant human insulin. Pramlintide and insulin must not be mixed. They must be administered as separate injections only.
Oral Medications
Pramlintide may delay the absorption of the orally administered drug, when pramlintide and the oral drug are taken together.
When you wish to consume an oral drug whose rapid activity is required (like analgesics, antibiotics, and oral contraceptives), the oral medication should be taken at least an hour prior to pramlintide injection or a couple of hours after.
Drugs Affecting Gastrointestinal Motility
As pramlintide affects the rate at which food passes from stomach to the small intestines, or “gastric emptying,” pramlintide should not be prescribed for patients consuming medications that alter gastrointestinal motility (e.g., atropine) or medications that reduce the intestinal absorption of nutrients
Drugs Affecting Glucose Metabolism
The following drugs may increase the risk of hypoglycemia when administered with pramlintide:
- Oral anti-diabetic products
- Angiotensin converting enzyme (ACE) inhibitors
- Disopyramide
- Fibrates
- Fluoxetine
- Monoamine oxidase inhibitors
- Pentoxifylline
- Propoxyphene
- Salicylates
- Somatostatin analogs
- Sulfonamide antibiotics
Pramlintide and these drugs should be co-administered with utmost care.
Who Should Not Take Amylin Analogues?
Do not use Pramlintide injection if you:
- Cannot tell when your blood sugar is low (hypoglycemia unawareness)
- Have a stomach problem called “gastroparesis” (delayed gastric emptying). This is when your stomach does not empty as fast as it should.
- Are allergic to pramlintide or any ingredients in pramlintide containing formulation.
What Are The Ingredients in Amylin Analogs?
Active ingredient: pramlintide acetate
Inactive ingredients: meta cresol, D-mannitol, acetic acid, and sodium acetate.
Parting Thoughts
Diabetes has taken up epidemic proportions in the last decade or so. Once a disorder affecting the elderly, today even youngsters aren’t safe from it. This can be attributed to a vastly changing lifestyle, bad dietary choices and an inactive daily routine.
Diabetes is a dietary disorder and can be reversed with a disciplined approach to life. Healthy eating habits, a regular exercise regimen, yoga, weight loss, meditation and intermittent fasting are some of the ways that can help reduce the severity of diabetes and work on its reversal.
The health complications associated with diabetes are more because of the side effects of prescription drugs, along with the damage that high blood sugar can cause if left unchecked. Dietary supplements can help bring back the balance of vital nutrients in the body which might be lost due to unhealthy diet as well as due to anti-diabetic drugs themselves.
Nachiket holds a first class degree in Pharmacy and is passionate about writing. He believes that subject experts must simplify medical concepts to make them interesting and accessible to everyone.
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References:
- Medline plus, U.S. National Library of Medicine
- Dailymed, U.S.National Library of Medicine
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=D2262F20-BEDB-43D9-B274-6CE275B0A69E
- Medline plus, U.S. National Library of Medicine
- Medline plus, U.S. National Library of Medicine
- Medline plus, U.S. National Library of Medicine