Pramlintide
Synthetic amylin analog that slows gastric emptying and suppresses glucagon for improved glycemic control in diabetes.
Chemical Identity
| Property | Value |
|---|---|
| Chemical Formula | C171H267N51O53S2 |
| Molecular Weight | 3949.4 Da |
| CAS Number | 151126-32-8 |
| Peptide Class | Amylin Analog (37 amino acids) |
| Sequence | Modified human amylin with Pro25,28,29 |
| Route | SC injection |
Structure
Pramlintide (Symlin) is a synthetic 37-amino acid analog of human amylin (islet amyloid polypeptide). Three proline substitutions at positions 25, 28, and 29 prevent amyloid fibril formation that occurs with native amylin, making the peptide suitable for pharmaceutical formulation.
Mechanism of Action
Pramlintide activates amylin receptors (calcitonin receptor + RAMP complexes) in the brainstem and hypothalamus, suppressing postprandial glucagon secretion, slowing gastric emptying, and promoting satiety through central vagal afferents. This complements insulin action by addressing postprandial glucose excursions.
Clinical Applications
- Type 1 diabetes: Adjunct to mealtime insulin
- Type 2 diabetes: Adjunct to mealtime insulin when glycemic targets not met
- Postprandial glucose control: Reduces postprandial glucose spikes by 30-50%
- Weight management: Modest weight loss (1-2 kg)
Pharmacokinetics
- Half-life: 48 minutes
- Tmax: 20 minutes
- Bioavailability: 30-40%
- Metabolism: Kidney (proteolytic)
- Route: SC injection before meals
Safety and Side Effects
Nausea (most common, 30%), vomiting, anorexia, headache, and hypoglycemia (when combined with insulin). Severe hypoglycemia risk if insulin not reduced. Slow titration required.
References
- Hollander, P.A., et al. (2002). Pramlintide for type 2 diabetes. Diabetes Care, 25, 724-730.
- Whitehouse, F., et al. (2002). Symlin 602 trial: pramlintide for type 1 diabetes. Diabetes Care, 25, 724-730.
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