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Side Effects of Pramlintide
by Edward J. Lamb
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Overview
Side Effects of Pramlintide
Doctors prescribe pramlintide when patients with type 1 or type 2 diabetes cannot control their blood sugar concentrations even though they eat properly and use insulin as prescribed. The injectable medication, which Amylin sells under the brand name Symlin, is a manmade form of a pancreatic hormone, and injecting both pramlintide and insulin raises patients' chances for experiencing life-threatening drops in blood sugar. Gastrointestinal side effects also occur often among pramlintide users.
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Hypoglycemia Warning
The prescribing information for pramlintide carries many warnings about users' risk for hypoglycemia. A Medication Guide distributed to patients each time they pick up a prescription for pramlintide reinforce these hypoglycemia warnings, stating in bolded and boxed text at the very top, "If ... low blood sugar (severe hypoglycemia) happens, it is seen within three hours after a Symlin injection. Severe low blood sugar makes it hard to think clearly, drive a car, use heavy machinery or do other risky activities where you could hurt yourself or others." To ensure they do suffer from hypoglycemia, patients must test their blood sugar before each meal, after each meal and before going to bed. Patients should also avoid alcohol and work with their doctors to adjust insulin doses downward, as drinking alcohol and using higher doses of insulin increases patients' likelihood of experiencing hypoglycemia. The symptoms of hypoglycemia include hunger, tremors, headache, sweating and, when severe, seizures and loss of consciousness.
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Other Warnings
Patients with very poorly controlled diabetes or poor insulin use habits should not receive prescriptions for pramlintide. Also, patients should not administer pramlintide doses while their blood sugar is low or when they have missed a meal. Pregnant or breastfeeding women should not administer pramlintide doses until they discuss the safety of doing so with their doctors.
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Common Side Effects
Many patients experience temporary and mild injection site reactions such as redness and irritation of the skin where they administer pramlintide. Other common side effects from pramlintide use include nausea and vomiting, headache, loss of appetite, abdominal pain, cough, dizziness, fatigue, sore throat and joint pain.
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Contraindications
Patients who cannot test their own blood sugar often cannot use pramlintide. Nor can patients who have a physiological condition called gastroparesis in which the stomach does not empty normally.
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Drug Interactions
Patients who take oral antidiabetic medications, blood pressure-lowering medications, aspirin, antidepressants, sulfonamide antibiotics (i.e., sulfa drugs), the antiarrhythmia drug disopyramide (e.g., Norpace from Pfizer) or the painkiller propoxyphene (e.g., Darvon from Xanodyne) should not take pramlintide because each can cause drops in blood sugar. Also, patients taking pramlintide should avoid any drug classified as an anticholinergic because anticholinergics can cause delays in stomach emptying. The anticholingeric class of drugs includes donepezil (Aricept from Esai), tolterodine (Detrol from Pharmacia) and ranitidine (Zantac from GlaxoSmithKline).
