|Drug class||Amylin analogue|
|Main uses||Type 1 and 2 diabetes with mealtime insulin|
|Side effects||Nausea, loss of appetite, headache, low blood sugar|
|Bioavailability||30 to 40%|
|Elimination half-life||~48 minutes|
|Chemical and physical data|
|Molar mass||3949.44 g·mol−1|
|3D model (JSmol)|
|(what is this?)|
Common side effects include nausea, loss of appetite, and headache. Other side effects may include low blood sugar and allergic reactions. Use is not recommended in people with gastroparesis. Safety in pregnancy is unclear. It is a amylin analogue.
In type 1 DM it is started at a dose of 15 mcg before eating and may be increased up to 60 mcg.
In type 2 DM it is started at 60 mcg and may be increased to 120 mcg.
Pramlintide is an analogue of amylin, a small peptide hormone that is released into the bloodstream by the β cells of the pancreas along with insulin after a meal. Like insulin, amylin is completely absent in individuals with Type I diabetes.
In synergy with endogenous amylin, pramlintide aids in the regulation of blood glucose by slowing gastric emptying, promoting satiety via hypothalamic receptors (different receptors than for GLP-1), and inhibiting inappropriate secretion of glucagon, a catabolic hormone that opposes the effects of insulin and amylin. Pramlintide also has effects in raising the acute first-phase insulin response threshold following a meal.
Since native human amylin is highly amyloidogenic and potentially toxic, the strategy for designing pramlintide was to substitute residues from rat amylin, which is less amyloidogenic although not completely  (but would presumably retain clinical activity). Proline residues are known to be structure-breaking residues, so these were directly grafted into the human sequence. Despite its enhanced stability compared to human amylin, pramlintide is still able to organize into amyloid material.
Amino acid sequences:
Pramlintide as protein is (positively charged).
Pramlintide has been approved by the FDA, for use by type 1 and type 2 diabetics who use insulin. Pramlintide allows patients to use less insulin, lowers average blood sugar levels, and substantially reduces what otherwise would be a large unhealthy rise in blood sugar that occurs in diabetics right after eating.
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