Pramlintide injection

What is Pramlintide injection?

PRAMLINTIDE (Symlin®) is a human-made form of the natural hormone amylin found in your body. Pramlintide slows down the movement of food through your stomach. This affects how fast the amount of sugar from your food enters your blood. Pramlintide is used with insulin to help lower the amount of sugar in your blood, especially high blood sugar that happens after meals. Keeping your blood sugar close to normal prevents long-term complications of diabetes including damage to the blood vessels, eyes, kidneys, or nerves. Even though your prescriber may decrease the amount of insulin you take at meals when you start using pramlintide, pramlintide will not replace your insulin injections. You should continue to use both pramlintide and insulin. Generic pramlintide injection is not yet available.

What should my health care professional know before I receive Pramlintide?

They need to know if you have any of these conditions:

• diarrhea

• fever or infection

• injury or trauma

• kidney disease

• nausea, vomiting

• osteoporosis

• recent low blood sugar or if you cannot tell when your blood sugar is low (hypoglycemia unawareness)

• recent surgery

• stomach problems like gastroparesis or other problems with proper emptying of the contents of the stomach

• thyroid disease

• an unusual reaction to pramlintide, metacresol, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

How should this medicine be used?

Pramlintide is for injection under the skin. Use exactly as directed. Do not use more pramlintide than prescribed and do not use it more or less often than prescribed. It is important to follow the directions given to you by your prescriber or health care professional. Your provider will teach you how to give this injection.

You should give your pramlintide injection right before eating a major meal and you should only take pramlintide if you are eating a meal. A major meal must have at least 250 calories or 30 grams of carbohydrates. If you skip a meal because you are sick, you are not hungry, or you are having surgery or a medical test, then do not inject pramlintide.

Pramlintide and insulin are usually given at the same time. But, do not mix pramlintide with any other injection, including insulin. You must use different syringes for pramlintide and insulin. Also, your injection site for pramlintide should be at least 2 inches away from your injection site for insulin.

Always check the appearance of your pramlintide before using it. Do not use pramlintide if it is cloudy or has solid particles in it.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What if I miss a dose?

It is important not to miss a dose of pramlintide or insulin. If you do miss a dose of pramlintide, wait until the next meal and take your usual dose of pramlintide at that meal. Do not take more than your usual dose. Your prescriber or health care professional should discuss a plan for missed doses of insulin with you. If you also miss a dose of insulin, follow their plan. Know the signs of low and high blood sugar and make sure a close family member or friend can also recognize these signs. Contact your prescriber or health care professional at once if you have any problems.

What drug(s) may interact with Pramlintide?

Pramlintide may interact with the following medications:

• atropine

• benztropine

• dicyclomine

• glycopyrrolate

• hyoscyamine

• medications for motion sickness (examples: dimenhydrinate, meclizine, scopolamine)

• propantheline

• trihexyphenidyl

• antidiarrheals (examples: loperamide, diphenoxylate)

• medicines used to treat stomach emptying or motility problems (examples: cisapride, metoclopramide)

• prescription medicines used to treat pain (examples: morphine, oxycodone)

• tricyclic antidepressants (examples: amitriptyline, clomipramine, nortriptyline)

Many medications may cause changes (increase or decrease) in blood sugar, these include:

• alcohol containing beverages

• angiotensin converting enzyme inhibitors (ACE inhibitors), often used for high blood pressure or heart problems (examples include captopril, enalapril, lisinopril)

• antiretroviral protease inhibitors (examples: indinavir, ritonavir, saquinavir)

• aspirin and aspirin-like drugs

• beta-blockers, often used for high blood pressure or heart problems (examples include atenolol, metoprolol, propranolol)

• certain medicines used for mental depression, emotional, or psychotic disturbances

• chromium

• clonidine

• cyclosporine

• diazoxide

• disopyramide

• epinephrine

• female hormones, such as estrogens, progestins, or contraceptive pills

• fenofibrate

• gemfibrozil

• glucagon

• growth hormone (somatropin)

• guanethidine

• isoniazid

• lithium

• male hormones or anabolic steroids

• medications to suppress appetite or for weight loss

• medicines for allergies, asthma, cold, or cough

• niacin

• nicotine (including nicotine found in patches and gum)

• pentoxifylline

• phenytoin

• quinolone antibiotics (examples: ciprofloxacin, levofloxacin, norfloxacin)

• some herbal dietary supplements

• steroid medicines such as prednisone or cortisone

• sulfonamide antibiotics

• tacrolimus

• thyroid hormones

• water pills (diuretics)

Some medications can hide the warning symptoms of low blood sugar (hypoglycemia). You may need to monitor your blood sugar more closely if you are taking one of these medications. These include:

beta-blockers, often used for high blood pressure or heart problems (examples include atenolol, metoprolol, propranolol)

clonidine

guanethidine

reserpine

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking Pramlintide?

Visit your prescriber for regular checks on your progress. To control your diabetes properly, you must use pramlintide with your insulin regularly and follow a regular diet and exercise schedule. Diabetes cannot be cured. Careful, daily control of blood sugar can postpone or prevent many of the long-term complications of diabetes.

Dangerously high or low blood sugar can occur when meals and diabetic medications are not spaced properly. Checking and recording your blood glucose and urine ketone levels regularly is important. Sometimes it is hard to tell the difference between low and high blood sugar (see side effects). Use a glucometer (blood glucose or sugar measuring device), whenever possible, before you treat high or low blood sugar.

When first starting to use pramlintide, you should check your blood sugar with your glucometer more often, especially before and after meals. This will help lower the chance of having very low blood sugars. Discuss with your health care professional or prescriber the results of your blood sugar monitoring at least once a week until your blood sugars, dose of pramlintide, and dose of insulin are stable.

Always carry a quick-source of sugar with you in case you have symptoms of low blood sugar (hypoglycemia). Examples include hard sugar candy or glucose tablets.

Try not to change the brand and type of syringe unless your health care professional or prescriber tells you to. Use a syringe one time only. Throw away syringe and needle in a closed container to prevent accidental needle sticks.

Wear a Medic Alert bracelet or necklace and/or carry an identification card with your name and address, condition, medication, and prescriber's name and address.

Many nonprescription cough and cold products contain sugar or alcohol. These can affect diabetes control or can alter the results of tests used to monitor blood sugar. Avoid alcohol. Avoid products that contain alcohol or sugar.

If you are going to have surgery, make sure you tell the health care professionals that you are diabetic and take pramlintide and insulin.

What side effects may I notice from receiving Pramlintide?

Learn how and when you should monitor your blood sugar, and what you should do if high or low blood sugar occurs.

Side effects that you should report to your prescriber or health care professional as soon as possible are:

• dizziness

• loss of appetite

• nausea/vomiting

• stomach pain

•symptoms of low blood sugar (hypoglycemia): anxiety or nervousness, confusion, difficulty concentrating, hunger, pale skin, nausea, fatigue, sweating, headache, palpitations, numbness of the mouth, tingling in the fingers, tremors, muscle weakness, blurred vision, cold sensations, uncontrolled yawning, irritability, rapid heartbeat, shallow breathing, and loss of consciousness. You should learn to recognize your own symptoms of hypoglycemia. Your symptoms may be different than others. If you are uncertain about your symptoms of hypoglycemia, check your blood sugar often to help you learn to recognize the symptoms. Hypoglycemia may cause you to not be aware of your actions or surroundings if it is severe, so you should let others know what to do if you cannot help yourself in a severe reaction. Your health care prescriber or diabetes educator will teach you how to treat hypoglycemia. Always carry a quick source of sugar such as candies or glucose tablets with you.

• symptoms of high blood sugar (hyperglycemia): dizziness, dry mouth, flushed dry-skin, fruit-like breath odor, loss of appetite, nausea, stomach ache, unusual thirst, frequent passing of urine

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• headache

• increase or decrease in fatty tissue under the skin, through overuse of a particular injection site

• itching, burning, swelling, or rash at the injection site

• tiredness

Where can I keep my medicine?

Keep out of the reach of children.

Store unopened vials in the refrigerator between 2—8 degrees C (36—46 degrees F). Do not freeze. Opened vials (vials currently in use) may be stored in the refrigerator or at room temperature, at approximately 25 degrees C (77 degrees F) or cooler. Keeping your pramlintide at room temperature decreases the amount of pain during injection. Once opened, your pramlintide can be used for 28 days. After 28 days, the vial of pramlintide should be thrown away.

Throw away any unused pramlintide after the expiration date or after the specified time for room temperature storage has passed.