Pramlintide (brand name Symlin) is a synthetic analog of amylin, a 37-amino-acid pancreatic hormone co-secreted with insulin from beta cells (MW ~3949.4 g/mol). FDA-approved in March 2005, it is the only amylin analog approved for clinical use and is indicated as adjunctive therapy for type 1 and type 2 diabetes patients on mealtime insulin who have failed to achieve adequate glycemic control. Pramlintide has three proline substitutions (positions 25, 28, 29) that prevent the amyloid aggregation inherent to native human amylin.
Category: Metabolic / Amylin Analog. Evidence rating: A (strong human clinical data).
Clinical status: FDA-approved (Symlin for T1D and T2D as adjunct to mealtime insulin, March 2005)
Pramlintide mimics the actions of endogenous amylin, a 37-amino-acid hormone co-secreted with insulin from pancreatic beta cells in response to meals. It binds to amylin receptors (calcitonin receptor/RAMP complexes) in the area postrema and other brain regions. Its three key pharmacological…
Safety considerations: Common (>=5%): nausea (28-48% initially, decreases with continued use and slow titration), headache, anorexia, vomiting, abdominal pain; FDA black box warning: increased risk of insulin-induced severe hypoglycemia, particularly in T1D, usually within the first 3 hours after injection; Mealtime insulin dose must be reduced by 50% when initiating pramlintide to avoid severe hypoglycemia.
Reviewed by the PeptideAtlas Editorial Team. Last reviewed: 2026-07-06.
Related peptides: Cagrilintide.
Compare: Pramlintide vs Cagrilintide.
Pramlintide was developed by Amylin Pharmaceuticals and approved by the FDA in 2005. It was never submitted for regulatory approval in the EU, Canada, or Australia, likely due to commercial considerations including the complexity of its dosing regimen and the requirement for separate injections from insulin.
Pramlintide slows gastric emptying and suppresses glucagon, both of which lower postprandial glucose. If mealtime insulin is not reduced by approximately 50% when starting pramlintide, the combined glucose-lowering effect can cause severe hypoglycemia. This is the basis for the FDA black box warning.
No. Pramlintide is a synthetic analog of human amylin with three proline substitutions (at positions 25, 28, and 29) that prevent the amyloid fibril aggregation that makes native amylin unstable as a drug. The proline substitutions are based on rat amylin, which naturally has these prolines and does not aggregate.
Pramlintide is FDA-approved only as adjunctive therapy for diabetes, not for weight loss alone. However, it does produce modest weight loss (-1 to -2 kg) in trials, and higher doses have been explored in obesity research. Cagrilintide, a next-generation long-acting amylin analog by Novo Nordisk, is being studied specifically for obesity.
Several factors limit adoption: the requirement for a separate injection from insulin at each meal (3+ extra injections daily), the need to titrate slowly to manage nausea, a black box warning for hypoglycemia, modest HbA1c benefit, and competition from GLP-1 agonists that are simpler to use.