SYMLIN® (pramlintide acetate) Injection

The dosing instructions are different for Type 1 and Type 2 patients. In addition the way prescriptions need to be written may be confusing to the patient, the physician and the pharmacist.

Symlin® is measured in mcg(micrograms) and most of us are used to measuring insulin in units. So we must be very careful to be clear as to the doses we want to use. Prescriptions must be written with the mcg designation after the dose. It is important to remember that 6mcg of Symlin® is volume equivalent to 1 unit of insulin.

The starting dose for a type 1 patient is 15mcg which is volume equivalent to 2.5 units of insulin. This is a very small amount and would be impossible to accurately dose in a 1cc(100 unit) syringe.
We need to be sure we order 3/10 cc syringes for our Symlin® patients and explain the dosing to them.

In a study published by Bell DS, et al. in the Arch Intern Med. 1991;151:2265-2269 there was a 43% error among medical professionals in accurately drawing 2 units into a 1cc(100 unit syringe) and a 19% error when drawing 5 units. This could significantly increase hypoglycemia in patients due to the Black box warning (see below).

The starting dose for an insulin using type 2 patient is 60mcg. This would be the equivalent volume of 10 units of insulin and this is titrated to 120mcg as tolerated. As you can see, if the prescriber, pharmacist or patient misinterpret the directions of units vs. mcg, severe problems can develop.

Patients are also suppose to decrease preprandial, rapid-acting or short-acting insulin dosages, including fixed-mix insulins (70/30) by 50% and monitor blood glucose frequently, including pre- and post-meals and at bedtime;

The manufacturer has prepared excellent “Starting Smart with Symlin” instruction sheets for both type 1 and type 2 patients and we have included them for you to print and use with your patients
Symlin_PI_and_Med_Guide.pdf
Symlin type2.pdf
Symlin type1 .pdf