Pramlintide for weight loss

Pramlintide in Symlin works for weight loss and diabetes by mimicking amylin, a hormone that gets released by your pancreas along with insulin when your blood sugar (glucose) rises. Pramlintide helps regulate blood glucose levels and appetite 3 ways:

1. It delays gastric emptying. Pramlintide slows the rate at which food moves from your stomach to the intestines. This delay helps prevent postprandial (post-meal) blood sugar spikes, and also makes you feel full sooner, so you may eat less. It doesn’t though affect how well you absorb nutrients. 
2. It promotes satiety. Pramlintide enhances feelings of satiety (or fullness) after meals, which helps decrease your overall food intake and may contribute to weight loss.
3. It suppresses glucose secretion. Pramlintide reduces the amount of glucose your liver produces by inhibiting glucagon, a hormone that tells your liver to release glucose.

While pramlintide in Symlin is only FDA-approved for glycemic control in type 1 and type 2 diabetes, it’s gained attention for promoting weight loss in clinical trials — even for people without diabetes. 

In a 6-week study of people with obesity, participants lost 2.1% of their body weight. By the end of the trial, they were eating fewer calories overall, enjoying smaller portions, and reported feeling more in control over their eating. They even consumed fewer calories when presented with extra-palatable high-sugar and high-fat foods during what the researchers called a “fast food challenge.” 

In another trial of people with obesity (but without diabetes), those who took pramlintide and implemented lifestyle changes, like diet and exercise, lost between 8.4 and 13.4 pounds in 4 months. After a year, up to 43% had lost at least 10% of their body weight, compared with only 12% from the placebo group. 

In a study of people with diabetes taking pramlintide, people with type 1 diabetes lost 3.7 pounds in 4 months, while people with type 2 diabetes mellitus lost 8.2 pounds.

Pramlintide is available only as brand-name Symlin. It comes in an injectable medication and is available in several dosage strengths, which vary depending on which pen your provider prescribes:

• The 1.5 mL SymlinPen 60 contains 1000 micrograms/milliliter (mcg/mL) of pramlintide to provide multiple doses for people prescribed 15-, 30-, 45-, or 60-microgram (mcg) doses.
• The 2.7 mL SymlinPen 120 contains 1000 mcg/mL of pramlintide for multiple doses for people prescribed 60- or 120-mcg doses.

To take pramlintide you inject it subcutaneously (under the skin) into your abdomen or thigh, right before each main meal that includes at least 250 calories or at least 30 grams of carbohydrates.

To minimize side effects like nausea, healthcare providers typically prescribe a low starting dose and increase it incrementally over time as you get used to the medication. For weight loss, healthcare providers may prescribe a lower dose 3 times daily, or a higher dose 2 times daily, depending on your tolerance.

If you miss a dose of pramlintide, just take your next dose as scheduled with a meal. Never take 2 doses at once.

Pramlintide is stored in the refrigerator. To avoid causing a reaction at the injection site, the medication guide recommends that it reach room temperature before you inject yourself.

Never mix pramlintide with insulin in the same syringe. Always take them separately.

Pramlintide offers modest weight loss compared to other injectable medications that are FDA-approved specifically for weight loss. For example, people with obesity but without diabetes may lose up to 17.6 pounds in 1 year when using pramlintide. In 68 weeks (about a year and a half), people taking Wegovy (semaglutide) can lose an average of 33.7 pounds or 14.9% of their initial body weight.

Clinical trials show that when compared to pramlintide, GLP-1 weight loss injections produce more weight loss. People taking Saxenda (liraglutide) lost at least 5%, and sometimes up to 10%, of their body weight over 56 weeks. And people taking Zepbound (tirzepatide) lost up to 20.9% of their body weight in 72 weeks. In all of these clinical trials, participants also implemented lifestyle changes like diet and exercise.

Mounjaro (tirzepatide) and Ozempic (semaglutide) may also produce more weight loss than pramlintide. Like pramlintide, they’re FDA-approved for people with type 2 diabetes, not for weight loss. In clinical trials, people taking Ozempic lost at least 5% and sometimes more than 10% of their body weight in 40 weeks. In clinical trials of Mounjaro, people with type 2 diabetes lost up to 13.9% of their body weight in 104 weeks (2 years).

Zepbound, Wegovy, and Saxenda are all FDA-approved for weight loss or weight management in people with obesity and overweight when combined with a reduced-calorie diet and increased physical activity. Mounjaro and Ozempic are FDA-approved for type 2 diabetes but may be prescribed off-label for weight loss. All of these medications have side effects that may include but aren’t limited to, nausea, vomiting, constipation, diarrhea, and headaches. All can have serious side effects and have an FDA-boxed warning for the risk of thyroid C-cell tumors. Before taking any medication, read the medication guide and ask your provider or pharmacist about all possible side effects, warnings, and drug interactions. 

The best way to find out which weight loss medication, if any, is best for you is to talk to a provider. 

Compare different GLP-1 agonist medications for weight loss.