Drugs that alter GI motility-  because of its effects on gastric emptying, do not consider pramilintide
therapy for patients taking drugs that alter GI motility- eg anticholinergic drugs eg atropine and
agents that slow the intestinal absorption of nutrients eg alphaglucosidase inhibitors

Pramilintide delays absorption of concomittantly administered drugs eg analgesics
Administer the agent at least 1 hour  prior to or 2 hours after pramilintide injection

Diabetes mellitus

Adverse reactions-

CNS-      dizziness 5%      fatigue  6%     headache   12%

GI -        abdominal pain   8%  amorexia  8%     nausea   26%    vomiting  7%

Respiratory -   coughing  5%      pharyngitis 4%

Hypersensitivity to the pramlitide or its components

Special Precaution-

Patient selection-  proper patient selection is critical to safe and effective use of pramlintide

Hypoglycemia-  pramilintide alone does not cause hypoglycemia
However  pramilintide is indicated to be coadministered with insulin therapy and in this
setting pramlintide increases the risk of insulin induced severe hypoglycemia

Drugs that increase the susceptibility to hypoglycemia-  addition of any antihyperglycemic
agents eg insulin , sulfonyl urea  or to other agents that may increase risk of hypoglycemia
may necessiciate insulin dose adjustments and monitoring of blood glucose
eg. ACE inhibitors, disopyramide, fibrates, fluoxetine, MAO inhibitors, pentoxifyline,
propoxyphene, salicylates, sulfonamide antibiotics.

Hypersensitivity reactions- patients may experience redness, swelling, or itching,
at the site of injection

Hazardous tasks- severe hypoglycemia associated with praminlintide occurs within the first
3 hours following a pramlintide injection. If severe hypoglycemia occurs while operating
a motor vehicle or while engaging in high risk activities serious injuries can occur.

Pregnancy- use  pramlintide during pregnancy only if the potential benefit justifies the
potential isk to the fetus.

Lactation-   administer to nursing women  only if the potential benefit outweighs the potential
risk to the infant

Children- safety and efficacy in children havenot been established

Elderly- carefully manage pramlitide and insulin regimens to obviate an increased risk
of severe hypoglycemia

Monitoring-  monitor blood glucose frequently including pre and post meals and at bed time.

Indication-
Diabetes mellitus

Dosage-
Type I diabetes- initiate pramilitide at  a  dose of 15mcg and titrate at 15mcg increments to a
maintenance  dose of 30 to 60 mcg as tolerated

Type II diabetes - initiate pramilitide at a dose of 60mcg and increase at a dose of 120mcg as
tolerated by the patient

Monitoring- monitor blood glucose levels frequently including before and after meals

1. Inform patients the potential risks and advantages of pramlintide therapy

2. Inform patients about self management practices including glucose monitoring,
   proper injection technique,timing of dosage, and proper storage of pramlintide

3. Inform patients of the importance of adherance to meal planning, physical activity,
    recognition and and management of hypoglycemia, and hyperglycemia and
    assesssment of diabetes complications

4. Instruct  patients on handling of special situations such as intercurrent conditions
    ( illness or stress)  an inadquate or omitted insulin dose, inadvertant administrationn
    of increased insulin or pramilintide dose, inadequate food intake or missed meals.

5. Always administer pramilintide and insulin as separate injections and never mix 
    the injection

6. Advice women with diabetes to inform their health care provider if they are pregnant
   or planning to become pregnant.

Pregnancy-
Use  pramlintide during pregnancy only if the potential benefit justifies the
potential isk to the fetus.

Lactation-  
Administer to nursing women  only if the potential benefit outweighs the potential
risk to the infant

Children-
Safety and efficacy in children havenot been established

Elderly-
Carefully manage pramlitide and insulin regimens to obviate an increased risk
of severe hypoglycemia