DosingIncidence of adverse effects in patients with type 2 diabetes (%)*Cost per month†Comments
Type 1 diabetesType 2 diabetes
Pramlintide (Symlin)1
Starting dosage: 15 mcg (2.5 units) SC immediately before major meals, increased by 15 mcg every three to seven days as tolerated

  • Starting dosage: 60 mcg

  • SC immediately before major meals, increased to target dose in three to seven days as tolerated

  • Target dose: 120 mcg (20 units)

  • Nausea: 28.0

  • Headache: 13.0

  • Anorexia 9.0

  • Abdominal pain: 8.0

  • Vomiting: 8.0

  • Severe hypoglycemia (i.e., patient needed assistance from another person): 4.7

  • Severe hypoglycemia requiring medical assistance: 0.4

120 mcg three times a day: $382A U-100, 0.3-mL syringe is recommended for administration; micrograms must be converted to units to ensure a correct dose; nausea (more commonly reported in type 1 patients2) is dose-dependent and appears to resolve over time; must be given in conjunction with insulin therapy; FDA pregnancy category C; should be given to nursing mothers only if the benefits of use outweigh the risks; safety and effectiveness in children have not been determined
Target dose: 60 mcg (10 units)
Exenatide (Byetta)3
Not indicated

  • Starting dosage: 5 mcg twice a day within one hour before morning and evening meals

  • Target dose: 10 mcg twice a day after one month of therapy if goals are not achieved

  • Nausea: 44.0

  • Diarrhea: 13.0

  • Vomiting: 13.0

  • Dizziness: 9.0

  • Headache: 9.0

  • Dyspepsia: 6.0

  • Hypoglycemia (exenatide plus sulfonylurea): 14.4 (5 mcg), 35.7 (10 mcg)

  • Hypoglycemia (exenatide plus metformin [Glucophage]): 4.5 (5 mcg), 5.3 (10 mcg)

5 mcg twice a day: $176
10 mcg twice a day: $207		Nausea and vomiting can be reduced by slowly titrating the dose4; not recommended for patients with a creatinine clearance less than 30 mL per minute (0.50 mL per second), for children, or for patients with severe gastrointestinal disease