Dulaglutide

Class
Hypoglycemic agents
Subclass
Glucagon-like peptide 1 receptor agonists
Substance name
Dulaglutide
Brand names
Trulicity®
Common formulations
Solution for injection
Dosage and administration
Adults patients
Treatment
Diabetes mellitus type 2
•
Start at: 0.75 mg SC weekly for 4 weeks
•
Maintenance: 0.75-1.5 mg SC weekly
Administered subcutaneously in the abdomen, thigh, or upper arm. Increase the dosage in 1.5 mg increments after at least 4 weeks on the current dose, up to 4.5 mg weekly, if additional glycemic control is needed.
Prevention
Prevention of cardiovascular events in patients with diabetes mellitus type 2 • With established CVD or multiple CVD risk factors
•
Start at: 0.75 mg SC weekly for 4 weeks
•
Maintenance: 0.75-1.5 mg SC weekly
Administered subcutaneously in the abdomen, thigh, or upper arm.
Indications for use
Labeled indications
Adults
•
Treatment of diabetes mellitus type 2
•
Prevention of cardiovascular events in patients with diabetes mellitus type 2 (with established CVD or multiple CVD risk factors)
Safety risks
Boxed warnings
Medullary thyroid carcinoma
•
Do not use dulaglutide in patients with a personal or family history of medullary thyroid cancer or in patients with MEN2. Counsel patients regarding the potential risk for and symptoms of medullary thyroid carcinoma.
Thyroid cancer
•
Maintain a high level of suspicion, as dulaglutide has been associated with potential risk of a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors.
Contraindications
Hypersensitivity to dulaglutide or its components
Severe gastrointestinal disease
•
Use with caution in patients with gastroparesis.
Warnings and precautions
Acute pancreatitis
•
Maintain a high level of suspicion, as dulaglutide has been associated with an increased risk of acute pancreatitis, including fatal and non-fatal hemorrhagic and necrotizing pancreatitis. Monitor patients for signs and symptoms of pancreatitis. Discontinue dulaglutide if acute pancreatitis is suspected.
AKI
•
Maintain a high level of suspicion, as dulaglutide has been associated with an increased risk of acute renal failure and worsening of chronic renal failure. Monitor renal function when initiating or up-titrating dulaglutide in patients with severe adverse gastrointestinal reactions.
Decreased blood glucose
•
Use caution in patients taking insulin or insulin secretagogues. Consider reducing the insulin or insulin secretagogue dose.
Exacerbation of diabetic retinopathy
•
Use caution in patients with diabetic retinopathy. Monitor patients for disease progression.
Gallstone disease
•
Maintain a high level of suspicion, as dulaglutide has been associated with an increased risk of cholelithiasis and cholecystitis.
Specific populations
Renal impairment
eGFR ≥ 15 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor renal function in patients reporting severe adverse gastrointestinal reactions.
eGFR < 15 mL/min/1.73 m²
•
Use with caution.
Renal replacement therapy
Any modality
•
Use with caution.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Consider safer alternatives. Evidence of fetal harm in animals. Insulin is the preferred first-line treatment for diabetes in pregnancy.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
↑ serum amylase, ↑ serum lipase, diarrhea, nausea, vomiting
Common 1-10%
•
AV block, abdominal distension, gastroesophageal reflux disease, ↑PR interval, abdominal pain, belching, constipation, dyspepsia, fatigue, flatulence, injection site reactions, loss of appetite, tachycardia
Uncommon < 1%
•
Acute cholecystitis, cholelithiasis, urticaria, skin rash, skin erythema, facial edema, lip swelling
Unknown frequency
•
Ileus, ↑ liver enzymes, angioedema, dysgeusia, aspiration, ↓ blood glucose, renal failure, cholestasis, hepatitis, anaphylaxis, acute pancreatitis
Interactions
Drug(s)
Check Interactions
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