Trulicity

Indications

Dulaglutide is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes. It can be used alone or with other diabetes medicines, including Metformin and Insulin. In people with type 2 diabetes and heart disease or heart risk factors, it also lowers the risk of heart attack, stroke and death from heart disease. It is not for type 1 diabetes.

How It Works

Dulaglutide is a GLP-1 receptor agonist. It copies a natural gut hormone called GLP-1, which is released after eating. It helps the pancreas release insulin when blood sugar is high, lowers the release of glucagon (a hormone that raises sugar), slows emptying of the stomach and reduces appetite. These effects lower blood sugar and often help with weight loss.

Dosage and Administration

Dulaglutide is injected under the skin of the stomach, thigh or upper arm once a week, on the same day each week, at any time of day, with or without food. The dose is as prescribed by your doctor; it is usually started at a low weekly dose and increased step by step. The first injection is usually given or taught by a doctor or nurse, after which patients can inject at home with the prefilled pen. If a dose is missed, take it if there are at least 3 days (72 hours) until the next dose; otherwise skip it.

Interactions

• Insulin and sulfonylureas (such as Gliclazide or Glimepiride): higher risk of low blood sugar; their dose may need to be reduced.
• Because it slows stomach emptying, it may change the absorption of oral medicines; follow your doctor's advice for medicines that need exact timing.
• Other GLP-1 receptor agonists should not be used at the same time.

Contraindications

• Personal or family history of medullary thyroid cancer, or multiple endocrine neoplasia type 2 (MEN 2).
• Allergy to Dulaglutide or any ingredient.
• Type 1 diabetes or diabetic ketoacidosis.

Side Effects

Common side effects include nausea, vomiting, diarrhoea, stomach pain, loss of appetite, indigestion, tiredness and injection-site reactions. These are usually worst at the start and ease over time. Low blood sugar can occur, mainly when used with Insulin or sulfonylureas. Less common but serious effects include inflammation of the pancreas (pancreatitis), gallstones, kidney problems from dehydration, and worsening of diabetic eye disease.

Get urgent medical help if you have severe, persistent stomach pain spreading to the back with or without vomiting, signs of a severe allergic reaction, a lump or swelling in the neck, trouble swallowing or hoarseness, severe vomiting or diarrhoea with signs of dehydration, or a severe low blood sugar episode with confusion or fainting.

Pregnancy and Lactation

Dulaglutide is not recommended during pregnancy; Insulin is usually preferred. Stop it at least 1 month before a planned pregnancy, or as advised by your doctor. It is not known if it passes into breast milk; it is generally not recommended while breastfeeding.

Precautions and Warnings

• Drink enough fluids, especially if you have vomiting or diarrhoea, to protect the kidneys.
• Tell your doctor if you have had pancreatitis, gallbladder disease, severe stomach or bowel disease or diabetic eye disease.
• Learn to recognise and treat low blood sugar.
• Tell the doctor or anaesthetist you use it before surgery or procedures needing an empty stomach.
• Never share a pen, even if the needle is changed.

Overdose

An overdose may cause severe nausea, vomiting and low blood sugar. Eat or drink something sugary if blood sugar is low, and seek medical help.

Therapeutic Class

Antidiabetic; glucagon-like peptide-1 (GLP-1) receptor agonist.

Storage

Store unused pens in a refrigerator at 2 to 8°C, do not freeze, and keep in the carton to protect from light. A pen may be kept at room temperature below 30°C for up to 14 days. Keep out of the reach of children.