Introduction
Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist indicated for the treatment of type 2 diabetes mellitus. Developed by Eli Lilly and Company, this once-weekly injectable medication has demonstrated efficacy in glycemic control while offering potential cardiovascular benefits and weight management effects.
Mechanism of Action
Dulaglutide is a long-acting GLP-1 receptor agonist that enhances glucose-dependent insulin secretion, suppresses inappropriate glucagon secretion, and slows gastric emptying. It activates GLP-1 receptors on pancreatic beta cells, promoting insulin release in response to elevated blood glucose levels while simultaneously inhibiting glucagon secretion from alpha cells. Additionally, Trulicity acts on central nervous system receptors to promote satiety and reduce food intake.
Indications
- Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
- Reduction of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease or multiple cardiovascular risk factors
Dosage and Administration
Initial dose: 0.75 mg subcutaneously once weekly Maintenance dose: May increase to 1.5 mg once weekly for additional glycemic control Maximum dose: 4.5 mg once weekly (after dose escalation) Administration:- Administer subcutaneously in abdomen, thigh, or upper arm
- May be given without regard to meals
- Rotate injection sites
- Prefilled pen device with automatic needle insertion
- Renal impairment: No dose adjustment necessary
- Hepatic impairment: No dose adjustment necessary
- Geriatric patients: No dose adjustment required
- Pediatrics: Safety and effectiveness not established
Pharmacokinetics
Absorption: Bioavailability approximately 90%; peak concentration reached in 24-72 hours Distribution: Volume of distribution ~19 L; highly protein-bound Metabolism: Proteolytic degradation; no significant hepatic metabolism Elimination: Half-life approximately 5 days; primarily eliminated via proteolysis with subsequent renal elimination of metabolites Steady-state: Achieved after 2-4 weeks of once-weekly dosingContraindications
- Personal or family history of medullary thyroid carcinoma
- Patients with Multiple Endocrine Neoplasia syndrome type 2
- History of hypersensitivity to dulaglutide or any product components
- Severe gastrointestinal disease, including gastroparesis
Warnings and Precautions
Boxed Warning: Risk of thyroid C-cell tumors- Pancreatitis: Discontinue promptly if pancreatitis is suspected
- Hypoglycemia: Increased risk when used with insulin secretagogues or insulin
- Renal impairment: Monitor renal function in patients reporting severe gastrointestinal reactions
- Hypersensitivity reactions: Angioedema and anaphylaxis reported
- Acute gallbladder disease: Has been reported in clinical trials
Drug Interactions
Significant interactions:- Insulin and insulin secretagogues: Increased risk of hypoglycemia (dose reduction may be necessary)
- Oral medications: May delay gastric emptying and affect absorption of orally administered drugs
- Warfarin: Monitor INR more frequently when initiating or changing Trulicity dose
Adverse Effects
Common adverse reactions (≥5%):- Nausea (12-21%)
- Diarrhea (9-13%)
- Vomiting (6-11%)
- Abdominal pain (6-9%)
- Decreased appetite (6-9%)
- Dyspepsia (5-7%)
- Pancreatitis
- Severe hypersensitivity reactions
- Acute kidney injury
- Severe gastrointestinal disease
Monitoring Parameters
- HbA1c every 3 months until stable, then every 6 months
- Fasting plasma glucose
- Renal function (serum creatinine, eGFR)
- Body weight
- Signs and symptoms of pancreatitis
- Thyroid nodules (baseline and periodically)
- Hypoglycemia symptoms, especially when used with other antidiabetic agents
- Injection site reactions
Patient Education
Administration instructions:- Demonstrate proper injection technique using prefilled pen
- Rotate injection sites weekly
- Store unused pens refrigerated; in-use pen may be kept at room temperature
- Continue diet and exercise regimen
- Recognize symptoms of hypoglycemia and appropriate management
- Report persistent severe gastrointestinal symptoms
- Seek immediate medical attention for symptoms of pancreatitis (severe abdominal pain with or without vomiting)
- Do not share pen with others
- Importance of regular follow-up and laboratory monitoring
- Report any thyroid symptoms (lump in neck, hoarseness, difficulty swallowing)
- Inform all healthcare providers about Trulicity use
References
1. FDA Prescribing Information: Trulicity (dulaglutide) 2. American Diabetes Association. Standards of Medical Care in Diabetes - 2023 3. Gerstein HC, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019 4. Wysham C, et al. Efficacy and safety of dulaglutide after 52 weeks in type 2 diabetes in a randomized controlled trial (AWARD-5). Diabetes Care 2014 5. Dungan KM, et al. Once-weekly dulaglutide versus once-daily liraglutide in metformin-treated patients with type 2 diabetes (AWARD-6): a randomised, open-label, phase 3, non-inferiority trial. Lancet 2014
This information is intended for educational purposes only and should not replace professional medical advice. Always consult with qualified healthcare providers for personalized medical guidance.