Drug Action
Dulaglutide is a long-acting glucagon-like peptide 1 (GLP-1) receptor agonist that augments glucose- dependent insulin secretion, and slows gastric emptying.
PDF page 757
Loading InternPractice…
Drug reference
Dulaglutide is a long-acting glucagon-like peptide 1 (GLP-1) receptor agonist that augments glucose- dependent insulin secretion, and slows gastric emptying.
PDF page 757
Endocrine system Type 2 diabetes mellitus as monotherapy if metformin inappropriate ▶BY SUBCUTANEOUS INJECTION ▶Adult: 0.75 mg once weekly Type 2 diabetes mellitus in combination with insulin or other antidiabetic drugs (if existing treatment fails to achieve adequate glycaemic control) ▶BY SUBCUTANEOUS INJECTION ▶Adult: 1.5 mg once weekly
PDF page 757
DUE TO INTERACTIONS ▶Dose of concomitant insulin or drugs that stimulate insulin secretion may need to be reduced.
PDF page 757
Severe gastro-intestinal disease— no information available
PDF page 757
Scottish Medicines Consortium (SMC) decisions SMC No. 1110/15 The Scottish Medicines Consortium has advised (January 2016) that dulaglutide (Trulicity ®) is accepted for restricted use for treating adults with type 2 diabetes to improve glycaemic control as add-on therapy in combination with Endocrine system other glucose-lowering medicines, when these, together with diet and exercise, do not provide adequate glycaemic control. It is restricted to use as part of a triple therapy in patients with inadequate glycaemic control on two oral anti-diabetic medicines, as an alternative GLP-1 agonist option.
PDF page 758
MHRA/CHM ADVICE: GLP-1 RECEPTOR AGONISTS: REPORTS OF DIABETIC KETOACIDOSIS WHEN CONCOMITANT INSULIN WAS RAPIDLY REDUCED OR DISCONTINUED (JUNE 2019) Serious and life-threatening cases of diabetic ketoacidosis have been reported in patients with type 2 diabetes mellitus on a combination of a glucagon-like peptide-1 (GLP-1) receptor agonist and insulin, particularly after discontinuation or rapid dose reduction of concomitant insulin. Healthcare professionals are advised that any dose reduction of insulin should be done in a stepwise manner with careful blood glucose self-monitoring, particularly when GLP-1 receptor agonist therapy is initiated. Patients should be informed of the risk factors for and signs and symptoms of diabetic ketoacidosis, and advised to seek immediate medical attention if these develop.
PDF page 757
→Appendix 1: dulaglutide
PDF page 757
▶Common or very common Appetite decreased. atrioventricular block. burping. constipation. diarrhoea. fatigue. gastrointestinal discomfort. gastrointestinal disorders. hypoglycaemia. nausea. sinus tachycardia. vomiting ▶Rare or very rare Anaphylactic reaction. angioedema. pancreatitis acute (discontinue)
PDF page 757
Manufacturer advises avoid—toxicity in animal studies.
PDF page 757
Manufacturer advises avoid— no information available. l HANDLING AND STORAGE Refrigerated storage is usually necessary (2 °C – 8 °C). Once in use, may be stored unrefrigerated for up to 14 days at a temperature not above 30 °C.
PDF page 757
There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Trulicity (Eli Lilly and Company Ltd) Dulaglutide 1.5 mg per 1 ml Trulicity 0.75mg/0.5ml solution for injection pre-filled pens | 4 pre-filled disposable injection P £73.25 DT = £73.25 Dulaglutide 3 mg per 1 ml Trulicity 1.5mg/0.5ml solution for injection pre-filled pens | 4 pre-filled disposable injection P £73.25 DT = £73.25
PDF page 758
Patients or carers should be given advice on how to administer dulaglutide injection. Acute pancreatitis Patients should be told how to recognise signs and symptoms of acute pancreatitis and advised to seek medical attention if symptoms such as persistent, severe abdominal pain develop. Missed doses If a dose is missed, it should be administered as soon as possible only if there are at least 3 days until the next scheduled dose; if less than 3 days remain before the next scheduled dose, the missed dose should not be taken and the next dose should be taken at the normal time.
PDF pages 757, 758
0.75 mg once weekly
First-line fragment. Read the complete Indications and Dose section above.
PDF page 757
1.5 mg once weekly
First-line fragment. Read the complete Indications and Dose section above.
PDF page 757