Names and pronunciation
(doo-la-gloo′-tide) Trulicity
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Drug reference
(doo-la-gloo′-tide) Trulicity
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Func. class.: Antidiabetic
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Chem. class.: Human glucagon–like peptide-1 (GLP-1) receptor agonist
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ACTION: Binds and activates known human glucagon-like peptide-1 (GLP-1) receptor agonist, mimics natural physiol- ogy for self-regulating glycemic control
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USES: Type 2 diabetes mellitus, once- weekly dosing
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CONTRAINDICATIONS: Hyper sensitivity
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Black Box Warning: Medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2 (MEN-2), thyroid cancer Precautions: Pregnancy, breastfeeding, children, geriatric patients, severe renal/ hepatic/GI disease, pancreatitis, vitamin D deficiency, burns, colitis, diarrhea, fever, GI bleeding/perforation/obstruction, ileus, infection, CDAD, thyroid disease, trauma, surgery, type 1 diabetes mellitus, tobacco smoking, vomiting
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SIDE EFFECTS CNS: Fatigue ENDO: Hypoglycemia GI: Nausea, vomiting, diarrhea, anorexia, gastroesophageal reflux, pancreatitis, flatulence, abdominal pain, constipation SYST: Secondary malignancy INTEG: Injection site reactions, rash, urticaria
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INTERACTIONS Increase: hypoglycemia—ACE inhibitors, disopyramide, sulfonylureas, androgens, fibric acid derivatives, alcohol Increase: hyperglycemia—phenothiazines, corticosteroids, anabolic steroids Decrease: effect of dulaglutide—niacin, dextrothyroxine, thiazide diuretics, tri- amterene, estrogens, progestins, oral contraceptives, MAOIs
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DOSAGE AND ROUTES • Adult: SUBCUT 0.75 mg weekly, may increase to 1.5 mg weekly
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Available forms: Solution for SUBCUT injection 0.75 mg/0.5 mL, 1.5 mg/0.5 mL, 3 mg/0.5 mL, 4.5 mg/0.5 mL (single-use pen)
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Administer: SUBCUT route • Do not use as first-line therapy for those who have inadequate glycemic con- trol on diet and exercise • Administer the dose at any time of day, with or without meals • If a dose is missed, take as soon as remembered, as long as the next dose is due at least 3 days later; if it is more than 3 days after the missed dose, wait until the next regularly scheduled dose • Give SUBCUT only, do not give IV or IM, inject into the thigh, abdomen, or upper arm, rotate sites with each injec- tion to prevent lipodystrophy • Properly dispose of the pen or syringe • Store in refrigerator for unopened pen; may store at room temperature after opening for up to 30 days, do not freeze • When using concomitantly with insu- lin, give as separate injections. Never mix them together. The two injections may be injected in the same body region, but not adjacent to each other • Part of pen is glass; if dropped on a hard surface, do not use
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Assess: • Fasting blood glucose, A1c levels (check twice a year or quarterly in those with therapy changes or uncon- trolled disease), postprandial glucose during treatment to determine diabe- tes control • Pancreatitis: severe abdominal pain, with or without vomiting; product should be discontinued • Hypo/hyperglycemic reaction that can occur soon after meals; for severe hypo- glycemia, give IV D50W, then IV dextrose solution • Nausea, vomiting, diarrhea, ability to tolerate product, may cause dehydra- tion • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit outweighs fetal risk; avoid breastfeeding, excretion is unknown
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Evaluate: • Therapeutic response: decrease in polyuria, polydipsia, polyphagia, clear sensorium, improving A1c, weight; ab- sence of dizziness, stable gait
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the symptoms of hypo/hypergly- cemia, what to do about each; to have glucagon emergency kit available; to carry a glucose source (candy, sugar cube) to treat hypoglycemia
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PHARMACOKINETICS Peak 24-72 hr, half-life 5 days, metabo- lized by catabolism
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• Adult: SUBCUT 0.75 mg weekly, may increase to 1.5 mg weekly
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