Dulaglutide Brand Name– TRULICITY
What is Dulaglutide
Dulaglutide is a synthetic glucagon-like peptide-1 receptor agonist (GLP-1 RA) and belongs to a class of antidiabetic agents called incretin mimetics. Incretins are endogenous compounds, including glucagon-like peptide-1 (GLP-1), that improve glycemic control once released into the circulation via the gut.
Dulaglutide subcutaneous injection is given just once weekly and is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Dulaglutide is also used for the reduction of cardiovascular (CV) mortality due to major cardiovascular events (MACE) in T2DM patients with established CV disease or multiple risk factors for CV disease.
In a CV outcomes trial (median follow-up of 5.4 years), the primary composite outcome of non-fatal myocardial infarction, non-fatal stroke, or death from CV causes (including unknown causes) occurred in 594 (12%) participants (incidence rate of 2.4 per 100 person-years) in the dulaglutide group and in 663 (13.4%) participants (an incidence rate of 2.7 per 100 person-years) in the placebo group (HR 0.88, 95% CI 0.79 to 0.99; p = 0.026).
When assessed within subgroups, the HR of the intervention on the primary outcome was similar in participants with and without previous CV disease.
As with other agents in this class, dulaglutide has a boxed warning regarding rodent C-cell tumor findings and the uncertain relevance to humans.
Metformin is first-line in the treatment of type 2 DM. Additional therapy with a GLP-1 RA that has proven cardiovascular (CV) benefit, like dulaglutide, should be considered in patients with indicators of high-risk or established CV disease, independent of baseline A1C or individualized A1C target. GLP-1 RAs have high glucose-lowering efficacy, but with variation within the drug class. GLP-1 RAs improve CV outcomes, as well as secondary outcomes such as heart failure (HF) and progression of renal disease, in patients with established CV disease or chronic kidney disease (CKD); this makes them an alternative treatment option in patients with indicators of high-risk or established heart failure HF or CKD who cannot tolerate a sodium-glucose cotransporter 2 inhibitor (SGLT2i).
For patients requiring an injectable medication, GLP-1 RAs are preferred to insulin due to similar or even better efficacy in A1C reduction, lower risk of hypoglycemia, and reductions in body weight.
Indications
- reduction of cardiovascular mortality
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus in combination with diet and exercise
Side Effects
- abdominal pain
- anaphylactoid reactions
- angioedema
- anorexia
- antibody formation
- AV block
- cholecystitis
- cholelithiasis
- constipation
- dehydration
- diarrhea
- dyspepsia
- edema
- eructation
- erythema
- fatigue
- flatulence
- gastroesophageal reflux
- hyperamylasemia
- hypoglycemia
- injection site reaction
- nausea
- new primary malignancy
- pancreatitis
- PR prolongation
- rash
- renal failure (unspecified)
- retinopathy
- sinus tachycardia
- urticaria
- vomiting
Monitoring Parameters
- blood glucose
- glycosylated hemoglobin A1c (HbA1c)
Contraindications
- breast-feeding
- burns
- children
- colitis
- Crohn’s disease
- dehydration
- diabetic ketoacidosis
- diabetic retinopathy
- diarrhea
- fever
- gastroparesis
- geriatric
- GI bleeding
- GI disease
- GI obstruction
- GI perforation
- history of angioedema
- hypoglycemia
- ileus
- infants
- infection
- inflammatory bowel disease
- medullary thyroid carcinoma (MTC)
- multiple endocrine neoplasia syndrome type 2 (MEN 2)
- neonates
- pancreatitis
- pregnancy
- pseudomembranous colitis
- renal failure
- renal impairment
- serious hypersensitivity reactions or anaphylaxis
- surgery
- thyroid C-cell tumors
- thyroid cancer
- thyroid disease
- tobacco smoking
- trauma
- type 1 diabetes mellitus
- ulcerative colitis
- vomiting
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
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- Aminosalicylate sodium, Aminosalicylic acid
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- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
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- Amoxicillin; Clarithromycin; Omeprazole
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- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
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- Triamterene
- Trifluoperazine
- Valsartan
