Trulicity

Trulicity contains the active ingredient dulaglutide, a GLP-1 receptor agonist that is given once a week as a subcutaneous injection. It is approved for the treatment of type 2 diabetes mellitus in adults.

Dulaglutide consists of a GLP-1 analog linked to an immunoglobulin fragment. This design extends the duration of action to one week. The ready-to-use single-dose pen makes administration particularly easy – the needle is already built in and not visible.

Trulicity is manufactured by Eli Lilly. The REWIND trial showed a cardiovascular benefit even in patients at lower risk.

Dulaglutide acts as a long-acting GLP-1 receptor agonist:

Insulin stimulation (glucose-dependent):

• Promotes insulin release when blood sugar is elevated
• Hypoglycemia possible even with monotherapy (common, 1-10%)

Glucagon inhibition:

• Lowers glucagon secretion
• Reduces hepatic glucose production

Slowed gastric emptying:

• Flatter postprandial blood sugar spikes

Appetite reduction:

• Central effect on the satiety centers
• Supports weight loss

Cardiovascular protection: The REWIND trial showed a reduction in major cardiovascular events.

Trulicity is suitable for:

• Adults with type 2 diabetes in combination with other antidiabetic medications
• Patients who prefer a weekly injection
• In cases of inadequate control with metformin alone or in combination
• Patients with cardiovascular risk

Not suitable:

• Type 1 diabetes
• Diabetic ketoacidosis
• Confirmed pancreatitis during previous treatment with dulaglutide
• Severe gastrointestinal diseases
• Pregnancy and breastfeeding

Prefilled pen (single dose) for subcutaneous injection:

• 0.75 mg once weekly (starting dose)
• 1.5 mg once weekly
• 3.0 mg once weekly
• 4.5 mg once weekly (maximum dose)

Dose escalation:

• Start with 0.75 mg for at least 4 weeks
• Increase in 4-week intervals as needed

Administration:

• Once weekly, on the same day of the week
• Subcutaneous injection into the abdomen, thigh, or upper arm
• Independent of meals and time of day

Using the pen: 1. Pull off the cap 2. Place the pen on the skin and unlock it 3. Press and hold the injection button 4. Wait for the click (the injection takes about 5 seconds) 5. Remove the pen – the needle is covered automatically

Missed dose: Take it as soon as possible if there are at least 3 days (72 hours) until your next regular dose, then return to your regular day of the week. If there are less than 3 days until your next dose, skip the missed dose.

Trulicity must not be used in cases of:

• Hypersensitivity to dulaglutide

Caution in cases of:

• History of pancreatitis
• Severe gastrointestinal disease
• Severe renal impairment
• Diabetic retinopathy

Pregnancy/breastfeeding: Use during pregnancy is not recommended. Trulicity should not be used while breastfeeding.

Very common (>10%):

• Nausea
• Diarrhea
• Vomiting
• Abdominal pain

Common (1-10%):

• Decreased appetite
• Fatigue
• Dyspepsia (indigestion)
• Constipation
• Flatulence
• Injection site reactions

Uncommon:

• Gallstones
• Tachycardia

Rare:

• Pancreatitis (acute inflammation of the pancreas)

Note: Gastrointestinal symptoms are most pronounced at the start of treatment and when the dose is increased. They usually improve within 2-4 weeks.

Insulin and sulfonylureas: Increased risk of hypoglycemia. A dose reduction may be necessary.

Oral medications: Slowed gastric emptying may affect absorption. Usually not clinically relevant.

Warfarin: Check INR at the start of treatment.