SubcutaneousType 2 diabetes mellitusAdult: As monotherapy when metformin is inappropriate: 0.75 mg once weekly. In combination with other glucose-lowering agents (e.g. insulin) when existing treatment fails to achieve adequate glycaemic control: 1.5 mg once weekly; may be increased if necessary to 3 mg once weekly after at least 4 weeks, then to 4.5 mg once weekly after another 4 weeks. An initial dose of 0.75 mg once weekly may be considered for potentially vulnerable patients. Max: 4.5 mg once weekly.
Child: As monotherapy when metformin is inappropriate or in combination with other glucose-lowering agents (e.g. insulin) when existing treatment fails to achieve adequate glycaemic control: ≥10 years Initially, 0.75 mg once weekly; may be increased if necessary to 1.5 mg once weekly after at least 4 weeks. Max: 1.5 mg once weekly.
SubcutaneousCardiovascular risk reductionAdult: As an adjunct to standard therapy in patients with type 2 diabetes mellitus who have established CV disease or multiple CV risk factors: Initially, 0.75 mg once weekly; may be increased to 1.5 mg once weekly after 4-8 weeks if additional glycaemic control is needed. May increase further to 3 mg once weekly, then to 4.5 mg once weekly at intervals of at least 4 weeks if necessary.
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ESRD (eGFR <15 mL/min/1.73 m2): Not recommended.
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Dulaglutide May be taken with or without food.
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Hypersensitivity. Personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2.
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Patient with severe gastrointestinal disease (including severe gastroparesis), pancreatitis, diabetic retinopathy. Not indicated for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Not a substitute for insulin. Not approved for use in weight management or aesthetic weight loss. Patients undergoing surgeries or procedures requiring deep sedation or anaesthesia may have an increased risk of pulmonary aspiration due to residual gastric contents caused by delayed gastric emptying associated with glucagon-like peptide-1 (GLP-1) agonists. Renal and hepatic impairment. Children. Pregnancy and lactation.
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Significant: Dehydration, pancreatitis, hypoglycaemia, acute kidney injury, diabetic retinopathy, acute gallbladder disease (e.g. cholelithiasis, cholecystitis), serious hypersensitivity reactions (e.g. anaphylactic reactions, angioedema), medullary thyroid carcinoma; delayed gastric emptying, which may lead to pulmonary aspiration (particularly in patients undergoing surgery or procedure requiring deep sedation or general anaesthesia).
Cardiac disorders: Sinus tachycardia, 1st-degree atrioventricular block.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain or distention, dyspepsia, constipation, flatulence, GERD, eructation.
General disorders and administration site conditions: Fatigue, inj site reactions (e.g. rash, erythema).
Metabolism and nutrition disorders: Decreased appetite.
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This drug may cause hypoglycaemia, especially when used in combination with other antidiabetic agents; if affected, do not drive or operate machinery. This drug may cause gastrointestinal effects (e.g. vomiting, diarrhoea) that may result in dehydration; ensure adequate fluid intake during treatment.
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Monitor plasma glucose; renal function (in patients reporting severe gastrointestinal reactions), HbA1c (at least twice yearly in patients with stable glycaemic control and are meeting treatment goals, or quarterly in patients in whom treatment goals have not been met, or with therapy changes); signs and symptoms of pancreatitis.
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Symptoms: Mild or moderate gastrointestinal events (e.g. nausea, vomiting, diarrhoea), non-severe hypoglycaemia. Management: Supportive treatment.
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Increased risk of hypoglycaemia with sulfonylureas or insulin. Delays gastric emptying and may alter the rate of absorption of concomitantly administered oral medications.
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Description:
Mechanism of Action: Dulaglutide is an agonist of human glucagon-like peptide-1 (GLP-1), a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. Activation of GLP-1 receptors increases intracellular cyclic AMP (cAMP) leading to glucose-dependent insulin release, decreases glucagon secretion and slows gastric emptying, resulting in lower fasting and postprandial blood glucose concentrations.
Pharmacokinetics:
Absorption: Absolute bioavailability: 47-65%. Time to peak plasma concentration: Approx 24-72 hours.
Distribution: Volume of distribution: Approx 17-19 L.
Metabolism: Undergoes degradation into amino acids by general protein catabolism pathways.
Excretion: Elimination half-life: Approx 5 days.
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Store between 2-8°C. Do not freeze. Protect from light. Once in use, may be stored at or below 30°C for up to 14 days.
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A10BJ05 - dulaglutide ; Belongs to the class of glucagon-like peptide-1 (GLP-1) analogues. Used in the treatment of diabetes.
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Anon. Dulaglutide. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 28/11/2022. Brayfield A, Cadart C (eds). Dulaglutide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/03/2025. Dulaglutide. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 10/03/2025. Eli Lilly and Company (NZ) Limited. Trulicity 1.5 mg/0.5 mL Solution for Injection data sheet 12 Aug 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 28/11/2022. GLP-1 and Dual GIP/GLP-1 Receptor Agonists: Potential Risk of Pulmonary Aspiration During General Anaesthesia or Deep Sedation. Medicines & Healthcare products Regulatory Agency. https://www.gov.uk/drug-safety-update. Accessed 10/03/2025. GLP-1 Receptor Agonists: Reminder of the Potential Side Effects and to Be Aware of the Potential for Misuse. Medicines & Healthcare products Regulatory Agency. https://www.gov.uk/drug-safety-update. Accessed 10/02/2025. Joint Formulary Committee. Dulaglutide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/03/2025. Trulicity 0.75 mg Solution for Injection in Pre-filled Syringe (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 10/03/2025. Trulicity 1.5 mg Solution for Injection in Pre-filled Syringe (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 28/11/2022. Trulicity 4.5 mg Solution for Injection in Pre-filled Pen (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 10/03/2025. Trulicity Injection, Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/03/2025. Trulicity Solution for Injection in Pre-filled Pen (Zuellig Pharma Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 25/03/2025.
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