Can a patient take Trulicity (dulaglutide) and Ozempic (semaglutide) together?

Concurrent Use of Trulicity and Ozempic is Not Recommended

Patients should not take Trulicity (dulaglutide) and Ozempic (semaglutide) together as they are both GLP-1 receptor agonists with overlapping mechanisms of action, which could increase the risk of adverse effects without providing additional clinical benefit.

Rationale for Avoiding Concurrent Use

Mechanism of Action Overlap

• Both Trulicity (dulaglutide) and Ozempic (semaglutide) are GLP-1 receptor agonists that work through the same pathway 1:
  • They stimulate insulin secretion in a glucose-dependent manner
  • They reduce glucagon secretion
  • They slow gastric emptying
  • They promote satiety and weight loss

Lack of Evidence Supporting Combined Use

• Current guidelines do not recommend combining GLP-1 receptor agonists 1:
  • The American Gastroenterological Association specifically advises against using multiple GLP-1 receptor agonists concurrently
  • There are no clinical trials demonstrating additional benefit from combining these medications

Increased Risk of Adverse Effects

• Using two GLP-1 receptor agonists simultaneously would likely increase the risk of common side effects 2:
  • Gastrointestinal disorders (nausea, vomiting, diarrhea) - occurring in 43-48% of patients on single agents
  • Potential for more severe adverse events like pancreatitis 3

Appropriate Therapeutic Alternatives

Choosing Between Agents

If a patient is considering both medications, they should choose one based on:

1. Efficacy comparison 2:

   • Semaglutide (Ozempic) demonstrated superior glycemic control compared to dulaglutide (Trulicity)
   • Semaglutide produced greater weight loss than dulaglutide in head-to-head trials
   • At high doses, semaglutide reduced HbA1c by 1.8 percentage points vs. 1.4 for dulaglutide

2. Dosing preference:

   • Both are administered once weekly 1, 4
   • Patient preference for specific injection device may be considered

Combination Therapy Options

If additional glycemic control is needed beyond a single GLP-1 RA:

• Consider adding an SGLT2 inhibitor instead of a second GLP-1 RA 1:
  • This combination provides complementary mechanisms of action
  • Both classes have cardiovascular and renal benefits
  • The combination addresses multiple pathophysiological defects in type 2 diabetes

Monitoring and Safety Considerations

For Patients on Either Agent

• Monitor for gastrointestinal side effects, which are the most common adverse events 2
• Be alert for signs of pancreatitis (severe abdominal pain, nausea, vomiting) 3
• Regular monitoring of renal function is recommended 5
• Consider potential drug interactions with medications requiring precise timing of absorption 5

Special Considerations

Insurance and Access Issues

• Using both medications would likely face insurance coverage challenges 6
• Prior authorization typically requires appropriate FDA-approved indications 6
• If weight management is the goal, specific weight-loss formulations of these medications may be more appropriate 6

Conclusion

Rather than combining Trulicity and Ozempic, patients should:

1. Choose the single most effective GLP-1 RA for their needs (evidence suggests semaglutide may offer greater HbA1c reduction and weight loss)
2. If additional therapy is needed, consider adding an agent from a different class (e.g., SGLT2 inhibitor)
3. Discuss with their healthcare provider about optimizing the dose of a single GLP-1 RA before considering combination therapy

This approach maximizes benefits while minimizing risks of adverse effects and unnecessary medication costs.