Side Effects of Trulicity (Dulaglutide)
Trulicity (dulaglutide) primarily causes gastrointestinal side effects including nausea, diarrhea, vomiting, and abdominal pain, which are typically transient but can be significant in some patients. 1, 2
Common Side Effects
Gastrointestinal Effects
- Nausea (most common side effect)
- Diarrhea
- Vomiting
- Stomach (abdominal) pain
- Decreased appetite
- Constipation
These gastrointestinal side effects typically occur in 15-20% of patients and are usually most prominent during dose initiation and titration 1. They often diminish over several weeks to months with continued use.
Other Common Side Effects
- Elevated heart rate (typically increases by ~5 bpm)
- Injection site reactions (rare, <1% of patients)
Serious Side Effects
Thyroid C-cell Tumors
- Black box warning regarding potential risk of thyroid C-cell tumors based on animal studies
- Human relevance not determined
- Contraindicated in patients with personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2) 2
Pancreatitis
- Inflammation of the pancreas can occur
- Stop using Trulicity immediately and seek medical attention if experiencing severe abdominal pain that may radiate to the back, with or without vomiting 2, 3
- Incidence rate: approximately 1.4 cases per 1000 patient-years 2
Hypoglycemia
- Risk is higher when used with other medications that can cause low blood sugar (sulfonylureas or insulin)
- Signs include dizziness, sweating, confusion, headache, blurred vision, and fast heartbeat 2
Allergic Reactions
- Serious allergic reactions including anaphylaxis can occur
- Symptoms include swelling of face/lips/tongue/throat, breathing problems, severe rash, dizziness, rapid heartbeat 2
Kidney Problems
- Can worsen existing kidney problems, especially if dehydration occurs due to gastrointestinal side effects
- Use with caution when initiating in patients with kidney disease 1, 2
Gallbladder Problems
- May cause cholelithiasis (gallstones) and gallstone-related complications
- Symptoms include pain in upper abdomen, fever, jaundice, and clay-colored stools 2
Gastrointestinal Disorders
- Severe constipation and small bowel obstruction/ileus have been reported 1, 2
- Particularly concerning in patients with pre-existing gastrointestinal disease
Managing Side Effects
For gastrointestinal effects:
- Slow dose titration (start with 0.75 mg weekly)
- Take with or without food
- Ensure adequate hydration
- Consider antiemetics for nausea if severe
For hypoglycemia risk:
- Monitor blood glucose closely when used with insulin or sulfonylureas
- Dose adjustment of other diabetes medications may be necessary
For injection site reactions:
- Rotate injection sites with each weekly dose
- Do not inject into areas where the skin is tender, bruised, red, or hard
Special Considerations
Surgery: Consider stopping Trulicity at least one week before elective procedures to minimize aspiration risk due to delayed gastric emptying 4
Monitoring: Regular follow-up to assess side effects and medication efficacy
Cardiovascular benefit: Despite side effects, dulaglutide has demonstrated cardiovascular benefits in large clinical trials 1
Remember that most side effects are mild to moderate in severity, with serious adverse events being relatively rare. The benefits of improved glycemic control and potential cardiovascular and renal benefits often outweigh the risks for most patients with type 2 diabetes.