What are the side effects of Trulicity (dulaglutide)?

Side Effects of Trulicity (Dulaglutide)

Trulicity (dulaglutide) primarily causes gastrointestinal side effects, including nausea, diarrhea, vomiting, and abdominal pain, which are typically most prominent during dose initiation and titration but generally decrease over time. 1

Common Side Effects

Gastrointestinal Effects

• Nausea, vomiting, and diarrhea (most common side effects, occurring in 15-20% of patients) 1
• Abdominal pain and dyspepsia
• Constipation (can be severe in some cases)
• Risk of small bowel obstruction/ileus, particularly concerning in patients with pre-existing gastrointestinal disease 1
• Highest incidence of GI effects typically occurs within the first 2 weeks of treatment initiation 2

Cardiovascular Effects

• Increased heart rate (typically ~5 beats per minute) 1
• While there are cardiovascular side effects, dulaglutide has demonstrated cardiovascular benefits in large clinical trials 1

Serious Side Effects

Pancreatitis

• Risk of acute pancreatitis (1.4 cases per 1000 patient-years) 3
• Presents with persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting 3
• FDA label warns to observe patients carefully for signs of pancreatitis after initiation 3

Hypoglycemia

• Low risk when used alone, but higher risk when combined with sulfonylureas or insulin 1
• Requires close monitoring of blood glucose when used with other diabetes medications 1

Allergic Reactions

• Serious hypersensitivity reactions including anaphylaxis and angioedema have been reported 3
• Symptoms include swelling of face/lips/tongue/throat, breathing problems, severe rash, dizziness, and rapid heartbeat 1

Thyroid C-cell Tumors

• FDA black box warning regarding risk of thyroid C-cell tumors based on animal studies 3
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 3

Renal Effects

• Can potentially worsen existing kidney problems, especially if dehydration occurs due to gastrointestinal side effects 1

Management of Side Effects

For Gastrointestinal Effects

• Start at low dose (0.75 mg) and titrate upward slowly 4, 3
• Reduce meal size and avoid high-fat diet 4
• Limit alcohol and carbonated drinks for reflux symptoms 4
• Ensure adequate hydration, especially if experiencing diarrhea 1
• Consider antiemetics for severe nausea 1

For Procedural Considerations

• Consider stopping Trulicity at least one week before elective procedures to minimize aspiration risk due to delayed gastric emptying 1
• Discontinue before scheduled surgery (3-4 days) 4

Monitoring Recommendations

• Monitor for signs of pancreatitis (persistent severe abdominal pain) 3
• Monitor blood glucose closely when used with insulin or sulfonylureas 1
• Be aware of symptoms of thyroid tumors (mass in neck, dysphagia, dyspnea, persistent hoarseness) 3

Most side effects are mild to moderate in severity, with severe gastrointestinal events occurring in less than 0.6% of patients 2. Treatment discontinuation due to nausea is generally low (≤1.5% of patients) 2.