What is the recommended dosage and guidance for a 60-year-old female patient on Trulicity (dulaglutide) and Jardiance (empagliflozin)?

Recommended Dosage and Guidance for a 60-Year-Old Female on Trulicity and Jardiance

For a 60-year-old female patient on Trulicity (dulaglutide) and Jardiance (empagliflozin), the recommended dosage is dulaglutide 0.75 mg once weekly (which can be increased to 1.5 mg weekly if needed for glycemic control) with no dose adjustment required for renal function, and empagliflozin 10 mg once daily (which can be increased to 25 mg daily if tolerated) as long as eGFR is ≥45 mL/min/1.73 m².

Dosing Recommendations

Trulicity (Dulaglutide)

• Starting dose: 0.75 mg injected subcutaneously once weekly 1, 2
• Titration: Can increase to 1.5 mg once weekly after at least 4 weeks if additional glycemic control is needed 2
• Maximum dose: Can be further increased to 4.5 mg once weekly in adults (after at least 4 weeks on the current dosage) if additional glycemic control is needed 2
• Administration: Can be administered any time of day, with or without food 2
• Renal considerations: No dose adjustment required regardless of renal function 3, 1

Jardiance (Empagliflozin)

• Starting dose: 10 mg once daily in the morning 4
• Titration: May increase to 25 mg once daily if tolerated 4
• Renal considerations:
  • Do not initiate if eGFR <45 mL/min/1.73 m² 4
  • Discontinue if eGFR persistently falls below 45 mL/min/1.73 m² 4
  • Assessment of renal function recommended prior to initiation and periodically thereafter 4

Combination Therapy Considerations

The combination of Trulicity (GLP-1 receptor agonist) and Jardiance (SGLT2 inhibitor) offers complementary mechanisms of action:

1. Synergistic efficacy: Research demonstrates that adding dulaglutide to SGLT2 inhibitor therapy results in significant improvements in glycemic control 5

   • Dulaglutide 1.5 mg added to SGLT2 inhibitors reduced HbA1c by 1.34% compared to 0.54% with placebo
   • Dulaglutide 0.75 mg added to SGLT2 inhibitors reduced HbA1c by 1.21%

2. Cardiovascular benefits: Both medications have demonstrated cardiovascular benefits 3

   • Dulaglutide has shown reduction in major adverse cardiovascular events (MACE) in patients with type 2 diabetes 6
   • SGLT2 inhibitors have proven cardiovascular and kidney benefits 3

Monitoring and Safety Considerations

Key monitoring parameters:

• Blood glucose and HbA1c: Regular monitoring to assess efficacy
• Renal function: Periodic assessment of eGFR, especially important for empagliflozin 3, 4
• Volume status: Watch for signs of dehydration, especially when initiating empagliflozin 3
• Ketones: Consider monitoring if patient develops symptoms suggestive of ketoacidosis 3

Potential adverse effects to monitor:

1. Gastrointestinal effects: Nausea, vomiting, diarrhea (more common with dulaglutide) 5
2. Genital mycotic infections: More common with SGLT2 inhibitors, especially in women (6% vs 1% with placebo) 3
3. Euglycemic diabetic ketoacidosis: Risk with SGLT2 inhibitors, particularly during acute illness 3
4. Hypoglycemia: Low risk when used without insulin or sulfonylureas 3, 5

Special Considerations for This Patient

For a 60-year-old female patient:

• Renal function: Ensure eGFR ≥45 mL/min/1.73 m² before initiating or continuing Jardiance 4
• Cardiovascular risk: This combination may be particularly beneficial if she has cardiovascular risk factors, which are common in this age group 3
• Hydration status: Educate on maintaining adequate hydration to prevent volume depletion 3
• Genital hygiene: Advise on daily hygienic measures to reduce risk of genital mycotic infections 3

Important Precautions

1. Sick day management: Consider pausing Jardiance during periods of acute illness to reduce risk of euglycemic ketoacidosis 3
2. Surgery: Consider temporarily withholding dulaglutide prior to elective procedures due to effects on gastric emptying 1
3. Thyroid monitoring: Be aware that dulaglutide is contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 2

By following these recommendations and monitoring parameters, this medication combination can effectively manage type 2 diabetes while providing cardiovascular and renal benefits in appropriate patients.