Trulicity (Dulaglutide) Dosing for Type 2 Diabetes
For adults with type 2 diabetes, Trulicity (dulaglutide) should be initiated at 0.75 mg subcutaneously once weekly, then titrated to 1.5 mg once weekly for additional glycemic control, with further increases up to a maximum of 4.5 mg once weekly if needed. 1
Adult Dosing Algorithm
- Starting dose: 0.75 mg subcutaneously once weekly
- First titration: Increase to 1.5 mg once weekly for additional glycemic control
- Further titration: If additional glycemic control is needed, increase dosage in 1.5 mg increments (to 3.0 mg, then 4.5 mg) after at least 4 weeks on the current dosage
- Maximum dose: 4.5 mg subcutaneously once weekly
Pediatric Dosing (10 years and older)
- Starting dose: 0.75 mg subcutaneously once weekly
- Maximum dose: 1.5 mg once weekly (after at least 4 weeks on the 0.75 mg dosage)
Administration Guidelines
- Administer once weekly, any time of day, with or without food 1
- Inject subcutaneously in the abdomen, thigh, or upper arm
- Rotate injection sites with each dose
- When using with insulin, administer as separate injections (never mix)
- If a dose is missed:
- Administer as soon as possible if ≥3 days (72 hours) until next scheduled dose
- Skip the missed dose if <3 days remain before next scheduled dose
Clinical Benefits and Indications
Dulaglutide is indicated for:
- Improving glycemic control in adults with type 2 diabetes
- Reducing major adverse cardiovascular events (MACE) in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors 2
The American College of Cardiology recognizes dulaglutide's ability to reduce MACE for people with type 2 diabetes with and without established cardiovascular disease 2.
Contraindications
- Personal or family history of medullary thyroid carcinoma
- Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
- History of serious hypersensitivity reaction to dulaglutide 1
Renal Considerations
- Not recommended in patients with eGFR <45 mL/min/1.73 m² 2
- Use caution in patients with a history of pancreatitis
Adverse Effects to Monitor
- Gastrointestinal effects: nausea, vomiting, diarrhea (most common)
- Hypoglycemia (risk increased when used with insulin, sulfonylureas, or glinides)
- Weight loss
- Injection site reactions 2
Perioperative Considerations
Due to concerns about delayed gastric emptying and potential risk of pulmonary aspiration, some guidelines suggest stopping dulaglutide before procedures requiring anesthesia 2. However, this must be balanced against the benefits of continued therapy, particularly in patients with established cardiovascular disease.
Clinical Pearls
- Dulaglutide has demonstrated cardiovascular benefits in reducing major adverse cardiovascular events in adults with type 2 diabetes 2
- Up-titrate slowly to reduce nausea and discontinue if pancreatitis is suspected
- Do not restart if pancreatitis is confirmed 2
- Rare cases of dulaglutide-induced acute pancreatitis have been reported 3
- Not recommended in patients with severe gastrointestinal disease, including severe gastroparesis 1
By following this dosing algorithm and monitoring for potential adverse effects, dulaglutide can be an effective treatment option for patients with type 2 diabetes, particularly those with or at risk for cardiovascular disease.