What is the recommended dosing for dulaglutide (Trulicity)?

Dulaglutide (Trulicity) Dosing Recommendations

The recommended starting dose of dulaglutide (Trulicity) is 0.75 mg injected subcutaneously once weekly, which can be increased to 1.5 mg once weekly for additional glycemic control if needed, with a maximum recommended dosage of 4.5 mg once weekly in adults. 1

Adult Dosing Protocol

• Initial dose: 0.75 mg subcutaneously once weekly 1
• Titration: Increase to 1.5 mg once weekly if additional glycemic control is needed 1
• Further titration: If additional glycemic control is needed, increase in 1.5 mg increments after at least 4 weeks on the current dosage 1
• Maximum dose: 4.5 mg subcutaneously once weekly 1
• No dose adjustment required for patients with renal impairment, including those with end-stage renal disease 2

Pediatric Dosing (10 years and older)

• Initial dose: 0.75 mg subcutaneously once weekly 1
• Maximum dose: 1.5 mg once weekly (after at least 4 weeks on the 0.75 mg dose) 1

Administration Guidelines

• Administer once weekly, any time of day, with or without food 1
• Inject subcutaneously in the abdomen, thigh, or upper arm 1
• Rotate injection sites with each dose 1
• When using with insulin, administer as separate injections (never mix) 1
• Injections can be in the same body region but should not be adjacent to each other 1

Missed Dose Management

• If ≥3 days (72 hours) until next scheduled dose: Administer the missed dose as soon as possible 1
• If <3 days before next scheduled dose: Skip the missed dose and administer the next dose on the regular schedule 1
• The day of weekly administration can be changed if necessary, as long as the last dose was administered ≥3 days before the new administration day 1

Special Populations

• No dose adjustment required for patients with any level of renal impairment, including end-stage renal disease 2
• No dose adjustment required for patients with hepatic impairment 2
• Dulaglutide can be used in patients with eGFR <15 mL/min/1.73 m² without dose adjustment, unlike some other GLP-1 receptor agonists 2

Clinical Considerations

• Dulaglutide has demonstrated cardiovascular benefit in reducing major adverse cardiovascular events in adults with type 2 diabetes with established cardiovascular disease or multiple risk factors 2
• Most common adverse effects are gastrointestinal (nausea, vomiting, diarrhea), which are typically transient 3, 4
• Monitor for signs of pancreatitis, which has been reported with dulaglutide use 4
• Up-titrate slowly to reduce gastrointestinal side effects 2
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 1

Combination Therapy Considerations

• Dulaglutide can be effectively combined with SGLT2 inhibitors for enhanced glycemic control 5
• When adding to sulfonylureas or insulin, consider reducing doses of these agents to minimize hypoglycemia risk 2
• Dulaglutide has shown renoprotective effects in patients with diabetic kidney disease 6

By following these dosing recommendations and clinical considerations, dulaglutide can be effectively used to improve glycemic control and potentially provide cardiovascular and renal benefits in appropriate patients with type 2 diabetes.