Is it safe to use Trulicity (dulaglutide) and Eliquis (apixaban) together?

Safety of Concurrent Use of Trulicity (Dulaglutide) and Eliquis (Apixaban)

Trulicity (dulaglutide) and Eliquis (apixaban) can be safely used together as there are no significant drug-drug interactions between these medications.

Pharmacological Considerations

• Apixaban (Eliquis) is a direct oral anticoagulant (DOAC) that is a substrate of both CYP3A4 enzymes and P-glycoprotein (P-gp)/BCRP transporters, which means its metabolism can be affected by drugs that interact with these pathways 1
• Dulaglutide (Trulicity) is a GLP-1 receptor agonist that does not significantly interact with CYP3A4 or P-gp/BCRP pathways that would affect apixaban metabolism 2, 3
• Significant interactions with apixaban typically occur with medications that are moderate to strong inhibitors of both CYP3A4 and P-gp/BCRP pathways, which dulaglutide is not 1

Clinical Evidence Supporting Safety

• There are no specific contraindications or warnings regarding the concurrent use of GLP-1 receptor agonists like dulaglutide with anticoagulants like apixaban in clinical guidelines 2
• The American Diabetes Association's Standards of Care (2025) does not list any contraindications for using GLP-1 receptor agonists with anticoagulants 2
• Unlike some small-molecule inhibitors that can significantly alter apixaban levels through P-gp inhibition, GLP-1 receptor agonists like dulaglutide do not have this effect 2

Monitoring Recommendations

• Regular monitoring for signs of unusual bleeding or bruising should continue as standard practice for patients on apixaban, regardless of dulaglutide use 1
• Monitor for potential side effects specific to each medication:
  • For dulaglutide: gastrointestinal side effects (nausea, vomiting, diarrhea) are most common 3, 4
  • For apixaban: bleeding risk should be assessed as with any anticoagulant 2
• While rare, monitor for signs of pancreatitis in patients taking dulaglutide, as cases have been reported 5

Special Considerations

• Renal function should be monitored in patients on both medications, as it can affect the dosing of apixaban 2
• Dulaglutide has shown benefit for renal endpoints in cardiovascular outcome trials, which may be an additional benefit in patients requiring anticoagulation 2
• Dulaglutide has demonstrated cardiovascular benefits in patients with type 2 diabetes, which may be particularly relevant for patients who require anticoagulation for cardiovascular indications 4

Practical Guidance

• No dose adjustments are required for either medication when used together 2, 1
• If a patient experiences GI side effects from dulaglutide, consider dietary modifications (smaller meals, avoiding high-fat foods) rather than discontinuing either medication 2
• For patients undergoing procedures, follow standard protocols for temporary discontinuation of apixaban; dulaglutide generally does not need to be discontinued for most procedures 2

In conclusion, the concurrent use of Trulicity (dulaglutide) and Eliquis (apixaban) is considered safe as there are no significant pharmacokinetic or pharmacodynamic interactions between these medications that would necessitate dose adjustments or contraindicate their combined use.