Does Trulicity Carry a Risk of Suicidal Thoughts or Behaviors?
No, Trulicity (dulaglutide) does not carry an FDA black-box warning for suicide risk, and current evidence does not establish a causal link between GLP-1 receptor agonists like dulaglutide and suicidality. 1
Evidence Assessment
GLP-1 Receptor Agonist Class Safety Profile
Disproportionate reporting of suicidal ideation was observed only with semaglutide and liraglutide in FDA Adverse Event Reporting System (FAERS) data from 2005-2023, but not with other GLP-1 receptor agonists including dulaglutide 1
No disproportionate reporting of suicidal behavior, suicide attempts, or completed suicide was observed for any FDA-approved GLP-1 receptor agonists, including dulaglutide 1
Using Bradford Hill criteria for causality and accounting for confounders, no causal link between GLP-1 receptor agonists and suicidality exists 1
Contrast with Other Weight Management Medications
This is an important distinction from other weight management medications that do carry suicide warnings:
Naltrexone/bupropion ER carries a black-box warning for risk of suicidal behavior/ideation in people younger than 24 years old who have depression 2
Liraglutide and semaglutide (GLP-1 agonists used for weight management) list "suicidal ideation and behavior" as a safety concern requiring monitoring 2, though causality remains unestablished
Known Safety Concerns for Dulaglutide
The established safety concerns for dulaglutide are different and include:
Gastrointestinal side effects (nausea in 52% of patients, vomiting, diarrhea) 2, 3
Pancreatitis risk - acute pancreatitis has been reported, though causality has not been definitively established 2, 4
Thyroid C-cell tumor risk (black-box warning based on rodent studies; human relevance not determined) 2
Acute kidney injury risk when initiating or increasing doses, particularly in patients with existing kidney disease 2
Hypoglycemia when used with insulin or sulfonylureas 2
Clinical Monitoring Recommendations
When prescribing dulaglutide:
Monitor for gastrointestinal symptoms (nausea, vomiting, diarrhea) which are the most common side effects 3
Assess for signs of pancreatitis (severe abdominal pain radiating to the back) and discontinue if suspected 2, 4
Monitor renal function before and during treatment, especially when initiating or escalating doses 2
Screen for personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 (MEN2) as these are contraindications 2
Routine monitoring for suicidality is not specifically required for dulaglutide based on current evidence, unlike medications with established suicide warnings 1
Important Caveat
While dulaglutide itself does not carry a suicide warning, patients with type 2 diabetes have higher rates of depression and may be at increased baseline risk for suicidal ideation independent of medication effects. Standard psychiatric screening as part of comprehensive diabetes care remains appropriate, but this is not specific to dulaglutide use.