How do you administer Trulicity (dulaglutide)?

How to Administer Trulicity (Dulaglutide)

Trulicity is administered as a subcutaneous injection once weekly at any time of day, with or without food, using a pre-filled single-dose pen injected into the abdomen, thigh, or upper arm. 1

Dosing Regimens

Adult Patients

• Starting dose: 0.75 mg subcutaneously once weekly 1
• Standard maintenance dose: 1.5 mg once weekly for additional glycemic control 1
• Dose escalation: If further glycemic control is needed, increase in 1.5 mg increments after at least 4 weeks on the current dose 1
• Maximum dose: 4.5 mg subcutaneously once weekly 1

Pediatric Patients (≥10 years)

• Starting 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 Technique

Injection Sites and Rotation

• Approved injection sites: Abdomen, thigh, or upper arm 1
• Site rotation: Rotate injection sites with each weekly dose to minimize local reactions 1
• When used with insulin: Administer as separate injections and never mix; injections may be given in the same body region but should not be adjacent to each other 1

Pre-Administration Inspection

• Visual inspection required: Solution should appear clear and colorless 1
• Do not use if: Particulate matter or discoloration is present 1

Timing Flexibility

• Administration schedule: Once weekly at any time of day, with or without food 1
• Day changes permitted: The weekly administration day can be changed if the last dose was administered 3 or more days before the new scheduled day 1

Missed Dose Management

If a dose is missed, administer as soon as possible only if there are at least 3 days (72 hours) until the next scheduled dose. 1

• Less than 3 days remaining: Skip the missed dose and administer the next dose on the regularly scheduled day 1
• After addressing missed dose: Resume the regular once-weekly dosing schedule 1

Renal Dosing Considerations

• No dose adjustment required for any level of renal impairment, including end-stage renal disease 2
• Monitoring recommendation: Monitor eGFR in patients with chronic kidney disease who report severe gastrointestinal adverse reactions 2
• Contraindication note: Some older guidelines suggested avoiding use in severe renal impairment/ESRD, but current FDA labeling does not require dose adjustment 2

Perioperative Management

Timing of Discontinuation

• For elective procedures: Consider stopping 1 week before surgery due to the weekly dosing schedule and prolonged half-life of 4.5-4.7 days 2
• Rationale: GLP-1 receptor agonists delay gastric emptying, potentially increasing aspiration risk during anesthesia 2
• Individual factors to consider: Drug characteristics, patient profile, procedure type, and anaesthetic technique must all be weighed against the adverse impact of drug cessation 2

Patient Education Requirements

• Training mandatory: Patients and caregivers must be trained on proper injection technique prior to initiation 1
• Thyroid monitoring awareness: Counsel patients about potential thyroid C-cell tumor risk and symptoms (neck mass, dysphagia, dyspnea, persistent hoarseness), though routine calcitonin monitoring is of uncertain value 1
• Gastrointestinal effects: Inform patients that nausea, vomiting, and diarrhea are the most common adverse events 3

Important Clinical Caveats

• Contraindications: Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 1
• Not studied in: Patients with history of pancreatitis or severe gastroparesis 1
• Hypersensitivity reactions: Rare cases of cutaneous hypersensitivity and anaphylactic reactions have been reported 1, 4