How to initiate dulaglutide (Trulicity) therapy in a patient?

From the Guidelines

To start a patient on Trulicity (dulaglutide), initiate with a 0.75 mg subcutaneous injection once weekly, as recommended by the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1. When starting Trulicity, it is essential to consider the potential benefits and risks, including the improvement of glycemic control in adults with type 2 diabetes and the reduction of major adverse cardiovascular events (MACE) for people with type 2 diabetes with and without established cardiovascular disease. Some key points to consider when initiating Trulicity include:

• The recommended dose for cardiovascular benefit is 0.75 mg subcutaneously per week, which can be titrated as tolerated to 1.5 mg or the maximally tolerated dose based on prescribing information 1.
• Indications for Trulicity include improving glycemic control in adults with type 2 diabetes and reducing MACE for people with type 2 diabetes with and without established cardiovascular disease 1.
• Dose modifications may be necessary, such as up-titrating slowly to reduce nausea and discontinuing if pancreatitis is suspected and not restarting if pancreatitis is confirmed 1.
• Contraindications include a history of serious hypersensitivity reaction to the drug, pregnancy or breastfeeding, severe renal impairment or end-stage renal failure, personal or family history of medullary thyroid cancer, and personal or family history of Multiple Endocrine Neoplasia syndrome type 2 1.
• Common adverse effects to monitor include nausea, vomiting, diarrhea, headache, weakness, or dizziness, as well as hypoglycemia when given with insulin, sulfonylureas, or glinides 1. It is crucial to weigh these factors and consider the individual patient's needs and medical history when starting Trulicity, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

The recommended starting dosage of TRULICITY is 0.75 mg injected subcutaneously once weekly. Prior to initiation, train patients and caregivers on proper injection technique [see Instructions for Use]. Administer TRULICITY once weekly, any time of day, with or without food. Inject TRULICITY subcutaneously in the abdomen, thigh, or upper arm. Rotate injection sites with each dose. Inspect TRULICITY visually before use It should appear clear and colorless. Do not use TRULICITY if particulate matter or coloration is seen.

To start a patient on TRULICITY, begin with a dose of 0.75 mg injected subcutaneously once weekly. Before initiating treatment, ensure that patients and caregivers are trained on the proper injection technique. TRULICITY can be administered at any time of day, with or without food, and should be injected subcutaneously in the abdomen, thigh, or upper arm, rotating injection sites with each dose. Visually inspect TRULICITY before use to ensure it appears clear and colorless. If particulate matter or coloration is seen, do not use the product 2.

From the Research

Initiating Trulicity (Dulaglutide) Treatment

To start a patient on Trulicity, consider the following steps:

• Ensure the patient has a confirmed diagnosis of type 2 diabetes and has been inadequately controlled with diet and exercise alone or in combination with other antihyperglycemic agents 3, 4.
• Evaluate the patient's medical history, including the presence of any cardiovascular or renal disease, as Trulicity has been shown to have beneficial effects on these conditions 5, 4, 6.
• Choose the appropriate dose of Trulicity, which is typically 0.75 mg or 1.5 mg administered subcutaneously once weekly 3, 4, 7.
• Consider the potential for gastrointestinal side effects, such as nausea, vomiting, and diarrhea, and counsel the patient on how to manage these symptoms 3, 5, 7.
• Monitor the patient's glycemic control, body weight, and other relevant clinical parameters to assess the efficacy and safety of Trulicity treatment 3, 5, 4.

Key Considerations

• Trulicity has been shown to be effective as monotherapy or in combination with other antihyperglycemic agents, including metformin, sulfonylureas, and insulin 3, 5, 4.
• The medication has a low inherent risk of hypoglycemia, making it a suitable option for patients with type 2 diabetes who are at risk for hypoglycemic events 3, 5, 4.
• Trulicity has been associated with significant reductions in major adverse cardiac events and renal disease progression in patients with type 2 diabetes 5, 4, 6.