Switching from Ozempic 2mg to Trulicity (Dulaglutide)
Start dulaglutide at 1.5 mg once weekly when switching from semaglutide 2 mg, as this represents the standard maintenance dose that provides comparable glycemic efficacy to higher-dose semaglutide. 1
Rationale for Starting Dose Selection
The FDA-approved starting dose of dulaglutide is 0.75 mg once weekly, with escalation to 1.5 mg after 4 weeks for additional glycemic control 1. However, when switching from semaglutide 2 mg (the maximum approved dose for diabetes), starting at the higher dulaglutide dose of 1.5 mg is appropriate because:
- Your patient is already tolerating a maximal-dose GLP-1 receptor agonist, making the lower starting dose unnecessary from a tolerability standpoint 1
- Semaglutide 2 mg provides more potent glycemic control than dulaglutide 0.75 mg, so starting at 0.75 mg would represent significant de-escalation and risk loss of glycemic control 2
- The 1.5 mg dose of dulaglutide is the standard maintenance dose that has demonstrated cardiovascular benefits in outcome trials 2
Dosing Algorithm
Week 1 onwards: Administer dulaglutide 1.5 mg subcutaneously once weekly at any time of day, with or without food 1
If additional glycemic control is needed after 4 weeks: Increase in 1.5 mg increments (to 3 mg, then 4.5 mg maximum) after at least 4 weeks on each dose 1
Critical Administration Details
- Inject subcutaneously in the abdomen, thigh, or upper arm, rotating injection sites with each dose 1
- No dose adjustments required for renal or hepatic impairment 2
- If using concomitant insulin, administer as separate injections in the same body region but not adjacent to each other 1
Monitoring During Transition
First 4 weeks after switching:
- Monitor blood glucose closely, especially if the patient is on insulin or sulfonylureas, as dose adjustments of these agents may be needed to prevent hypoglycemia 2
- Assess for gastrointestinal symptoms (nausea, vomiting, diarrhea) at each contact, though these should be minimal given prior GLP-1 RA exposure 1, 3
- Evaluate glycemic control with HbA1c at 12 weeks to determine if dose escalation is needed 1
Common Pitfall to Avoid
Do not start at 0.75 mg "to be safe" in a patient already on semaglutide 2 mg. The 0.75 mg starting dose is designed to minimize gastrointestinal side effects in GLP-1 RA-naive patients 1. Your patient has already demonstrated tolerance to a more potent GLP-1 RA, and starting too low risks deterioration of glycemic control during the transition period 2.
Contraindications to Verify
Confirm the patient does not have personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), as dulaglutide is absolutely contraindicated in these conditions 1