What is the dosing of Trulicity (dulaglutide)?

From the Guidelines

Trulicity (dulaglutide) should be initiated at a dose of 0.75 mg injected subcutaneously once weekly and titrated as needed to achieve glycemic control, with no dose adjustment required for patients with chronic kidney disease (CKD) 1.

Key Considerations

• The medication comes in a pre-filled pen that should be injected into the abdomen, thigh, or upper arm.
• The injection site should be rotated with each dose to reduce the risk of lipodystrophy.
• The medication should be stored in the refrigerator but can be kept at room temperature for up to 14 days.
• Patients should administer Trulicity on the same day each week, but the day can be changed if necessary as long as the last dose was administered at least 3 days prior.

Dosing and Titration

• After at least 4 weeks on the initial dose of 0.75 mg, the dose can be increased to 1.5 mg once weekly if additional glycemic control is needed.
• For patients requiring further glycemic control, the dose may be increased to 3 mg once weekly after at least 4 weeks on the 1.5 mg dose, and then to a maximum of 4.5 mg once weekly if needed after at least 4 weeks on the 3 mg dose.

Mechanism of Action

• Trulicity works by mimicking the incretin hormone GLP-1, which stimulates insulin secretion, inhibits glucagon release, and slows gastric emptying, helping to lower blood glucose levels in people with type 2 diabetes.

Important Safety Information

• Trulicity has been shown to have a beneficial effect on major adverse cardiovascular events (MACE) and heart failure (HF) in patients with type 2 diabetes 1.
• The medication has also been shown to have a beneficial effect on renal endpoints in cardiovascular outcomes trials (CVOTs), driven by albuminuria outcomes 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

2.1 Adult Dosage The recommended starting dosage of TRULICITY is 0.75 mg injected subcutaneously once weekly. Increase the dosage to 1.5 mg once weekly for additional glycemic control. If additional glycemic control is needed, increase the dosage in 1.5 mg increments after at least 4 weeks on the current dosage. The maximum recommended dosage is 4.5 mg injected subcutaneously once weekly.

The dosing of Trulicity is as follows:

• Starting dosage: 0.75 mg injected subcutaneously once weekly
• Dosage increase: Increase to 1.5 mg once weekly for additional glycemic control, and further increase in 1.5 mg increments after at least 4 weeks on the current dosage
• Maximum recommended dosage: 4.5 mg injected subcutaneously once weekly 2

From the Research

Dosing of Trulicity

• The recommended dosage of dulaglutide (Trulicity) is 0.75 mg/0.5 mL subcutaneously once weekly, which can be increased as needed for adequate glycemic control 3.
• In a case report, a patient was on dulaglutide (Trulicity) at 0.75 mg q. weekly for about two years, and the dose was increased to 1.5 mg q. weekly two months ago 3.
• There is no direct information on the dosing of Trulicity in the other studies, as they focus on semaglutide, another glucagon-like peptide-1 receptor agonist.
• However, the studies on semaglutide provide information on the dosing of this medication, which may be relevant for comparison:
  • The initial doses of semaglutide were 3 mg orally and 0.25 mg by injection 4.
  • The maximum prescribed dose was 1 mg (injectable) in 28 (45.2%) patients and 14 mg (orally) in 2 (14.2%) patients 4.
  • In another study, the maximal dose of oral semaglutide was 14 mg 5.