From the Guidelines
Trulicity (dulaglutide) should be initiated at a dose of 0.75 mg injected subcutaneously once weekly and titrated as tolerated to 1.5 mg or maximally tolerated dose based on prescribing information. The dosing of Trulicity is based on the most recent evidence from the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1. The recommended doses for cardiovascular benefit are as follows:
- Initiate 0.75 mg SC per week
- Titrate as tolerated to 1.5 mg or maximally tolerated dose based on prescribing information. Some key points to consider when prescribing Trulicity include:
- Indications: improve glycemic control in adults with T2D, reduce MACE for people with T2D with and without established CV disease
- Dose modifications: up-titrate slowly to reduce nausea and discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed
- Contraindications: history of serious hypersensitivity reaction to drug, pregnancy or breast feeding, severe renal impairment or end-stage renal failure
- Cautions: hypoglycemia risk increased with insulin, sulfonylureas, or glinides, may delay gastric emptying, not recommended in patients with clinically meaningful gastroparesis
- Adverse effects to monitor: nausea, vomiting, diarrhea, headache, weakness, or dizziness, hypoglycemia when given with insulin, sulfonylureas, or glinides, weight loss, injection site reactions. It's also worth noting that the 2022 management field guide for health care professionals in the 21st century provides additional information on the approved indications and recommended kidney dose adjustments for GLP-1 RAs and SGLT2 inhibitors in the United States 1. However, the most recent and highest quality study on Trulicity dosing is the 2020 expert consensus decision pathway 1. The 2018 management of hyperglycemia in type 2 diabetes report also provides information on GLP-1 receptor agonists, but it is not as recent or specific to Trulicity dosing as the 2020 expert consensus decision pathway 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 recommended starting dosage of Trulicity is 0.75 mg injected subcutaneously once weekly.
- The maximum recommended dosage is 4.5 mg injected subcutaneously once weekly.
- Dosage can be increased in 1.5 mg increments after at least 4 weeks on the current dosage for additional glycemic control 2.
From the Research
Trulicity Dosing
- Trulicity, also known as dulaglutide, is a once-weekly glucagon-like peptide-1 receptor agonist used to treat type 2 diabetes 3.
- The dosing of Trulicity is typically 1.5 mg once weekly, administered via subcutaneous injection 3, 4.
- Trulicity has been shown to be effective in reducing HbA1c levels, with a significant reduction in major adverse cardiac events (MACE) and hospitalization for heart failure (HHF) 3, 5.
- The medication has also been found to have a beneficial effect on body weight and renal outcomes, with improvements in renal resistive index (RRI) and a reduction in the risk of kidney failure 6, 5.
Administration and Efficacy
- Trulicity is administered via a single-dose pen or a prefilled syringe, and can be injected at any time of day, with or without food 4.
- The medication has been shown to have an early onset of glycemic control, lasting up to 104 weeks, and has been found to be superior to placebo, metformin, sitagliptin, exenatide BID, and insulin glargine in reducing HbA1c levels 4.
- Trulicity has also been found to have a favorable safety profile, with a low risk of hypoglycemia and no increased risk of severe hypoglycemia, retinopathy, or pancreatic events 3, 5.