What is the recommended Trulicity (dulaglutide) dosing regimen for weight loss in a patient with no known contraindications?

Trulicity (Dulaglutide) Dosing for Weight Loss

Trulicity (dulaglutide) is NOT FDA-approved for weight loss and should not be used for this indication. 1, 2, 3

FDA-Approved Indications for Dulaglutide

Dulaglutide is approved exclusively as an adjunct to diet and exercise for the treatment of adults with type 2 diabetes mellitus, not for obesity management. 2, 3 The medication is administered as a once-weekly subcutaneous injection at doses of 0.75 mg or 1.5 mg. 4, 2, 5

Why Dulaglutide Is Not Appropriate for Weight Loss

If your goal is weight loss without diabetes, you need a different medication. The FDA has approved specific GLP-1 receptor agonists for obesity management, but dulaglutide is not among them. 1

FDA-Approved GLP-1 Receptor Agonists for Weight Loss

For patients seeking weight loss (BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities), the appropriate options are:

• Semaglutide 2.4 mg weekly (Wegovy): Achieves 14.9% total body weight loss at 68 weeks, with 64.9% of patients achieving ≥10% weight loss 1
• Liraglutide 3.0 mg daily (Saxenda): Achieves mean weight loss of 5.24-6.1% 1
• Tirzepatide (Zepbound): Achieves superior weight loss of 20.9% at 72 weeks with the 15 mg dose 1, 6

Clinical Context: Dulaglutide's Role in Diabetes Management

While dulaglutide does produce modest weight reduction as a secondary benefit in patients with type 2 diabetes (particularly at the 1.5 mg dose), this effect is substantially less than medications specifically approved for obesity management. 2, 3

Dulaglutide Dosing for Type 2 Diabetes

• Starting dose: 0.75 mg subcutaneously once weekly 4, 2
• Maintenance dose: Can be increased to 1.5 mg once weekly for additional glycemic control 4, 2
• Administration: Same day each week, any time of day, with or without meals 2, 3

The 1.5 mg dose provides greater HbA1c reduction and more consistent bodyweight reductions compared to the 0.75 mg dose, but weight loss remains a secondary benefit, not the primary therapeutic goal. 2

Safety Considerations

Dulaglutide carries the same class-wide safety concerns as other GLP-1 receptor agonists:

• Gastrointestinal effects: Nausea, vomiting, and diarrhea are the most common adverse events 2, 3
• Pancreatitis risk: Rare but serious, with documented cases of dulaglutide-induced acute pancreatitis 4
• Contraindications: Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 1

Recommendation Algorithm

For weight loss in non-diabetic patients:

1. First-line: Tirzepatide 15 mg weekly (greatest weight loss: 20.9%) 1, 6
2. Second-line: Semaglutide 2.4 mg weekly (proven cardiovascular benefit if established CVD present) 1
3. Third-line: Liraglutide 3.0 mg daily (if weekly injections not tolerated) 1

For type 2 diabetes with obesity:

1. First-line: Tirzepatide (superior glycemic control AND weight loss) 1
2. Second-line: Semaglutide 2.4 mg weekly (if established cardiovascular disease) 1
3. Dulaglutide may be considered if the above options are unavailable or not tolerated, but recognize it provides inferior weight loss outcomes 2, 3

Common Pitfall to Avoid

Do not prescribe dulaglutide off-label for weight loss. 1 While some clinicians may use it off-label, this practice lacks FDA approval, provides suboptimal weight loss compared to approved alternatives, and may create insurance authorization challenges. 1 Patients deserve access to the most effective evidence-based treatments, which for obesity management means semaglutide 2.4 mg or tirzepatide, not dulaglutide. 1, 6