Dulaglutide

Indications and mechanism of action1,2

Dulaglutide is a long-acting glucagon-like peptide 1 (GLP-1) receptor agonist. It is indicated for improvement of glycaemic control and reduction in the risk of cardiovascular events in adults with type 2 diabetes.

GLP-1 receptor agonists improve glycaemic control through:

increasing the amount of insulin released by the pancreas – this helps the body to use and store glucose

reducing the amount of glucagon released by the pancreas – this reduces the amount of glucose produced by the liver

slowing gastric emptying – food is absorbed from the stomach more slowly, reducing appetite and lowering blood glucose after a meal.

Trulicity can be used as a monotherapy or in combination with other glucose-lowering medicines, such as metformin, insulin and sulfonylureas.1

Other considerations for use

Dipeptidyl peptidase 4 (DPP-4) inhibitors (eg, vildagliptin) are another class of medicines used to treat type 2 diabetes. DPP-4 inhibitors have a similar mechanism of action to dulaglutide. Clinical guidelines state that dulaglutide and DPP-4 inhibitors should not be given together due to the potential for adverse effects without any additional benefit for diabetes control.3,4

Adverse drug reactions1

The most frequently reported adverse reactions with dulaglutide are gastrointestinal events (nausea, vomiting, diarrhoea, stomach pain, decreased appetite and dyspepsia).

Some of the more serious adverse effects described in the dulaglutide data sheet are discussed below. Remind patients to seek medical attention if they experience any symptoms of concern.

Gastrointestinal adverse reactions

Gastrointestinal adverse reactions are common in people taking dulaglutide and peak in the first few weeks of treatment. While these reactions are typically mild to moderate in severity, there have been reports of these reactions leading to dehydration and acute kidney injury.

Dulaglutide is not recommended in patients with severe pre-existing gastrointestinal disease, including severe gastroparesis.

Elevated pancreatic enzymes and pancreatitis

Elevated pancreatic enzymes can occur in people taking dulaglutide. While this alone does not always indicate pancreatitis, cases of acute pancreatitis have been reported. If pancreatitis is confirmed, dulaglutide should be permanently stopped.

Cholecystitis

Cholecystitis (inflammation of the gallbladder) has been reported to occur uncommonly in people taking dulaglutide.

Hypoglycaemia

Hypoglycaemia occurs more commonly when dulaglutide is used with insulin or sulfonylureas. Consider lowering the dose of insulin or sulfonylurea to reduce the risk of hypoglycaemia.