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Trulicity
dulaglutide
Black Box Warnings .
Thyroid C-cell Tumor Risk
contraindicated in pts w/ medullary thyroid carcinoma (MTC) hx or family hx, or in pts w/ multiple endocrine neoplasia syndrome type 2 (MEN 2); dose-related and duration-dependent incr. in thyroid C-cell tumor incidence observed in rodents, but human relevance unknown; uncertain value of routine serum calcitonin or thyroid ultrasound monitoring; advise pts of potential MTC risk and thyroid tumor sx (e.g., neck mass, dysphagia, dyspnea, persistent hoarseness)
Adult Dosing .
Dosage forms: INJ (pen): 0.75 mg per injection, 1.5 mg per injection, 3 mg per injection, 4.5 mg per injection
diabetes mellitus, type 2
- [0.75-4.5 mg SC qwk]
- Start: 0.75 mg SC qwk x4wk, then may incr. to 1.5 mg SC qwk x4wk, then may incr. by 1.5 mg/wk no more frequently than q4wk; Max: 4.5 mg/wk; Info: give doses >72h apart
cardiovascular event risk reduction (DM type 2 pts w/ estab. cardiovascular dz or multiple cardiovascular risk factors)
- [0.75-4.5 mg SC qwk]
- Start: 0.75 mg SC qwk x4wk, then may incr. to 1.5 mg SC qwk x4wk, then may incr. by 1.5 mg/wk no more frequently than q4wk if additional glycemic control needed; Max: 4.5 mg/wk; Info: give doses >72h apart
renal dosing
- [see below]
- renal impairment: no adjustment; Info: caution advised if ESRD
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ (pen): 0.75 mg per injection, 1.5 mg per injection, 3 mg per injection, 4.5 mg per injection
diabetes mellitus, type 2
- [10 yo and older]
- Dose: 0.75-1.5 mg SC qwk; Start: 0.75 mg SC qwk x4wk, then may incr. to 1.5 mg SC qwk; Max: 1.5 mg/wk; Info: give doses >72h apart
renal dosing
- [see below]
- renal impairment: no adjustment; Info: caution advised if ESRD
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- medullary thyroid CA hx
- medullary thyroid CA family hx
- multiple endocrine neoplasia syndrome type 2
- diabetes mellitus, type 1
- caution: hypersensitivity to GLP-1 agonists
- caution: hepatic impairment
- caution: renal impairment
- caution: volume depletion
- caution: pancreatitis risk
- caution: pancreatitis hx
- caution: GI dz, severe
- caution: gastroparesis, severe
- caution: diabetic retinopathy
- caution: surgery
Drug Interactions .
Overview
dulaglutide
GLP-1 agonist
- antidiabetic agent
- decreases gastrointestinal motility
- delays atrioventricular conduction
- caution advised w/ oral narrow therapeutic index drugs; dulaglutide delays gastric emptying, may reduce rate and extent of oral drug absorption
Contraindicated
- potassium chloride
- potassium citrate
Avoid/Use Alternative
- brigatinib
- clonidine
- crizotinib
- desogestrel (contraceptive)
- dienogest (contraceptive)
- drospirenone (contraceptive)
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethinyl estradiol (contraceptive)
- ethynodiol (contraceptive)
- etrasimod
- exenatide
- fingolimod
- landiolol
- levonorgestrel (contraceptive)
- levonorgestrel (post-coital contraceptive)
- liraglutide
- lixisenatide
- lofexidine
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- ozanimod
- ponesimod
- semaglutide
- siponimod
- ulipristal (post-coital contraceptive)
Monitor/Modify Tx
- acebutolol
- adenosine
- alclometasone topical
- alectinib
- alfentanil
- alpelisib
- amcinonide topical
- amiodarone
- apraclonidine ophthalmic
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- articaine
- asenapine
- asparaginase
- atazanavir
- atenolol
- betamethasone
- betamethasone topical
- betaxolol
- betaxolol ophthalmic
- bisoprolol
- bortezomib
- brentuximab vedotin
- brexpiprazole
- budesonide
- bumetanide
- bupivacaine
- bupivacaine liposomal
- calaspargase
- capivasertib
- carbamazepine
- cariprazine
- carteolol ophthalmic
- carvedilol
- ceritinib
- chloroprocaine
- chlorothiazide
- chlorthalidone
- ciprofloxacin
- clobetasol topical
- clocortolone topical
- clozapine
- copanlisib
- corticotropin
- cortisone
- dabrafenib
- danazol
- darunavir
- decitabine
- deflazacort
- delafloxacin
- desonide topical
- desoximetasone topical
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- diazoxide
- diflorasone topical
- digoxin
- diltiazem
- disopyramide
- donepezil
- dronedarone
- eliglustat
- enfortumab vedotin
- ensartinib
- ephedra
- epinephrine
- esmolol
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethacrynic acid
- ethinyl estradiol (hormone replacement)
- etonogestrel (contraceptive)
- everolimus
- fentanyl
- flecainide
- fludrocortisone
- fluocinolone otic
- fluocinolone topical
- fluocinonide topical
- flurandrenolide topical
- fluticasone propionate topical
- fosamprenavir
- fosphenytoin
- furosemide
- galantamine
- ginkgo
- glimepiride
- glipizide
- glyburide
- goserelin
- guanfacine
- halcinonide topical
- halobetasol topical
- histrelin
- hydrochlorothiazide
- hydrocortisone
- hydrocortisone topical
- iloperidone
- inavolisib
- indapamide
- insulin
- isoniazid
- ivabradine
- labetalol
- lacosamide
- lamotrigine
- lanreotide
- lasmiditan
- leuprolide
- levobunolol ophthalmic
- levofloxacin
- levothyroxine
- lidocaine
- liothyronine
- lopinavir/ritonavir
- lorlatinib
- lumateperone
- lurasidone
- lurbinectedin
- lutetium Lu 177 dotatate
- medroxyprogesterone (contraceptive)
- mefloquine
- megestrol
- mepivacaine
- methylprednisolone
- metolazone
- metoprolol
- midodrine
- mometasone topical
- moxifloxacin
- nadolol
- nateglinide
- nebivolol
- nelfinavir
- neostigmine
- niacin (vitamin B3)
- norelgestromin (contraceptive)
- norepinephrine
- octreotide
- ofloxacin
- olanzapine
- paliperidone
- pasireotide
- pegaspargase
- peginterferon alfa 2a
- pentamidine
- phenylephrine
- phenytoin
- pindolol
- praziquantel
- prednicarbate topical
- prednisolone
- prednisone
- procainamide
- propafenone
- propranolol
- pseudoephedrine
- pyridostigmine
- quetiapine
- quinidine (antiarrhythmic)
- quinine
- regadenoson
- remifentanil
- remimazolam
- repaglinide
- risperidone
- ritonavir
- rivastigmine
- ropivacaine
- sacrosidase
- segesterone (contraceptive)
- sirolimus albumin-bound
- somapacitan
- somatrogon
- somatropin
- sotalol
- spironolactone
- succinylcholine
- sucralfate
- sufentanil
- sugammadex
- temsirolimus
- teprotumumab
- tesamorelin
- thalidomide
- thyroid
- ticagrelor
- timolol
- timolol ophthalmic
- tipranavir
- torsemide
- triamcinolone
- triamcinolone topical
- triamterene
- triptorelin
- vamorolone
- verapamil
- vorinostat
- warfarin
- ziprasidone
Caution Advised
- acetaminophen
- amoxicillin
- ampicillin
- azithromycin
- barium
- bedaquiline
- cefaclor
- cefadroxil
- cefdinir
- cefixime
- cefpodoxime
- cefprozil
- cefuroxime axetil
- cephalexin
- clarithromycin
- clindamycin
- cycloserine
- dapsone
- demeclocycline
- dicloxacillin
- doxazosin
- doxycycline
- erythromycin
- ethionamide
- fosfomycin
- gepotidacin
- lefamulin
- linezolid
- metoclopramide
- metronidazole
- mexiletine
- minocycline
- omadacycline
- penicillin V
- pivmecillinam
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- rifabutin
- rifampin
- rifapentine
- sarecycline
- secnidazole
- sulfadiazine
- sulfamethoxazole
- sulfasalazine
- sulopenem
- tedizolid phosphate
- tetracycline
- tinidazole
- trimethoprim
Adverse Reactions .
Serious Reactions
- thyroid C-cell tumor (animal studies)
- medullary thyroid CA
- hypersensitivity rxn
- anaphylaxis
- angioedema
- acute kidney injury
- GI rxn, severe
- pancreatitis
- cholelithiasis
- cholecystitis
- ileus
- perioperative aspiration
Common Reactions
- nausea
- diarrhea
- vomiting
- abdominal pain
- appetite decr.
- dyspepsia
- fatigue
- tachycardia
- injection site rxn
- amylase incr.
- lipase incr.
- PR prolongation
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; risk of teratogenicity and embyrotoxicity based on animal data at 13x and 14x MRHD and drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: proteolytic degradation; CYP450: unknown
Excretion: unknown; Half-life: 5 days
Subclass: Diabetes: GLP-1 Agonists ; GLP-1 Agonists, Cardiovascular
Mechanism of Action
activates glucagon-like-peptide-1 (GLP-1) receptor, increasing insulin secretion, decreasing glucagon secretion, and delaying gastric emptying (incretin mimetic)
Formulary .
No Formulary Selected
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