Generic Name

Trulicity

Mechanism

Trulicity (dulaglutide) is a long‑acting recombinant glucagon‑like peptide‑1 (GLP‑1) analog.
• Glucose‑dependent insulin secretion: binds the GLP‑1 receptor on pancreatic β‑cells, amplifying insulin release only when glucose is elevated.
• Glucagon suppression: decreases glucagon secretion from α‑cells, reducing hepatic glucose production.
• Delayed gastric emptying and satiety signaling: lowers post‑prandial excursions and supports weight loss.
• The molecule is fused to the Fc portion of IgG4, providing a slow‑release profile for once‑weekly dosing.

Pharmacokinetics

• Absorption: Subcutaneous 0.75–1.5 mg once weekly; peak plasma ≈ 7 days.
• Distribution: ≈ 44 L volume, < 35 % protein binding.
• Metabolism: Proteolytic cleavage; no hepatic CYP involvement.
• Elimination: Renal (≈ 10 %) and fecal (≈ 80 %) routes; half‑life 5–7 days.
• Renal impairment: No dose adjustment for mild‑moderate CKD; caution if eGFR < 30 mL/min/1.73 m².

Indications

• Type 2 Diabetes Mellitus (T2DM) as add‑on to diet, exercise, or metformin, for:
• HbA1c reduction
• Weight control
• Cardiovascular risk reduction (≥ 1 % ASCVD risk)

Contraindications

• Contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or MEN 2 syndrome.
• Warnings
• Pancreatitis: monitor symptoms; discontinue if suspected.
• Hypoglycemia: risk increases with sulfonylureas or insulin.
• Thyroid C‑cell hyperplasia: risk in predisposed individuals.

Dosing

• Starter dose: 0.75 mg SC once weekly (initial week).
• Titration: Increase to 1.5 mg after 4 weeks if HbA1c > 7.5 %; higher doses (3–4.5 mg) available for stronger control.
• Injection sites: abdomen, thigh, or upper arm; rotate peripherally.
• Missed dose: Give within 5 days; if > 5 days, skip and resume next scheduled dose.

Adverse Effects

• Common
• Nausea (≈ 24 %) – dose‑dependent
• Vomiting, diarrhea, abdominal discomfort
• Injection‑site reactions (redness, induration)
• Serious
• Acute pancreatitis (rare)
• Thyroid C‑cell tumors (preclinical evidence)
• Hypoglycemia when combined with insulin or sulfonylureas
• Severe allergic reactions (anaphylaxis)

Monitoring

• HbA1c: baseline, 4, 12, and 24 weeks, then every 6–12 months.
• Weight: baseline and at 8–12 weeks.
• Renal function (Serum creatinine, eGFR): baseline, then annually in CKD.
• Pancreatitis markers: abdominal pain, serum amylase/lipase if symptomatic.
• Thyroid function tests (TFTs) in high‑risk patients.

Clinical Pearls

• Smooth GI onset: Starting at 0.75 mg mitigates nausea; most patients tolerate escalation to 1.5 mg by week 4.
• Cardiovascular advantage: The 1.5 mg dose meets FDA‑approved CV benefit; consider in patients with ASCVD or high ASCVD risk.
• Avoid overlapping GLP‑1 agents: Co‑use of multiple GLP‑1 agonists increases adverse events without added benefit.
• Switching strategy: When transitioning from other GLP‑1s, wait ~3 days to avoid overlapping peaks.
• Storage: Refrigerate 2–8 °C; do not freeze. Use vials within 12 weeks after first use.
• Cost‑sharing tips: Verify eligibility for manufacturer coupons or patient assistance programs; insurance often covers once‑weekly administration, enhancing adherence.

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• *This pharmacology drug card is tailored for medical students and healthcare professionals seeking a succinct, evidence‑based reference on Trulicity.*