Trulicity
Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) agonist that helps control blood sugar in people 10 years and older with Type 2 diabetes. It's also approved to lower the risk of heart problems like heart attacks, strokes, and heart-related death in certain adults with Type 2 diabetes. The medication is injected under the skin once a week. Common side effects include nausea, vomiting, diarrhea, and stomach pain. When taken with certain diabetes medications like insulin, there's a higher risk of low blood sugar (hypoglycemia).
What is Trulicity (dulaglutide)?
What is Trulicity (dulaglutide) used for?
Manage Type 2 diabetes in people 10 years and older, along with diet and exercise
Lower the risk of heart problems like heart attack, stroke, or death in adults with Type 2 diabetes who have heart disease or heart-related risk factors
How Trulicity (dulaglutide) works
Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist. It acts like the natural GLP-1 hormone in the body. This hormone lowers blood sugar by helping your pancreas release more insulin, stopping your liver from releasing more sugar, and slowing digestion.
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What are the side effects of Trulicity (dulaglutide)?
Common Side Effects
- Nausea (12-21%)
- Diarrhea (7-13%)
- Vomiting (6-13%)
- Stomach pain (7-9%)
- Low appetite (5-9%)
- Fatigue (4-6%)
- Indigestion (3-6%)
Other Side Effects
- Constipation
- Passing gas
- Stomach bloating
- Heartburn
- Fast heart rate
- Injection site reactions (rash, redness)
Serious Side Effects
- Thyroid cancer: lump in the neck, trouble breathing or swallowing, hoarseness
- Inflammation of the pancreas (pancreatitis): severe stomach pain that spreads to your back, nausea, vomiting
- Kidney problems: tiredness, dry and itchy skin, urinating more often, bloody or foamy urine, swelling in your feet or ankles, muscle cramping
- Gallbladder problems: severe upper stomach and back pain, yellowing of the skin or eyes, fever, nausea, vomiting
- Serious allergic reaction: rash; hives; swelling of face, tongue, and throat; trouble breathing
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Thyroid cancer—new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Diarrhea
- Loss of appetite
- Nausea
- Upset stomach
Pros and cons of Trulicity (dulaglutide)
Pros
Works well at lowering A1C
Comes as a ready-to-use injectable pen
Only used once a week
Helps with weight loss
Cons
Commonly causes nausea, vomiting, diarrhea, and stomach pain
Potential risk for thyroid tumors
Can cause problems in the pancreas, kidney, and gallbladder
Not recommended for people with stomach problems
Pharmacist tips for Trulicity (dulaglutide)
Ask your prescriber how often you should check your blood sugar while using Trulicity (dulaglutide). Keep track of your readings and share them with your care team so they can adjust your dose if needed.
Using Trulicity (dulaglutide) with certain diabetes medications, like insulin, can raise your risk of low blood sugar (hypoglycemia). Learn to recognize symptoms like sweating, shakiness, anxiety, and hunger, and know how to treat it.
Trulicity (dulaglutide) can cause stomach-related side effects like nausea, vomiting, and diarrhea. If these symptoms become severe or don’t go away, contact your prescriber.
Drink plenty of fluids while using Trulicity (dulaglutide) to help prevent dehydration, especially if you experience stomach-related side effects. Serious cases of dehydration can also lead to kidney problems.
Tell your prescriber right away if you have severe stomach pain that doesn’t go away, especially if it spreads to your back. This could be a sign of pancreatitis, a serious condition that causes inflammation of the pancreas.
Store unopened Trulicity (dulaglutide) pens in the refrigerator. You can also keep them out at room temperature (below 86°F) for up to 14 days. Don't freeze your pens because this might damage the medication. If a pen is frozen, throw it away and use a new one.
The Instructions for Use that come with your medication provide detailed steps on how to use your Trulicity (dulaglutide) pen. You can also watch an instructional video. If you have questions, contact a member of your healthcare team
Each Trulicity (dulaglutide) pen is single-use and provides one dose. You can inject it at any time of day, with or without food.
Inject Trulicity (dulaglutide) under the skin of your stomach or thigh. If someone else is giving the injection, they can also use the back of your upper arm. Rotate injection sites each week to avoid skin irritation or damage.
If you miss a dose of Trulicity (dulaglutide) and your next dose is at least 3 days away, inject the missed dose as soon as you remember, then continue your usual weekly schedule. If your next dose is less than 3 days away, skip the missed dose and inject your next dose on schedule. Don't take two doses within 3 days since this can lead to side effects.
If you drop your Trulicity (dulaglutide) pen, don't use it. Some parts of the pen contain glass, which can break. Use a new pen instead.
After you inject your dose, throw away the Trulicity (dulaglutide) pen and needle in a sharps container or a sturdy plastic container, such as an empty milk carton or laundry detergent bottle. Don't throw them in the trash.
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Frequently asked questions about Trulicity (dulaglutide)
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What are the risks and warnings for Trulicity (dulaglutide)?
Trulicity (dulaglutide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Thyroid cancer
Risk factors: Personal or family history of medullary thyroid carcinoma (MTC) | Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
Animal studies show that Trulicity (dulaglutide) causes thyroid tumors in rats and mice, but it's unclear if it has the same effect in humans. To be safe, don't use Trulicity (dulaglutide) if you or a family member has had medullary thyroid cancer (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Let your prescriber know if you notice a lump on your neck, trouble breathing or swallowing, or hoarseness that won't go away, as these might be signs of thyroid cancer. If you’re worried about this risk, talk to your prescriber.
Inflammation of the pancreas (pancreatitis)
Risk factors: Higher doses of Trulicity (dulaglutide)
In some rare cases, people taking Trulicity (dulaglutide) have had pancreatitis, a serious condition that causes inflammation of the pancreas. Watch for signs of pancreatitis, including severe stomach pain that can spread to your back, with or without vomiting. If you have these symptoms, stop using Trulicity (dulaglutide) right away and contact your prescriber.
Low blood sugar when used with certain diabetes medications
Risk factors: Also using insulin, sulfonylureas, or glinides
If you take Trulicity (dulaglutide) with insulin, a sulfonylurea (e.g. glipizide), or a glinides (e,g., repaglinide), you have a higher risk of low blood sugar (hypoglycemia), including severe cases.
Your prescriber might need to lower the dose of insulin, the sulfonylurea, or the repaglinide to help reduce this risk. Learn to recognize the signs of low blood sugar, such as shakiness, sweating, dizziness, confusion, hunger, or weakness. If you're concerned about your blood sugar levels or need help monitoring them, talk to your prescriber.
Severe allergic reactions
Some people taking Trulicity (dulaglutide) have had severe allergic reactions, including anaphylaxis and angioedema (swelling under the skin). If you develop swelling of the face, lips, throat, or trouble breathing, stop using Trulicity (dulaglutide) immediately and get emergency medical help.
Kidney damage
Risk factors: History of kidney problems | Dehydration
Some people taking Trulicity (dulaglutide) developed new or worsening kidney problems, known as acute kidney injury. In some cases, treatment required dialysis, even in people who had no previous kidney problems. Most of the time, this happened in people who had nausea, vomiting, diarrhea, or dehydration after taking the medication.
If you have kidney problems or develop severe stomach-related side effects while using Trulicity (dulaglutide), your prescriber might check your kidney labs. To prevent kidney damage, drink plenty of fluids during treatment to stay hydrated. Tell your prescriber if you have trouble urinating or if you're not urinating as much as usual while taking this medication.
Severe stomach-related side effects
Using Trulicity (dulaglutide) can cause stomach-related side effects like nausea, vomiting, and diarrhea, and in some cases, they can be severe. Because Trulicity (dulaglutide) hasn't been studied in people with severe stomach conditions, it's not recommended if you have gastroparesis (slow stomach emptying). If you have a history of stomach problems, talk to your prescriber before using this medication.
Worsening eye problems in people with diabetic retinopathy
Risk factors: History of diabetic retinopathy | Rapid improvement in managing blood sugar levels
Some people using Trulicity (dulaglutide) have reported diabetic retinopathy complications during treatment. If you already have diabetic retinopathy, your prescriber will check your eyes to make sure it doesn't get worse. Get medical attention if you notice changes in your vision or eye pain.
Gallbladder problems
Some people using Trulicity (dulaglutide) have developed gallbladder problems like gallstones. Contact your prescriber right away if you have severe stomach pain, nausea, vomiting, or yellowing of the skin or eyes. They might need to run blood tests to check your gallbladder.
Breathing fluid into your lungs during anesthesia or deep sedation
Trulicity (dulaglutide) slows down digestion, which can make food stay in your stomach longer. Rare cases have been reported where people taking GLP-1 medications like Trulicity (dulaglutide) breathed fluid into the lungs during general anesthesia or deep sedation. Tell your prescriber before any surgery or procedure if you're taking this medication.
Trulicity (dulaglutide) dosage forms
Typical dosing for Trulicity (dulaglutide)
Trulicity (dulaglutide) is injected under the skin in the stomach or thigh. If someone else is giving you the injection, they can also use the back of your upper arm.
You start with a low dose, and after at least 4 weeks, your prescriber might raise it if you need better blood sugar control. If you have stomach-related side effects, your prescriber might lower your dose.
Adults: The typical starting dose is 0.75 mg once a week. The maximum dose is 4.5 mg once a week.
Children: The typical starting dose is 0.75 mg once a week. The maximum dose is 1.5 mg once a week.
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How much does Trulicity (dulaglutide) cost?
Trulicity (dulaglutide) contraindications
Personal or family history of medullary thyroid cancer (MTC)
What are alternatives to Trulicity (dulaglutide)?
Manage Type 2 diabetes in people 10 years and older, along with diet and exercise
Lower the risk of heart problems like heart attack, stroke, or death in adults with Type 2 diabetes who have heart disease or heart-related risk factors
Type 2 diabetes in people age 10 and older, together with a balanced diet and exercise
Lowering the risk of serious heart-related problems in adults with Type 2 diabetes and heart disease
Lower the risk of heart attack, stroke, and death due to heart problems in adults with Type 2 diabetes and heart disease
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References
Best studies we foundEli Lilly and Company. (2024). TRULICITY- dulaglutide injection, solution [package insert]. DailyMed.
Memon, R. J., et al. (2023). Angioedema. StatPearls.
National Cancer Institute. (2019). Medullary thyroid cancer (MTC).
National Kidney Foundation (2024). Acute Kidney Injury (AKI).
National Organization for Rare Disorders. (2023). Multiple endocrine neoplasia type 2.
Trulicity. (n.d.). Using your Trulicity pen.
You and Your Hormones. (2021). Insulin.
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