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Trulicity: 7 things you should know

Trulicity: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Jul 28, 2020.

1. How it works
  • Trulicity is a brand (trade) name for dulaglutide.
  • Dulaglutide mimics the actions of GLP-1, a naturally occurring hormone that helps to regulate blood glucose levels. By binding to and activating the GLP-1 receptor, it stimulates insulin secretion and lowers glucagon secretion when blood glucose levels are high. It also causes a slowing down in how fast the stomach empties.
  • Trulicity belongs to the class of medicines called GLP-1 receptor agonists.
2. Upsides
  • Trulicity may be used in the treatment of type 2 diabetes alongside diet modification and increased exercise.
  • Trulicity may also be given to reduce the risk of future cardiovascular events, such as a heart attack or stroke, in people with type 2 diabetes who also have heart disease.
  • Trulicity is effective at reducing blood glucose levels and it also reduces body weight.
  • Trulicity is given once a week, preferably on the same day each week (for example, every Monday). The day of weekly administration can be changed if necessary as long as the last dose was administered three or more days before.
  • There are two different strengths of Trulicity: 0.75mg and 1.5mg.
  • The dosage of Trulicity does not need to be adjusted in people with kidney disease. There is limited information about using Trulicity in people with liver disease; use with caution.
3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Common side effects of Trulicity include hypoglycemia (low blood sugar levels) when used with other insulin-lowering medications, nausea, vomiting, diarrhea, abdominal pain, decreased appetite, dyspepsia, and fatigue.
  • Trulicity needs to be given by injection under the skin (subcutaneous). However, self-administration is easy to learn for most people.
  • Trulicity does not take the place of insulin and is not effective in people with type 1 diabetes or for the treatment of diabetic ketoacidosis.
  • Animal studies have reported thyroid C-cell tumors in rats given dulaglutide (the active ingredient of Trulicity). Once case of thyroid tumors was reported in a phase 3 clinical trial using Trulicity. It is not known how much dulaglutide increases the risk in humans of these tumors, but the use of Trulicity is contraindicated in people with a family history of thyroid cancer or those with Multiple Endocrine Neoplasia syndrome type 2.
  • Trulicity may increase the risk of pancreatitis. If this occurs, Trulicity should be discontinued and not restarted. There have also been reports of kidney damage, which may require hemodialysis, in people treated with GLP-1 receptor agonists (RA), such as Trulicity. Anaphylaxis and angioedema have also been reported with GLP-1 RAs and the initial administration of Trulicity should preferably be done in a medical facility.
  • Trulicity has not been adequately studied in pregnant women and should not be used unless the perceived benefits outweigh the risks of uncontrolled diabetes, which include preeclampsia, spontaneous abortions, and preterm delivery. Animal studies indicate there may be a risk to the fetus from exposure to Trulicity.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here. 4. Bottom Line

  • Trulicity mimics the effects of GLP-1, a naturally occurring hormone that stimulates insulin secretion and lowers glucagon secretion from the liver. It lowers blood glucose levels in people with type 2 diabetes and may reduce body weight; however, it does not appear to be as effective as Ozempic. It is given by subcutaneous injection under the skin once weekly.
5. Tips
  • Ask your doctor or nurse to show you how to self-administer Trulicity before you first do it yourself. Trulicity should be injected just under the skin into the abdomen, thigh, or upper arm. Change injection sites each week so that you are not injecting into the same bit of skin every week. Always inspect the injection and do not use Trulicity if it contains particles or discoloration is seen.
  • If you also need to self-administer insulin, administer the insulin at a different site to the Trulicity, at least 15cm apart. Never mix insulin with Trulicity and never share your injection with another person. Taking Trulicity with insulin (as well as other medications such as sulfonylureas that also lower blood sugar levels) increases your risk of hypoglycemia (low blood sugar levels) so monitor yourself for symptoms of low blood sugar which include sweating, shaking, dizziness, a fast heartbeat, and mood changes.
  • If you need to change the day you administer Trulicity, you can, as long as you allow at least 72 hours between two doses (for example, you can change from a Monday morning administration to a Thursday morning administration).
  • If you miss a dose of Trulicity, administer it as soon as possible, but within 4 days of the missed dose. If there are less than 3 days (72 hours) until the next scheduled dose, skip the missed dose and just administer the next dose on the regularly scheduled day.
  • Report any symptoms of a possible thyroid tumor (such as a lump in the neck, shortness of breath, difficulty swallowing, or persistent hoarseness) to your doctor immediately.
  • If you develop persistent, severe, abdominal pain, which may radiate to the back or be accompanied by vomiting, ring your doctor immediately as Trulicity can increase your risk of developing pancreatitis.
  • Trulicity may temporarily worsen diabetic retinopathy, an eye condition. Tell your doctor if you notice any change in your vision.
  • If you are a woman, use adequate contraception to ensure you do not become pregnant while taking Trulicity. For a planned pregnancy, it is recommended Trulicity is discontinued at least two months before conception. Tell your doctor if you inadvertently become pregnant while taking Trulicity.
6. Response and Effectiveness
  • Treatment with Trulicity 0.75mg subcutaneously reduced HbA1c levels by 9% and blood glucose levels by 16.1% when fasting. Bodyweight was reduced by 1.5%.
  • Treatment with Trulicity 1.5mg subcutaneously reduced HbA1c levels by 10.5% and blood glucose levels by 17.7% when fasting. Bodyweight was reduced by 2.3%.
  • In comparison trials, Trulicity appears more effective than sitagliptin (Januvia), but not as effective as Ozempic at improving blood glucose control and reducing bodyweight.
7. Interactions

Medicines that interact with Trulicity may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Trulicity. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Trulicity include:

  • acetazolamide
  • anticonvulsants such as phenytoin
  • antidepressants such as tricyclic antidepressants (such as amitriptyline, nortriptyline) or monoamine oxidase inhibitors (MAOI) (eg, selegiline, isocarboxazid, and phenelzine)
  • antipsychotics, such as aripiprazole
  • beta-blockers, such as atenolol, labetalol, and metoprolol, may enhance the hypoglycemic effects
  • bexarotene
  • ciprofloxacin
  • corticosteroids, such as prednisone or cortisone
  • diuretics, such as bumetanide, HCTZ, and bendroflumethiazide
  • HIV medications, such as amprenavir, atazanavir, and fosamprenavir
  • hormones, such as ethinylestradiol and hydroxyprogesterone
  • insulin (may increase risk of hypoglycemia)
  • isoniazid
  • other medications that affect blood sugar levels or are used for diabetes, such as glimepiride, or metformin.

Trulicity may also enhance the toxic effects of alcohol, causing flushing.

Because Trulicity causes a delay in gastric emptying, it may impact the absorption of any medication taken orally. However, in clinical trials, this did not appear to change the effects of other medications.

Note that this list is not all-inclusive and includes only common medications that may interact with Trulicity. You should refer to the prescribing information for Trulicity for a complete list of interactions.

References
  • Trulicity (dulaglutide) [Package Insert] Eli Lilly and Company https:// /pro/trulicity.html
  • Pratley RE, Aroda VR, Lingvay I, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018;6(4):275-286. doi:10.1016/S2213-8587(18)30024-X
Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Trulicity only for the indication prescribed.

Copyright 1996-2020 . Revision date: July 28, 2020.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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