Published: 7 December 2023
Publications
Spotlight on dulaglutide
Published: 7 December 2023
Prescriber Update 44(4): 70–72
December 2023
This article gives an overview of dulaglutide – how it works, how it
is used and its adverse reactions.
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.
Products in New Zealand
One dulaglutide product (Trulicity) is currently approved and available in New Zealand. It is given once a week as a subcutaneous injection.1
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.
New Zealand case reports
Up to 27 October 2023, the Centre for Adverse Reactions Monitoring (CARM) had received 54 adverse reaction reports where dulaglutide was the suspect medicine, including 36 serious reports. Most of the reports relate to the gastrointestinal system. Table 1 shows the top five most frequently reported adverse reactions.
CARM has received two reports with co-administration of dulaglutide and a DPP-4 inhibitor. The reported reactions were:
- CARM ID 142859: dyspepsia and headache
- CARM ID 145391: dizziness and sinus tachycardia.
Table 1: Top five most frequently reported adverse reactions for dulaglutide received by the Centre for Adverse Reactions Monitoring, up to 27 October 2023
| Adverse reaction | Number of reportsa |
|---|---|
| Nausea | 18 |
| Vomiting | 14 |
| Diarrhoea | 14 |
| Abdominal painb | 13 |
| Pancreatitisc | 8 |
- The number of reports for each reaction adds to more than the total number of reports for dulaglutide as some people reported more than one adverse reaction
- Includes abdominal pain, abdominal discomfort, abdominal colic and abdominal cramp
- Includes pancreatitis and necrotising pancreatitis
Source: Centre for Adverse Reactions Monitoring, data extracted 27 October 2023
More information
- For more information about dulaglutide, see the data sheet and consumer medicines information (CMI): Search for a data sheet or CMI.
- Healthify has specific information for consumers about dulaglutide, plus more general information about type 2 diabetes and medicines to treat it.
References
- Eli Lilly and Company (NZ) Limited. 2023. Trulicity New Zealand Data sheet 9 June 2023. URL: medsafe.govt.nz/profs/Datasheet/t/trulicityinj.pdf (accessed 13 October 2023).
- Dungan K and DeSantis A. 2023. Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. In: UpToDate 8 September 2023. URL: uptodate.com/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus (accessed 13 October 2023).
- bpacNZ. 2022. Do not prescribe vildagliptin and dulaglutide concurrently. Best Practice Bulletin: Issue 61. URL: bpac.org.nz/bulletin/bestpractice/sixty-one.aspx#3 (accessed 13 October 2023).
- New Zealand Formulary (NZF). 2023. NZF v136:Dulaglutide 1 October 2023. URL: nzf.org.nz/nzf_71107 (accessed 13 October 2023).
