BSN Tracker

dulaglutide

Brand: Trulicity

⚠ BBW Prototype: liraglutide
Drug Class: GLP-1 receptor agonist
Drug Family: antidiabetic
Subclass: once-weekly long-acting GLP-1 agonist
Organ Systems: endocrinecardiovascular

Mechanism of Action

GLP-1 analog fused to an IgG4 Fc fragment, which extends half-life to ~5 days allowing once-weekly dosing. Activates GLP-1 receptors to glucose-dependently stimulate insulin secretion, suppress glucagon, slow gastric emptying, and reduce appetite.

GLP-1 receptor (GLP-1R)

Indications

  • type 2 diabetes mellitus
  • cardiovascular risk reduction in T2DM with established CVD or CV risk factors

Contraindications

  • personal or family history of medullary thyroid carcinoma
  • MEN2

Adverse Effects

Common

  • nausea
  • diarrhea
  • vomiting
  • abdominal pain

Serious

  • pancreatitis
  • gallbladder disease
  • medullary thyroid carcinoma (rodent data)
  • first-degree AV block (rare)

Pharmacokinetics (ADME)

Absorption subcutaneous; single-dose auto-injector; once weekly
Distribution Vd ~19.2 L
Metabolism proteolytic catabolism
Excretion proteolytic degradation
Half-life ~5 days
Onset delayed (days to weeks)
Peak 24–72 hours
Duration 7 days
Protein Binding not applicable (IgG4 fusion)
Vd 19.2 L

Drug Interactions

Drug / Agent Mechanism Severity
oral medications gastric emptying delay; monitor timing of time-sensitive oral drugs minor

Nursing Considerations

  1. Inject subcutaneously once weekly on the same day each week; can be taken with or without food.
  2. Pre-filled single-dose auto-injector pen is designed for self-administration; teach patient injection technique.
  3. REWIND trial demonstrated 12% reduction in MACE; preferred in patients with or at risk for CV events.
  4. Nausea is most common with initiation; reassure patients it typically improves over 4–8 weeks.

Clinical Pearls

  • Dulaglutide's once-weekly prefilled pen with a concealed needle is consistently rated highly for ease of use in patient surveys, driving excellent adherence.
  • The REWIND cardiovascular outcomes trial included a broader population (CV risk factors without established CVD) than other GLP-1 outcome trials, extending the benefit to primary prevention.

Safety Profile

Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Cardiovascular Risk Reduction In T2DM With Established CVD Or CV Risk Factors GLP-1 Receptor Agonist Type 2 Diabetes Mellitus
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