Injection: 0.75 mg/5 mL, 1.5 mg/5 mL in prefilled pens
As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus: The recommended initiating dose is 0.75 mg given once weekly. Usual maintenance dose is 0.75 to 1.5 mg once weekly. Doses are to be given subcutaneously in the abdomen, upper arm, or thigh.
Monitor: HbA1C, FBG, Body Weight
Pharmacology/Pharmacokinetics:
Dulaglutide is a human glucagon-like peptide-1 (GLP-1) receptor antagonist (90% similar to human GLP-1). In the presence of glucose, dulaglutide increases intracellular cyclic AMP which results in the release of insulin from pancreatic beta cells. This insulin release decreases as glucose levels decrease. Dulaglutide also decreases glucagon gastric emptying. Unlike human GLP-1 which has a half-life of about 2 minutes, dulaglutide has a half-life of about 5 days. Peak concentrations are reached in a median 48 hours post dose. Steady state levels are reached in 2-4 weeks. Dulaglutide is endogenously metabolized similar to other proteins.
Drug Interactions:
Dulaglutide reduces gastric emptying which may change the rate and extent of orally administered drugs. Currently no dosage adjustments to orally administered drugs has been identified.
Contraindications/Dosages:
Contraindicated in patients with a personal or family history of medullary thyroid carcinoma and in patients with Multiple Endocrine Neoplasia syndrome type 2. DULAglutide increases the risk of medullary thyroid carcinoma, pancreatitis, hypoglycemia, and renal impairment. Not recommended for use in patients with severe gastrointestinal disease, include severe gastroparesis. Pregnancy Category C.
Adverse Effects:
Most common adverse effects are gastrointestinal in nature and dose-related: Nausea (12-21%), diarrhea (9-13%), abdominal pain (6-9%), decreased appetite (5-9%), dyspepsia (4-6%), and fatigue (4-6%). Rare but serious adverse effects include medullary thyroid carcinoma, pancreatitis, and renal impairment.
Promptly report any signs of thyroid carcinoma (mass in neck, dysphagia, dyspnea, or persistent hoarseness).
Promptly report any symptoms of pancreatitis (persistent severe abdominal pain with or without vomiting).
If a dose is missed, administer it as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose. If less than 3 days remain before the next schedule dose, skip the missed dose and administer the next dose on the regularly scheduled day.
Read and understand the medication guide which comes with the medication.
Store unused pens in the refrigerator. Opened pens may be stored below 86F (30C) for 14 days. If exposed to temperatures over 86F, it should be discarded. Do not store in the freezer or allow to freeze.
Do not store pens with needle attached. Use a new needle for each dose.
