Action and Spectrum

• dulaglutide is a medication used to treat type 2 diabetes. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. dulaglutide works by stimulating the release of insulin and reducing the production of glucagon, which helps to lower blood sugar levels in people with type 2 diabetes.
• dulaglutide stimulates the pancreas to release insulin in response to high blood sugar levels.
• dulaglutide also inhibits the secretion of glucagon, a hormone that raises blood sugar levels by stimulating the liver to release glucose.
• dulaglutide slows down the emptying of the stomach, which helps to reduce the rate at which glucose enters the bloodstream also helps to reduce appetite, which may lead to weight loss in some people.
• In terms of its spectrum, dulaglutide helps to lower blood sugar levels in people with type 2 diabetes by stimulating insulin secretion and inhibiting glucagon secretion. It can help to reduce
• appetite and promote weight loss in some people with type 2 diabetes. Also shown to reduce the risk of cardiovascular events in people with type 2 diabetes.
• dulaglutide has also been shown to reduce the risk of kidney damage in people with type 2 diabetes.

Drug Interaction

Adverse Reaction

Frequency defined 

>10%

Increased amylase (20%)

Diarrhea (7-12.6%)

Increased lipase (14%)

Nausea (12.4-21.1%)

1-10%

Vomiting (5.6-9.3%)

Fatigue (4.2-5.6%)

Decreased appetite (4.9-8.6%)

Dyspepsia (2.3-5.8%)

Severe hypoglycemia (2.7-3.4%)

Constipation (3.7-3.9%)

Flatulence (1.4-3.4%)

Abdominal pain (6.5-9.4%)

Abdominal distension (2.3-2.9%)

Sinus tachycardia (2.8-3%)

Gastroesophageal reflux disease (1.7-2%)

Eructation (0.6-1.6%)

AV block (0.9-1.7%)

<1%

Injection-site reactions

Cholelithiasis

Cholecystitis

Hypersensitivity

Pancreatitis

Black Box Warning

Black Box Warning

dulaglutide carries a warning for the risk of thyroid C-cell tumors in animal studies. This warning is based on the findings of thyroid C-cell tumors in rodents treated with other GLP-1 receptor agonists.

dulaglutide should not be used in people with a personal or family history of medullary thyroid carcinoma (MTC) or in people with multiple endocrine neoplasia syndrome type 2 (MEN 2).

People taking dulaglutide should also be advised to report any symptoms of thyroid tumors, such as a lump in the neck, difficulty swallowing, hoarseness, or persistent cough, to their healthcare provider.

Regular monitoring of thyroid function and imaging is not recommended for people taking dulaglutide, except in cases of suspected MTC or MEN 2.

Contraindication / Caution

Contraindication /Caution:

• Hypersensitivity: dulaglutide is contraindicated in patients with a known hypersensitivity to the drug or any of its components.
• Medullary thyroid carcinoma: dulaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2).
• Pancreatitis: GLP-1 receptor agonists, including dulaglutide, have been associated with acute pancreatitis. Dulaglutide should be used with caution in patients with a history of pancreatitis.
• Diabetic ketoacidosis: dulaglutide should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.
• Impaired renal function: dulaglutide should be used with caution in patients with impaired renal function, as it has not been studied in patients with severe renal impairment (eGFR less than 30 mL/min/1.73m2).
• Gastrointestinal disease: dulaglutide may cause gastrointestinal adverse reactions such as nausea, vomiting, diarrhea, and constipation. dulaglutide should be used with caution in patients with a history of gastrointestinal disease, including gastroparesis.
• Pregnancy and breastfeeding: dulaglutide is classified as pregnancy category C, and its safety during pregnancy and breastfeeding is unknown. dulaglutide should only be used during pregnancy or breastfeeding if the potential benefit justifies the potential risk to the fetus or infant.

Pregnancy / Lactation

Pregnancy consideration:

Pregnancy category: NA

Lactation:

The excretion of drug into human milk is unknown

Pregnancy Categories:     

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester.

Category B: There were lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology:

dulaglutide is a GLP-1 receptor agonist that binds to and activates the GLP-1 receptor in pancreatic beta-cells, which results in the release of insulin in response to high blood sugar levels.

It also inhibits the secretion of glucagon, a hormone that increases blood sugar levels by promoting the production of glucose in the liver. dulaglutide also slows down gastric emptying and reduces appetite, which can lead to weight loss.

Pharmacodynamics:

In pancreatic beta-cells, dulaglutide stimulates the release of insulin in response to high blood sugar levels. This effect helps lower blood sugar levels in people with type 2 diabetes and inhibits the secretion of glucagon, a hormone that raises blood sugar levels by promoting glucose production in the liver.

By inhibiting glucagon secretion, dulaglutide helps to further reduce blood sugar levels in people with type 2 diabetes. Overall, the pharmacodynamics of dulaglutide involves its effects on blood sugar control, weight loss, and cardiovascular and renal protection in people with type 2 diabetes.

Pharmacokinetics:

Absorption

Absolute SC bioavailability for 3 mg and 4.5 mg doses estimated to be like 1.5 mg, although not been specifically studied and concentrations increased proportional to dose from 0.75-4.5 mg.

Distribution

Distributed about 3.09 L through central way and 5.98 L through peripheral way.

Metabolism

Degraded into its component amino acids by general protein catabolism pathways.

Elimination and Excretion

The half-life is around 5 days and clearance recorded as 0.142 L/hr.

Adminstartion

Administration:

dulaglutide is administered by subcutaneous injection once a week. The injection can be given at any time of the day, with or without food. The recommended starting dose is 0.75 mg once a week, which can be increased to 1.5 mg once a week after four weeks if needed to achieve blood sugar control.

Before administering dulaglutide, it is important to check the medication label and ensure that the solution is clear and free of particles. The injection site should also be cleaned with an alcohol swab to reduce the risk of infection.

Patient Information Leaflet

Patient information leaflet

Generic Name: dulaglutide

Pronounced: DOO-la-GLOO-tide

Why do we use dulaglutide?

dulaglutide is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.

dulaglutide is also used to help reduce the risk of serious heart problems such as heart attack or stroke in adults who have type 2 diabetes and heart disease.