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Trulicity ® (dulaglutide)
This information is intended for UK registered healthcare professionals only in response to your search for information. For current information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk
Should Trulicity® (dulaglutide) therapy be modified for surgical procedures or hospitalization?
The use of dulaglutide in patients undergoing surgical procedures or hospitalization has not been evaluated. For additional considerations please see below.
Content Overview
Drug Interactions
Dulaglutide delays gastric emptying and has the potential to impact the rate of absorption of concomitantly administered oral medicinal products.1
In clinical pharmacology studies, dulaglutide doses up to 1.5 mg did not affect the absorption, to any clinically relevant degree, of the tested orally administered medicinal products that included
- lisinopril
- metoprolol
- digoxin
- norelgestromin
- ethinylestradiol
- atorvastatin
- metformin
- paracetamol
- warfarin, and
- sitagliptin.1
For patients receiving dulaglutide in combination with oral medicinal products with rapid gastrointestinal absorption or prolonged release, there is a potential for altered medicinal product exposure, particularly at the time of dulaglutide treatment initiation. 1
No dosage adjustments of concomitant medications are required.2
There is limited experience with the use of concomitant medications in clinical trials with dulaglutide doses of 3 mg and 4.5 mg.2
For full information on drug interactions please refer to the Trulicity summary of product characteristics (SmPC).
Precautions
Aspiration in association with general anaesthesia or deep sedation
Cases of pulmonary aspiration have been reported in patients receiving GLP-1 receptor agonists undergoing general anaesthesia or deep sedation. Therefore, the increased risk of residual gastric content due to delayed gastric emptying should be considered prior to performing procedures with general anaesthesia or deep sedation.1
On 28-Jan-2025, the MHRA issued a drug safety update on the potential risk of pulmonary aspiration during general anaesthesia or deep sedation that can be accessed at https://www.gov.uk/drug-safety-update/glp-1-and-dual-gip-slash-glp-1-receptor-agonists-potential-risk-of-pulmonary-aspiration-during-general-anaesthesia-or-deep-sedation. 3
This update includes reference to a UK consensus statement produced by expert members of a Working Party established by the Association of Anaesthetists, on elective peri-operative management of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists and sodium-glucose cotransporter-2 inhibitors.3
Pancreatitis
Use of GLP‑1 receptor agonists has been associated with a risk of developing acute pancreatitis. In clinical trials, acute pancreatitis has been reported in association with dulaglutide.1
Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, dulaglutide should be discontinued. If pancreatitis is confirmed, dulaglutide should not be restarted. In the absence of other signs and symptoms of acute pancreatitis, elevations in pancreatic enzymes alone are not predictive of acute pancreatitis.1
Use in combination with Insulin or Sulfonylurea
Patients receiving dulaglutide in combination with sulphonylurea or insulin may have an increased risk of hypoglycaemia. The risk of hypoglycaemia may be lowered by a reduction in the dose of sulphonylurea or insulin.1
Renal or hepatic impairment
Renal impairment
No dose adjustment is required in patients with mild, moderate or severe renal impairment (eGFR < 90 to ≥ 15 mL/min/1.73 m2).1
There is very limited experience in patients with end stage renal disease (< 15 mL/min/1.73 m2), therefore dulaglutide can not be recommended in this population.1
Dehydration, sometimes leading to acute renal failure or worsening renal impairment, has been reported in patients treated with dulaglutide, especially at the initiation of treatment.1
Many of the reported adverse renal events occurred in patients who had experienced nausea, vomiting, diarrhoea, or dehydration.1
Patients treated with dulaglutide should be advised of the potential risk of dehydration, particularly in relation to gastrointestinal adverse reactions and take precautions to avoid fluid depletion.1
Hepatic impairment
No dose adjustment is required in patients with hepatic impairment.1
For full information on precautions and other prescribing information please refer to the Trulicity SmPC.
Pharmacokinetic background information
Inject dulaglutide
- once weekly on the same day every week
- at any time of day, and
- with or without food.2
Following subcutaneous administration to patients with type 2 diabetes, dulaglutide reaches peak plasma concentrations in 48 hours.1
Steady‑state plasma concentrations were achieved between 2 to 4 weeks of once‑weekly administration of dulaglutide (1.5 mg).1
Absolute subcutaneous bioavailability for 3 mg and 4.5 mg doses were estimated to be similar to 1.5 mg, although this has not been specifically studied.2
The elimination half-life was approximately 5 days.1
For full information on pharmacokinetics please refer to the Trulicity SmPC.
References
1Trulicity [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
2Data on file, Eli Lilly and Company and/or one of its subsidiaries.
3El-Boghdadly K, Dhesi J, Fabb P, et al. Elective peri-operative management of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists and sodium-glucose cotransporter-2 inhibitors: a multidisciplinary consensus statement. Anaesthesia 2025. https://doi.org/10.1111/anae.16541
Date of Last Review: 11 July 2024