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Trulicity ® (dulaglutide)
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What to do if one or more Trulicity® (dulaglutide) doses are missed?
If one dose of dulaglutide is missed and there are more than 3 days until the next scheduled dose, it should be administered as soon as possible. Information below discusses what to do if multiple doses are missed.
Content Overview
One missed dose of dulaglutide
Dulaglutide is a human glucagon-like peptide-1 receptor agonist for once-weekly administration.1
If patients miss a dulaglutide dose, their next dose depends on how much time there is before the patient's next regularly scheduled injection day ().1
If a dose of dulaglutide is missed and there are… |
Then… |
And... |
at least 72 hours until the next scheduled dose |
it should be administered as soon as possible |
patients can resume their regular once-weekly dosing schedule. |
less than 72 hours remaining before the next scheduled dose |
the missed dose should be skipped; the next dose should be administered on the regularly scheduled day |
The day of weekly administration can be changed, as long as the last dulaglutide dose was administered longer than 3 days (72 hours) ago.1
Missed doses while on dulaglutide 1.5 mg
All clinical studies that supported original marketing approval of dulaglutide in adults evaluated dulaglutide 0.75 mg and 1.5 mg without dose escalation; patients were initiated and maintained on either 0.75 mg or 1.5 mg for the duration of the trials.1
In AWARD-PEDS, the study of dulaglutide in pediatric patients, patients randomized to dulaglutide 0.75 mg were initiated directly on this dose. However, patients randomized to dulaglutide 1.5 mg were first started on the 0.75 mg dose and escalated to dulaglutide 1.5 mg after 4 weeks only if they tolerated the 0.75 mg dose in the opinion of the investigator.3
Patients who miss doses while on dulaglutide 1.5 mg once weekly may resume dosing at 1.5 mg at any time and expect comparable tolerability to that experienced prior to the dose interruption. This applies to both adult and pediatric patients.1
Three or more missed doses while on dulaglutide 3 mg or 4.5 mg
Upon initiation, a slow, stepwise dose escalation of weekly dulaglutide and other glucagon-like peptide-1 receptor agonists can attenuate the occurrence and severity of adverse gastrointestinal events with higher doses.4,5
Given the elimination half-life of dulaglutide of approximately 5 days, dulaglutide levels would be reduced by >90% after 3 or more weeks of missed dosing.1
However, whether the waning of “tolerance” or “tachyphylaxis” against the occurrence of adverse gastrointestinal events follows the same time course is unknown.1
Therefore, health care providers should use their best judgment when resuming dulaglutide dosing in patients who have missed 3 or more doses of dulaglutide 3 mg or 4.5 mg and may consider restarting treatment at the 1.5 mg once weekly dose.1
This decision can be informed by the patient’s prior gastrointestinal tolerability experience while taking dulaglutide and should be accompanied by appropriate monitoring for gastrointestinal side effects after resumption of dosing.1
Pharmacokinetics of dulaglutide
Improvement in glycemic control can be observed after the first dulaglutide dose and is sustained throughout the once-weekly dosing interval.1
Steady-state plasma concentrations are achieved between 2 and 4 weeks following once-weekly administration.1
Once steady state is achieved, missing 2 or more consecutive doses may result in subtherapeutic dulaglutide concentrations ().1
References
1Data on file, Eli Lilly and Company and/or one of its subsidiaries.
2Trulicity [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
3Arslanian SA, Hannon T, Zeitler P, et al; AWARD-PEDS Investigators. Once-weekly dulaglutide for the treatment of youths with type 2 diabetes. N Engl J Med. 2022;387(5):433-443. https://doi.org/10.1056/NEJMoa2204601
4Nauck MA, Petrie JR, Sesti G, et al; Study 1821 Investigators. A phase 2, randomized, dose-finding study of the novel once-weekly human GLP-1 analog, semaglutide, compared with placebo and open-label liraglutide in patients with type 2 diabetes. Diabetes Care. 2016;39(2):231-241. https://doi.org/10.2337/dc15-0165
5Frias JP, Bonora E, Nevarez Ruiz L, et al. Efficacy and safety of dulaglutide 3.0 mg and 4.5 mg versus dulaglutide 1.5 mg in metformin-treated patients with type 2 diabetes in a randomized controlled trial (AWARD-11). Diabetes Care. 2021;44(3):765-773. https://doi.org/10.2337/dc20-1473
Date of Last Review: 17 April 2024