Formulary
Dulaglutide: Indications, Dosing, Side Effects and Interactions
Dulaglutide is a long-acting glucagon-like peptide 1 (GLP-1) receptor agonist that augments glucose-dependent insulin secretion, and slows gastric emptying.
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Dulaglutide: Indications, Dosing, Side Effects and Interactions
Dulaglutide is a long-acting glucagon-like peptide 1 (GLP-1) receptor agonist that augments glucose-dependent insulin secretion, and slows gastric emptying.
Drug action
Dulaglutide is a long-acting glucagon-like peptide 1 (GLP-1) receptor agonist that augments glucose-dependent insulin secretion, and slows gastric emptying.
Indications and dose
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate)**
- **Adult** (By Subcutaneous Injection): 0.75 mg once weekly.
**Type 2 diabetes mellitus in combination with other antidiabetic drugs (including insulin) if existing treatment fails to achieve adequate glycaemic control**
- **Adult** (By Subcutaneous Injection): 1.5 mg once weekly; increased if necessary to 3 mg once weekly after at least 4 weeks, then increased if necessary to 4.5 mg once weekly after another 4 weeks, a starting dose of 0.75 mg once weekly may be considered for potentially vulnerable patients; maximum 4.5 mg per week.
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate), or in combination with other antidiabetic drugs (including insulin), if existing treatment fails to achieve adequate glycaemic control for dulaglutide**
- **Child 10-17 years** (By subcutaneous injection): 0.75 mg once weekly; increased if necessary to 1.5 mg once weekly, dose increased after at least 4 weeks.
Cautions
General anaesthesia or deep sedation (risk of pulmonary aspiration due to delayed gastric emptying)
Contraindications
Severe gastro-intestinal disease-no information available
Side effects
Common or very common Appetite decreased; atrioventricular block; burping; constipation; diarrhoea; fatigue; gastrointestinal discomfort; gastrointestinal disorders; hypoglycaemia; nausea; sinus tachycardia; vomiting Uncommon Dehydration; gallbladder disorders Rare or very rare Angioedema; pancreatitis acute Side-effects, further information Discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain. If pancreatitis confirmed, do not restart treatment.
Interactions
**Severe interactions:**
- After coadministration with up to 3 mg of dulaglutide at steady state, there were no statistically significant differences on AUC (0-12) , C max or t max of paracetamol.
- Statistically significant delays in lisinopril t max of approximately 1 hour were observed on Days 3 and 24 of the study.
- Statistically significant reductions in C max of 26 % and 13 % and delays in t max of 2 and 0.30 hours were observed for norelgestromin and ethinyl estradiol, respectively.
**Other interactions (28):**
- Dulaglutide delays gastric emptying and has the potential to impact the rate of absorption of concomitantly administered oral medicinal products.
- In the clinical pharmacology studies described below, dulaglutide doses up to 1.5 mg did not affect the absorption of the orally administered medicinal products tested to any clinically relevant...
- 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...
- Sitagliptin Sitagliptin exposure was unaffected when coadministered with a single 1.5 mg dose of dulaglutide.
- Following coadministration with 2 consecutive 1.5 mg doses of dulaglutide, sitagliptin AUC (0- ) and C max decreased by approximately 7.4 % and 23.1 %, respectively.
- Sitagliptin t max increased approximately 0.5 hours following coadministration with dulaglutide compared to sitagliptin alone.
Pregnancy
Manufacturer advises avoid-toxicity in animal studies.
Breast feeding
Manufacturer advises avoid- no information available.
Renal impairment
Avoid if eGFR less than 15 mL/minute/1.73 m 2 (limited information available), M see Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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