Dulaglutide
Dulaglutide is a GLP-1 receptor agonist injected under the skin once weekly. Dulaglutide is used for Type 2 diabetes — blood sugar control and Cardiovascular risk reduction.
Pronunciation: doo'' la gloo' tide.
- Generic name
- dulaglutide
- Brand names
- TRULICITY
- Drug class
- GLP-1 receptor agonist (glucagon-like peptide-1 receptor agonist); incretin mimetic
- Form
- Solution for injection in a single-dose pre-filled pen
- Route
- Subcutaneous injection
- Legal status
- Prescription-only medicine (per cited labelled product; exact national legal status not further specified in the research notes)
Availability and supply rules vary by country
Trade names by country: United States · United Kingdom · Canada
Australia: · Full directory
What dulaglutide is and how it works
Dulaglutide is a GLP-1 receptor agonist injected under the skin once weekly. It activates the GLP-1 receptor in pancreatic beta cells, increases insulin secretion in a glucose-dependent manner, decreases glucagon secretion, and slows gastric emptying. It is used to improve blood sugar control in type 2 diabetes and, in adults, to reduce the risk of major adverse cardiovascular events. (2) (4) (5)
Dulaglutide controls diabetes but does not cure it. Approved indication wording, dosing, and some warnings differ between the US and EU/UK labelling, so the exact local product information applies. All starting, escalating, reducing, and stopping decisions are made with the prescriber.
Mechanism of action: how dulaglutide works
Dulaglutide is a GLP-1 receptor agonist that activates the GLP-1 receptor, a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. It increases insulin secretion in a glucose-dependent manner, decreases glucagon secretion, and slows gastric emptying. When used with insulin or an insulin secretagogue (e.g., sulfonylurea), it may increase the risk of hypoglycaemia, including severe hypoglycaemia. (2) (4) (5)
What is Dulaglutide used for?
Type 2 diabetes — blood sugar control (United States)
The US label indicates dulaglutide, as an adjunct to diet and exercise, to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus. (2)
Type 2 diabetes — blood sugar control (EU/UK wording)
The EU Summary of Product Characteristics indicates dulaglutide for patients 10 years and above with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise: as monotherapy when metformin is considered inappropriate due to intolerance or contraindications, or in addition to other diabetes medicines. (4)
Cardiovascular risk reduction (United States)
The US label indicates dulaglutide to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors. The MedlinePlus summary describes this as reducing the risk of heart attack, stroke, or death in adults with type 2 diabetes who have or are at risk of heart disease. (2) (5)
Before taking dulaglutide
Do not take / not appropriate for
- Do not use dulaglutide if you have a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). (all products) (2) (5)
- Do not use dulaglutide after a serious hypersensitivity reaction to dulaglutide or any component of the product. (all products) (2) (4)
- Dulaglutide should not be used in type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis; it is not a substitute for insulin (EU/UK wording). (per EU/UK product information) (4)
Tell your clinician about
- Any personal or family history of thyroid cancer or MEN 2, and any neck lump, hoarseness, difficulty swallowing, or shortness of breath.
- Any allergy to dulaglutide, any part of the product, or other medicines, foods, or substances, and what symptoms occurred.
- Pancreatitis, diabetic retinopathy, severe stomach problems including gastroparesis or other digestion problems, or gallbladder, kidney, or liver disease.
- Pregnancy, plans for pregnancy, or breastfeeding.
- All prescription and non-prescription medicines, vitamins, nutritional supplements, and herbal products, including insulin, sulfonylureas or other insulin secretagogues, and other diabetes medicines.
- Any planned surgery, including dental surgery, and any planned general anaesthesia or deep sedation.
- Illness, infection or fever, unusual stress, or injury, which can affect blood sugar and treatment needs.
Dulaglutide dosage and how to take it
- Dulaglutide is injected subcutaneously (under the skin) into the abdomen, thigh, or upper arm; it must not be given intravenously or intramuscularly.
- Inject once weekly on the same day each week, at any time of day, with or without meals.
- The day of weekly injection can be changed if needed, as long as the last dose was given 3 or more days (72 hours) before the new day.
- Use dulaglutide exactly as directed; do not use more or less of it or more often than prescribed. All dose changes are decided with the prescriber.
- Always inject dulaglutide in its own pre-filled pen; never mix it with any other medication. Rotate the injection site within the chosen area with each dose.
- Check the solution before injecting: it should be clear, colourless, and free of solid particles.
- Never reuse or share dosing pens; dispose of pens in a puncture-resistant container and ask a doctor or pharmacist how to dispose of the container.
- If insulin is also used, the two injections can be given in the same body area but not right next to each other.
- Tell the doctor or dentist that you use dulaglutide if you are having surgery, including dental surgery.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2) (4) (5)
Missed dose
If a dose is missed, give it as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose; if less than 3 days (72 hours) remain, skip the missed dose and give the next dose on the regularly scheduled day. In either case, resume the regular once-weekly schedule. Never take more than one dose within 3 days (72 hours), and do not take an extra dose to make up for a missed one.
Overdose
Effects reported with overdose in clinical studies were primarily mild or moderate gastrointestinal events (such as nausea and vomiting) and non-severe low blood sugar. Consider contacting a poison help line or medical toxicologist for further management advice, and seek urgent medical assessment; care is supportive according to the person's signs and symptoms, with frequent glucose checks. If the person has collapsed, had a seizure, has trouble breathing, or cannot be woken, call emergency services immediately. (2) (4) (5)
Dulaglutide side effects
The most frequently reported reactions in clinical trials were gastrointestinal — nausea, vomiting, and diarrhoea — generally mild or moderate and transient, peaking during the first 2 weeks of treatment. Gastrointestinal events were mostly reported during the first 2–3 days after the initial dose and declined with subsequent doses. Tell the prescriber about side effects that are severe or do not go away.
Nausea, diarrhoea, vomiting, abdominal pain
What to notice: These are the most frequent reactions and are usually mild to moderate and transient.
What to do: Discuss troublesome or persistent symptoms with the prescriber; dose decisions are made with the prescriber. (2) (4) (5)
Decreased appetite, dyspepsia, constipation, flatulence, abdominal distension, gastro-oesophageal reflux, eructation, heartburn
What to notice: Digestive symptoms that may occur during treatment.
What to do: Tell the prescriber if severe, worsening, or persistent. (4) (5)
Tiredness (fatigue)
What to notice: Reported as a common effect.
What to do: Tell the prescriber if it is severe or does not go away. (4) (5)
Injection site reactions
What to notice: Injection site adverse events were reported in 1.9% of patients; potentially immune-mediated reactions (e.g., rash, erythema) in 0.7%, usually mild.
What to do: Tell the treatment team if severe, worsening, or persistent. (4)
Possible acute pancreatitis
What to notice: Ongoing pain that begins in the upper left or middle of the stomach and may spread to the back, with or without vomiting.
What to do: Seek medical attention promptly; if pancreatitis is suspected, the prescriber decides whether treatment continues, and confirmed pancreatitis means dulaglutide is not restarted. (5) (4)
Hypersensitivity or possible anaphylaxis
What to notice: Hives, rash, itching, difficulty breathing or swallowing, or swelling of the lips, tongue, face, or throat.
What to do: Seek emergency medical treatment immediately. (5) (4)
Gallbladder or liver-related symptoms
What to notice: Pain in the upper stomach, fever, yellowing of the skin or eyes, or clay-coloured stools.
What to do: Contact the prescriber promptly for assessment. (5) (4)
Vision, heartbeat, or fainting symptoms
What to notice: Vision changes, fast heartbeat, or dizziness or fainting.
What to do: Seek medical assessment promptly. (5)
Dehydration from gastrointestinal effects
What to notice: Nausea, vomiting, or diarrhoea with dehydration, sometimes leading to acute kidney injury or worsening kidney function, especially at treatment start.
What to do: Take precautions to avoid fluid loss and seek medical advice if dehydration develops. (4)
Serious warnings
Thyroid C-cell tumours (US boxed warning) — serious
Symptoms: A lump or swelling in the neck, hoarseness, difficulty swallowing, or shortness of breath.
Action: Tell the doctor if you or anyone in your family has or has ever had thyroid cancer or MEN 2; the doctor will probably advise against dulaglutide in that case. Call the doctor immediately for the listed symptoms. Dulaglutide caused dose-related thyroid C-cell tumours in rats after lifetime exposure; it is unknown whether it causes MTC or other thyroid C-cell tumours in humans. (2) (5)
Low blood sugar (hypoglycaemia) with insulin or an insulin secretagogue — serious
Symptoms: Low blood sugar, which can be severe, when dulaglutide is combined with insulin or an insulin secretagogue (e.g., sulfonylurea).
Action: Know the signs of low blood sugar and how to treat it. The prescriber may lower the insulin or sulfonylurea dose; blood glucose self-monitoring is needed to adjust those doses, particularly when dulaglutide is started and insulin is reduced. (2) (4)
Acute pancreatitis — serious
Symptoms: Ongoing pain beginning in the upper left or middle of the stomach that may spread to the back, often with vomiting.
Action: Seek medical attention promptly. If pancreatitis is suspected, the prescriber decides whether treatment continues; if pancreatitis is confirmed, dulaglutide should not be restarted. Pancreatic enzyme elevations alone, without other signs and symptoms, are not predictive of acute pancreatitis. (4) (5)
Acute kidney injury and dehydration — serious
Symptoms: Dehydration from nausea, vomiting, or diarrhoea, sometimes leading to acute kidney injury or worsening kidney function, especially at treatment initiation.
Action: Be aware of the risk of dehydration, especially with gastrointestinal effects, and take precautions to avoid fluid loss; seek medical advice if dehydration develops. (4) (2)
Pulmonary aspiration with general anaesthesia or deep sedation — serious
Symptoms: Aspiration reported in patients receiving GLP-1 receptor agonists during general anaesthesia or deep sedation, related to delayed gastric emptying and residual gastric content.
Action: The increased risk from delayed gastric emptying should be considered before procedures requiring general anaesthesia or deep sedation; tell the treating team that you use dulaglutide. (4) (2)
Severe gastrointestinal disease and gastroparesis — serious
Symptoms: Severe gastrointestinal symptoms, including severe gastroparesis (impaired gastric emptying).
Action: Dulaglutide has not been studied in severe gastrointestinal disease including severe gastroparesis and is not recommended in this group; events related to impaired gastric emptying, including severe gastroparesis, have been reported. Monitor and consider dose modification or discontinuation in patients who develop severe gastrointestinal symptoms. (4)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Insulin and insulin secretagogues (e.g., sulfonylureas) | Increased risk of hypoglycaemia, including severe hypoglycaemia. | The prescriber may lower the dose of the insulin or sulfonylurea; blood glucose self-monitoring is needed to adjust these doses, particularly when dulaglutide is started and insulin is reduced, and a stepwise approach to insulin dose reduction is recommended. (2) (4) |
| Oral medicines with rapid gastrointestinal absorption or prolonged release | Dulaglutide delays gastric emptying and can affect the rate of absorption of concomitant oral medicines; altered exposure is possible, particularly at treatment initiation. | The prescriber may change doses of other medicines or monitor carefully; give a complete medicine list. (4) (2) |
| Sitagliptin | Sitagliptin exposure was largely unaffected by dulaglutide; co-administration increased dulaglutide exposure and Cmax by approximately 38% and 27%, which is not considered clinically relevant. | No specific dose adjustment is stated in the cited sources; the prescriber manages combination therapy. (4) (2) |
| Paracetamol, atorvastatin, digoxin, lisinopril, metoprolol, warfarin, oral contraceptives, metformin | Pharmacokinetic studies showed no clinically relevant interactions requiring dose adjustment for these medicines when given with dulaglutide. | No dose adjustment is required for these medicines according to the cited product information. (4) |
Special populations
Children and adolescents
Dulaglutide is indicated for patients 10 years of age and older with type 2 diabetes (US and EU/UK labelling). In children the starting dose is 0.75 mg once weekly, and if needed it may be increased to a maximum of 1.5 mg once weekly after at least 4 weeks. Safety and efficacy in children under 10 years have not been established. The safety profile in patients aged 10 years and above is comparable with adults. (2) (4)
Pregnancy and breastfeeding
Tell the prescriber promptly if you are pregnant or planning pregnancy; decisions to continue, change or stop treatment are made together with the prescriber. US labelling notes limited human data, animal studies suggesting possible fetal risk, and that use in pregnancy should occur only if the potential benefit justifies the potential fetal risk; poorly controlled diabetes in pregnancy also carries risks. EU/UK labelling does not recommend dulaglutide during pregnancy. For breastfeeding, human milk data are lacking (US) and a risk to newborns/infants cannot be excluded (EU/UK); weigh benefits with the prescriber. (2) (4) (5)
Kidney impairment
EU/UK labelling states no dose adjustment is required in mild, moderate, or severe renal impairment (eGFR < 90 to ≥ 15 mL/min/1.73m2); experience in end-stage renal disease (< 15 mL/min/1.73m2) is very limited, so dulaglutide cannot be recommended in that population. US labelling reports no overall differences in safety or effectiveness according to renal function across studied degrees of renal function. (4) (2)
Liver impairment
EU/UK labelling states no dose adjustment is required in hepatic impairment. US labelling reports no clinically relevant change in dulaglutide pharmacokinetics in varying degrees of hepatic impairment but limited clinical experience, so use with caution in mild, moderate, or severe hepatic impairment. The US source has no renal or hepatic dose adjustment table. (4) (2)
Older people and driving
No dose adjustment is required based on age. Dulaglutide has no or negligible influence on the ability to drive or use machines, but when used with a sulfonylurea or insulin, take precautions to avoid hypoglycaemia while driving and using machines. (4)
Monitoring
Before starting
- Confirm the diagnosis of type 2 diabetes, the exact local indication, background diabetes therapy, and age eligibility.
- Assess personal or family history of medullary thyroid carcinoma or MEN 2, and hypersensitivity to dulaglutide or product components.
- Ask about pancreatitis, diabetic retinopathy, severe stomach problems including gastroparesis, and gallbladder, kidney, or liver disease.
- Review all medicines, especially insulin and insulin secretagogues, which raise hypoglycaemia risk.
- Discuss pregnancy, plans for pregnancy, and breastfeeding.
During treatment
- Keep all doctor and laboratory appointments; the doctor may order tests to check the body's response.
- Reassess blood sugar control and any dose escalation with the prescriber.
- When combined with insulin or a sulfonylurea, monitor for hypoglycaemia and follow the prescriber's plan for adjusting those doses.
- Watch for gastrointestinal symptoms and dehydration, and for symptoms of pancreatitis, thyroid C-cell tumour, or hypersensitivity.
- Make the treatment team aware of dulaglutide use before procedures requiring general anaesthesia or deep sedation.
Storage
Keep the pre-filled pens in the original carton in the refrigerator at 2–8 °C (36–46 °F), protected from light. If necessary, each single-dose pen can be kept at room temperature (up to 30 °C / 86 °F) for a total of up to 14 days. Do not freeze; do not use if it has been frozen. Keep out of the sight and reach of children. Do not flush the medication down the toilet; use a medicine take-back programme where available and ask a pharmacist about disposal options.
Professional information
Clinician-facing context only. Use the current local indication, dosing table, and product information; dosing and treatment decisions remain with the prescriber.
United States
Indication: Type 2 diabetes mellitus (adults and pediatric patients 10 years of age and older)
Dose summary: Adults: starting dose 0.75 mg subcutaneously once weekly; after 4 weeks may increase to 1.5 mg once weekly for additional glycemic control; if further control is needed, increase in 1.5 mg increments after at least 4 weeks on the current dose; maximum 4.5 mg once weekly. Pediatric patients (10 years and older): starting dose 0.75 mg once weekly; if needed, increase to a maximum of 1.5 mg once weekly after at least 4 weeks on 0.75 mg, to reduce the risk of gastrointestinal adverse reactions.
Renal context: The US label has no dose adjustment table; no overall differences in safety or effectiveness were observed in studies across varying degrees of renal function, including a dedicated trial in moderate to severe chronic kidney disease. (2)
EU/UK
Indication: Type 2 diabetes mellitus, patients 10 years and above, as monotherapy or in addition to other diabetes medicines
Dose summary: Adults: monotherapy 0.75 mg once weekly; add-on therapy 1.5 mg once weekly. If needed, the 1.5 mg dose can be increased after at least 4 weeks to 3 mg once weekly, and the 3 mg dose after at least 4 weeks to 4.5 mg once weekly; maximum 4.5 mg once weekly. Paediatric patients (10 years and above): starting dose 0.75 mg once weekly; if needed, increase to 1.5 mg once weekly after at least 4 weeks; maximum 1.5 mg once weekly. With metformin and/or pioglitazone or metformin and/or SGLT2 inhibitor, the current doses can be continued; when adding to a sulfonylurea or insulin, a reduction in their dose may be considered.
Renal context: No dose adjustment in mild, moderate, or severe renal impairment (eGFR < 90 to ≥ 15 mL/min/1.73m2); very limited experience in end-stage renal disease (< 15 mL/min/1.73m2), so not recommended in that population. No dose adjustment in hepatic impairment. No dose adjustment based on age. (4)
Hepatic guidance
EU/UK: no dose adjustment in hepatic impairment. US: no clinically relevant change in dulaglutide pharmacokinetics in varying degrees of hepatic impairment, but limited clinical experience, so use with caution in mild, moderate, or severe hepatic impairment.
Overdose note
Reported overdose effects were primarily mild or moderate gastrointestinal events (e.g., nausea, vomiting) and non-severe hypoglycaemia. Management is supportive according to clinical signs and symptoms, with consideration of poison help or toxicologist advice (US Poison Help line 1-800-222-1222). (2) (4) (5)
Frequently asked questions
Does dulaglutide cure type 2 diabetes?
No. Dulaglutide controls diabetes but does not cure it. Continue using it as directed, and discuss any desire to change or stop treatment with the prescriber. (5)
What should I do if I miss my weekly dose?
Give the missed dose as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose; if less than 3 days remain, skip it and give the next dose on the regular day, then resume the normal weekly schedule. Do not take an extra dose to make up for the missed one. (2) (5) (4)
Can I inject dulaglutide and insulin in the same area?
You can inject both in the same body area, but do not give the injections right next to each other. (5)
Why does the label warn about low blood sugar?
Combining dulaglutide with insulin or an insulin secretagogue such as a sulfonylurea increases the risk of hypoglycaemia, including severe hypoglycaemia; the prescriber may lower the dose of those medicines. Know the signs of low blood sugar and how to treat it. (2) (4)
What is the mechanism of action of dulaglutide?
Dulaglutide is a GLP-1 receptor agonist that activates the GLP-1 receptor, a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. It increases insulin secretion in a glucose-dependent manner, decreases glucagon secretion, and slows gastric emptying. When used with insulin or an insulin secretagogue (e.g., sulfonylurea), it may increase the risk of hypoglycaemia, including severe hypoglycaemia. (2) (4) (5)
References
- TRULICITY (dulaglutide) injection, for subcutaneous use — prescribing informationDailyMed, U.S. National Library of Medicine · United States · dated 2026-06-16 · accessed 2026-09-15 · source 1
- Trulicity (dulaglutide) injection prescribing information — addendum (same SPL set id)DailyMed / openFDA drug label API, U.S. National Library of Medicine · United States · dated 2026-06-16 · accessed 2026-10-12 · source 2
- Trulicity (dulaglutide) prescribing information — verbatim excerpts (set_id 463050bd-2b1c-40f5-b3c3-0a04bb433309, effective 20260616)openFDA drug label API, U.S. National Library of Medicine · United States · dated 2026-06-16 · accessed 2026-10-13 · source 3
- Trulicity (dulaglutide) — EPAR product information, Summary of Product CharacteristicsEuropean Medicines Agency · European Union / United Kingdom · accessed 2026-10-17 · source 4
- Dulaglutide Injection: MedlinePlus Drug InformationMedlinePlus, U.S. National Library of Medicine · United States · dated 2025-08-15 · accessed 2026-10-17 · source 5
Brand names by country
Single-ingredient dulaglutide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Trulicityinjection, solution · 4.5 mg/.5mL, .75 mg/.5mL, 3 mg/.5mL, 1.5 mg/.5mL · a-s medication solutionsregulator source
United Kingdom
- Trulicityreference source
Canada
- TRULICITYregulator source