|Trade names||Trulicity, others|
|Drug class||GLP-1 agonist|
|Main uses||Type 2 diabetes|
|Side effects||Nausea, diarrhea, vomiting, abdominal pain, decreased appetite|
|Typical dose||0.75 to 4.5 mg q wk|
|Chemical and physical data|
|Molar mass||59670.63 g·mol−1|
Dulaglutide, sold under the brand name Trulicity among others, is a medication used to treat type 2 diabetes. Among those in this group at high risk, it may decrease the risk of heart disease. It is used together with diet and exercise. It is give once weekly by injection under the skin.
Common side effects include nausea, diarrhea, vomiting, abdominal pain, and decreased appetite. Other side effects may include pancreatitis, low blood sugar, allergic reactions, kidney problems, and certain thyroid tumors. It is a glucagon-like peptide-1 receptor agonist (GLP-1 agonist) which increases the amount of insulin released by the pancreas in response to food.
Dulaglutide was approved for medical use in the United States and Europe in 2014. In the United Kingdom it costs the NHS about £73 every 4 weeks at a dose of 1.5 mg. This amount in the United States costs about 735 USD. In 2018, it was the 149th most commonly prescribed medication in the United States, with more than 4 million prescriptions.
The compound is indicated for adults with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycemic control. Dulaglutide is not indicated in the treatment of subjects with type 1 diabetes mellitus or patients with diabetic ketoacidosis because these problems are the result of the islet cells being unable to produce insulin and one of the actions of dulaglutide is to stimulate functioning islet cell to produce more insulin. Dulaglutide can be used either stand-alone or in combination with other medicines for type 2 diabetes, in particular metformin, sulfonylureas, thiazolidinediones, and insulin taken concomitantly with meals.[non-primary source needed]
It is started at a dose of 0.75 mg once per week and may be increased 4.5 mg once per week.
The most common side effects include gastrointestinal disorders, such as dyspepsia, decreased appetite, nausea, vomiting, abdominal pain, diarrhea. Some patients may experience serious adverse reactions: acute pancreatitis (symptoms include persistent severe abdominal pain, sometimes radiating to the back and accompanied by vomiting), hypoglycemia, renal impairment (which may sometimes require hemodialysis). The risk of hypoglycemia is increased if the drug is used in combination with sulfonylureas or insulin. There is also a potential risk of medullary thyroid carcinoma associated with the use of the drug.
People with a personal or family history of medullary thyroid cancer (MTC) or affected by multiple endocrine neoplasia type 2 should not take dulaglutide, because it could increase the risk of these cancers.
Mechanism of action
Dulaglutide binds to glucagon-like peptide 1 receptors, slowing gastric emptying and increases insulin secretion by pancreatic Beta cells. Simultaneously the compound reduces the elevated glucagon secretion by inhibiting alpha cells of the pancreas, as glucagon is known to be inappropriately elevated in diabetic patients. GLP-1 is normally secreted by L cells of the gastrointestinal mucosa in response to a meal.
The safety and effectiveness of dulaglutide were evaluated in six clinical trials in which 3,342 subjects with type 2 diabetes received dulaglutide. Subjects receiving dulaglutide had an improvement in their blood sugar control as observed with reductions in HbA1c level (hemoglobin A1c is a measure of blood sugar control).
The U.S. Food and Drug Administration (FDA) approved dulaglutide with a Risk Evaluation and Mitigation Strategy (REMS), and granted the approval of Trulicity to Eli Lilly and Company. The REMS consists of a number of steps that Eli Lilly will take to make physicians aware of the risk of pancreatitis and the potential risk of medullary thyroid carcinoma associated with the drug.
Society and culture
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