Dulaglutide

Subcutaneous
Adjunct to type 2 diabetes mellitus

May be taken with or without food.

Personal or family history of medullary thyroid carcinoma (MTC), patient with multiple endocrine neoplasia syndrome type 2 (MEN 2).

Patient with history of hypersensitivity, pancreatitis, severe gastrointestinal disease (e.g. gastroparesis) and those at risk for developing conduction abnormalities (e.g. ischaemic heart disease, cardiomyopathies). Not intended for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Renal and hepatic impairment. Pregnancy and lactation.

Significant: Acute pancreatitis, severe gastroparesis, hypoglycaemia, serious hypersensitivity reactions (e.g. anaphylaxis, angioedema), tachycardia, thyroid tumours.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, constipation, dyspepsia, flatulence, abdominal pain or discomfort, GERD.
General disorders and administration site conditions: Inj site pain, pruritus, erythema.
Metabolism and nutrition disorders: Decreased appetite.
Nervous system disorders: Fatigue.

SC: C

Rotate injection sites within the same body region and use a new needle for each injection. When used in combination with other antidiabetic agents, this drug may cause hypoglycaemia, if affected, do not drive or operate machinery.

Monitor serum glucose, HbA_1c, renal function, signs and symptoms of pancreatitis.

Symptoms: Gastrointestinal disorders (e.g. nausea vomiting), hypoglycaemia. Management: Supportive treatment.

Increased risk of hypoglycaemia with sulfonylureas or insulin. May delay gastric emptying and reduce the rate of absorption of oral medications.

Description: Dulaglutide is an analogue of glucagon-like peptide-1 (GLP-1), an incretin hormone linked to a modified human Ig G4 fragment and act as GLP-1 receptor agonist. Activation of GLP-1 stimulates insulin release by increasing intracellular cyclic AMP (cAMP) in pancreatic beta cells and suppression of glucagon secretion in a glucose-dependent manner. It also slows gastric emptying thus reduces postprandial glucose (PPG) concentration.
Pharmacokinetics:
Absorption: Absolute bioavailability: 47-65%. Time to peak plasma concentration: Approx 24-72 hours.
Distribution: Volume of distribution: Approx 17-19 L.
Metabolism: Undergoes degradation into amino acids by general protein catabolism pathways.
Excretion: Elimination half-life: Approx 5 days.

Unopened preparation: Store between 2-8°C. Do not freeze. Protect from light. Once opened: Store below 30°C for up to 14 days.

Antidiabetic Agents

A10BJ05 - dulaglutide ; Belongs to the class of glucagon-like peptide-1 (GLP-1) analogues. Used in the treatment of diabetes.

Anon. Dulaglutide. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/03/2018.

Anon. Dulaglutide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/03/2018.

Buckingham R (ed). Dulaglutide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018.

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Joint Formulary Committee. Dulaglutide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018.

Trulicity 0.75 mg Solution for Injection in Pre-filled Syringe (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 05/03/2018.

Trulicity Injection, Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/03/2018.