dulaglutide

Contraindicated in:

Hypersensitivity;
Personal or family history of medullary thyroid carcinoma;
Multiple endocrine neoplasia syndrome type 2;
History of pancreatitis;
Type 1 diabetes;
Diabetic ketoacidosis;
Severe GI disease (including severe gastroparesis).

Use Cautiously in:

History of angioedema or anaphylaxis to another GLP-1 receptor agonist;
Hepatic/renal impairment;
Diabetic retinopathy (may ↑ risk of complications);
Undergoing elective surgery or procedure requiring general anesthesia or deep sedation;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <10 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: pruritus, rash

GI: abdominal pain, nausea, vomiting, cholecystitis, cholelithiasis, constipation, diarrhea, dyspepsia, PANCREATITIS

GU: acute renal failure.

Local: injection site reactions

Metab: ↓appetite

Neuro: fatigue

Resp: aspiration

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with insulin or agents that increase insulin secretion, including sulfonylureas, may ↑ the risk of serious hypoglycemia; use cautiously and consider dose ↓ of insulin or agents increasing insulin secretion.
May alter absorption of concurrently administered oral medications due to delayed gastric emptying.

Availability ⬆ ⬇

Solution for injection (prefilled pens): 0.75 mg/0.5 mL; 1.5 mg/0.5 mL; 3 mg/0.5 mL; 4.5 mg/0.5 mL

Route/Dosage ⬆ ⬇

Type 2 Diabetes

SUBQ (Adults ): 0.75 mg once weekly; after ≥4 wk, may ↑ to 1.5 mg once weekly to obtain glycemic control; if additional glycemic control still needed, may then ↑ to 3 mg once weekly after ≥4 wk; if additional glycemic control still needed, may then ↑ to 4.5 mg once weekly after ≥4 wk.
SUBQ (Children ≥10 yr): 0.75 mg once weekly; after ≥4 wk, may ↑ to 1.5 mg once weekly to obtain glycemic control.

Risk Reduction of Major Cardiovascular Events

SUBQ (Adults ): 0.75 mg once weekly; after ≥4 wk, may ↑ to 1.5 mg once weekly to obtain glycemic control; if additional glycemic control still needed, may then ↑ to 3 mg once weekly after ≥4 wk; if additional glycemic control still needed, may then ↑ to 4.5 mg once weekly after ≥4 wk.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Acts as an acylated human glucagon-like peptide-1 (GLP-1, an incretin) receptor agonist; increases intracellular cyclic AMP (cAMP), leading to insulin release when glucose is elevated, which then subsides as blood glucose decreases toward euglycemia. Also decreases glucagon secretion and delays gastric emptying.

Therapeutic effects:

Improved glycemic control.
Reduction in risk of cardiovascular death, nonfatal MI, or nonfatal stroke.

Classifications ⬆ ⬇

Therapeutic Classification: antidiabetics

Pharmacologic Classification: glucagon like peptide 1 glp 1 receptor agonists

Pharmacokinetics ⬆ ⬇

Absorption: 0.75 mg dose: 65% absorbed following SUBQ administration; 1.5 mg dose: 47% absorbed following SUBQ administration.

Distribution: Unknown.

Metabolism/Excretion: Degraded by protein catabolic processes.

Half-Life: 5 days.

Time/Action Profile ⬆ ⬇

(↓ in A1c)

ROUTE		ONSET		PEAK		DURATION
SUBQ		within 4 wk		13 wk		unknown

Patient/Family Teaching ⬆ ⬇

Instruct patient on manufacturer’s instructions for use of pen and to take dulaglutide as directed. Pen should never be shared between patients, even if needle is changed. Store pen in refrigerator; do not freeze. After initial use, pen may be stored at room temperature up to 14 days. Advise patient to read the Medication Guide before starting dulaglutide and with each Rx refill in case of changes.
Take missed dose as soon as remembered; if ≤72 hr until next scheduled dose, omit and take next dose as scheduled.
Inform patient that nausea is the most common side effect but usually ↓ over time.
Advise patient to never mix insulin and dulaglutide together. Both injections may be given in the same body area but not right next to each other.
Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
Review signs of hypoglycemia and hyperglycemia. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 teaspoons of sugar, honey, or corn syrup dissolved in water and notify health care professional.
Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemia or hyperglycemia.
Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness, and health care professional should be notified if significant changes occur.
Advise patient to notify health care professional if changes in vision occur during therapy.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise patient to notify health care professional immediately if signs of pancreatitis (nausea, vomiting, abdominal pain) or hypersensitivity (swelling of face, lips, tongue or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; very rapid heartbeat) occur.
Inform patient of risk of benign and malignant thyroid C-cell tumors. Advise patient to notify health care professional if symptoms of thyroid tumors (lump in neck, hoarseness, trouble swallowing, shortness of breath) or allergic reaction (swelling of face, lips, tongue, or throat; fainting or feeling dizzy; very rapid heartbeat; problems breathing or swallowing; severe rash or itching) occur.
Advise patient to inform health care professional of medication regimen before procedures or surgery due to ↑ risk of aspiration with general or deep sedation.
Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
Rep: Insulin is the preferred method of controlling blood glucose during pregnancy. Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Emphasize importance of routine follow-up exams.

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Indications ⬇

Contraind./Precautions ⬆ ⬇