Dulaglutide belongs to a group of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. It is used along with other medications to improve blood glucose (sugar) levels for people with type 2 diabetes. Dulaglutide may also be used alone when metformin cannot be used or is not tolerated. It works by helping your body make more insulin and control blood glucose levels. This medication should be used as part of an overall diabetes management plan that includes a diet and exercise program.

Dulaglutide is also used for people with type 2 diabetes who also have cardiovascular disease or risk factors for cardiovascular disease. It is used in addition to diet, exercise, and other medications to reduce the risk of non-fatal stroke.

Dulaglutide is not a substitute for insulin. However, it may be used at the same time as insulin.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended adult starting dose of dulaglutide is 0.75 mg, injected subcutaneously (under the skin), once a week. It may be injected at any time of the day, without regard to meals. If necessary, your doctor may slowly increase the dose to a maximum of 4.5 mg once weekly. Do not change your dose unless your doctor has told you to do so. Your doctor or diabetes educator will show you how to inject this medication.

If you are also using insulin, each medication should be injected separately. Dulaglutide should be clear and colourless. Do not use this medication if you notice anything unusual in the appearance of the solution, such as cloudiness, discolouration, or clumping.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Dulaglutide is used with the guidance and supervision of a doctor. Your doctor or nurse may ask you to inject the medication at home once they have instructed you and are certain that you won't have any problems with doing it at home. Do not attempt to prepare or inject this medication on your own until you completely understand how to inject a dose.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, inject it as soon as possible and continue with your regular schedule. If it is less than 3 days until your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication in the refrigerator; do not allow it to freeze. Protect it from direct heat and light. Keep this and all medication out of the reach of children. These single-use prefilled pens and syringes may be stored at room temperature for up to 14 days.

0.75 mg/0.5 mL
Each single-use prefilled pen or prefilled syringe contains 0.75 mg of dulaglutide per 0.5 mL of solution. Nonmedicinal ingredients: trisodium citrate dehydrate, citric acid anhydrous, mannitol, and polysorbate 80 in water for injection.

1.5 mg/0.5 mL
Each single-use prefilled pen or prefilled syringe contains 1.5 mg of dulaglutide per 0.5 mL of solution. Nonmedicinal ingredients: trisodium citrate dehydrate, citric acid anhydrous, mannitol, and polysorbate 80 in water for injection.

Do not take this medication if you:

• are allergic to dulaglutide or any ingredients of the medication
• have had or have a family member who has had medullary thyroid cancer
• have multiple endocrine neoplasia syndrome type 2 (a disease where people have tumours in more than one gland in their body)
• are pregnant or breast-feeding

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• bloating
• constipation
• decreased appetite
• diarrhea
• fatigue
• gas
• heartburn
• reaction at the injection site (e.g., redness, swelling, pain)
• nausea
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• rapid or pounding heartbeat
• symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
• symptoms of a thyroid tumour (e.g., lump in neck, trouble swallowing, breathing, or hoarseness)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• symptoms of severe low blood sugar (e.g., disorientation, loss of consciousness, seizures)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health.

Diabetes identification: It is important to either wear a bracelet (or necklace) or carry a card indicating you have diabetes and are taking medication to manage your blood glucose levels.

Heart problems: This medication may increase heart rate and may affect how electrical impulses travel through the heart muscle. If you have heart disease (e.g., recent heart attack, angina, heart failure) or an abnormal heart rhythm (e.g., heart block or fast heart rate), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Intestinal problems: The safety and effectiveness of using this medication have not been established for people who have problems with slowed movement of food through the digestive tract. If you have digestive system problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: The safety and effectiveness of using this medication for people with reduced kidney function has not been studied. Ensure that you are drinking enough water to prevent dehydration if you experience nausea or vomiting with this medication. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: The safety and effectiveness of using this medication for people with reduced liver function have not been studied. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood glucose (hypoglycemia): People who use dulaglutide and are also taking a sulfonylurea (e.g., glyburide, gliclazide) or insulin to control high blood sugar are more at risk of experiencing hypoglycemia (low blood sugar). If you experience symptoms of hypoglycemia such as a cold sweat, nervousness or shakiness, fast heartbeat, headache, hunger, confusion, lightheadedness, weakness, and numbness or tingling of the tongue or lips, contact your doctor. Your doctor may need to adjust the dose of your medication(s).

Pancreatitis (inflammation of the pancreas): Dulaglutide can cause pancreatitis. If you experience symptoms of pancreatitis such as severe and persistent abdominal pain that may move to the back with or without vomiting, contact your doctor immediately. If you have previously had pancreatitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Risk of thyroid cancer: In rare cases, people have developed thyroid cancer while using dulaglutide. People with a personal or family history of thyroid cancer or people who have multiple endocrine neoplasia syndrome type 2 (a disease where people have tumours in more than one gland in their body) should not use this medication. If you develop symptoms of a thyroid tumour, such as difficulty swallowing, a mass in the neck or persistent hoarseness, contact your doctor as soon as possible.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

If you are planning to become pregnant, talk to your doctor about stopping this medication. You should not become pregnant for at least 1 month after stopping dulaglutide, to give the medication enough time to completely leave the body.

Breast-feeding: It is not known if dulaglutide passes into breast milk. If you are breast-feeding and taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between dulaglutide and any of the following:

• atypical antipsychotics (e.g., aripiprazole, cariprazine, chlorpromazine, clozapine, quetiapine, risperidone)
• basiliximab
• beta-adrenergic blockers (e.g., atenolol, metoprolol, propranolol, sotalol)
• bortezomib
• brigatinib
• buserelin
• ceritinib
• corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• dabrafenib
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, indapamide)
• dolutegravir
• epinephrine
• estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
• everolimus
• glucagon
• goserelin
• hepatitis C antivirals (e.g., glecaprevir and pibrentasvir, ledipasvir, sofosbuvir, velpatasvir, voxilaprevir)
• HIV protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir)
• hydroxychloroquine
• leuprolide
• linezolid
• lorlatinib
• megestrol
• mifepristone
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• niacin
• nilotinib
• other diabetes medications (e.g., glyburide, insulin, repaglinide)
• other GLP-1 receptor agonists
• pegvisomant
• progestins (e.g., cyproterone, desogestrel, levonorgestrel, medroxyprogesterone)
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin)
• salicylates (e.g., acetylsalicylic acid, bismuth subsalicylate)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline, vortioxetine)
• sirolimus
• somatostatin-like medications (e.g., lanreotide, octreotide, pasireotide)
• somatrogon
• somatropin
• sulfamethoxazole
• sulfadiazine
• sunitinib
• tacrolimus
• temsirolimus
• terbutaline
• tramadol
• venetoclax
• vilazodone
• vorinostat

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.