Generic Name

Dulaglutide

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Classification

FDA Approved Indications

• Adults with type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Dulaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that enhances glucose-dependent insulin secretion, suppresses inappropriate glucagon secretion, and slow gastric emptying, leading to improved glycemic control.

Dosage and Administration

Adult: Initially 0.75 mg once weekly, titrating up to 1.5 mg once weekly based on response; may increase to 3 mg or 4.5 mg per week for additional glycemic control.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution due to potential for renal impairment and other comorbidities; no specific dose adjustment guidelines, start at lower dose if needed.

Renal Impairment: Use with caution in patients with renal impairment; no specific dose adjustment for mild to moderate impairment but monitor closely.

Hepatic Impairment: No dose adjustment required.

Pharmacokinetics

Absorption: Bioavailability approximately 100% after subcutaneous administration.

Distribution: Large volume of distribution; approximately 0.17 L/kg.

Metabolism: Degraded by proteolytic cleavage and excretion of metabolites; not metabolized by CYP enzymes.

Excretion: Excreted primarily via renal pathways as metabolites.

Half Life: Approximately 5 days, allowing once-weekly dosing.

Contraindications

• Personal or family history of medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome type 2

Precautions

• Use with caution in patients with gastroparesis, renal impairment, or a history of pancreatitis. Monitor for signs of pancreatitis and hypersensitivity reactions.

Adverse Reactions - Common

• Nausea (Common)
• Diarrhea (Common)
• Vomiting (Common)
• Abdominal pain (Common)

Adverse Reactions - Serious

• Pancreatitis (Rare)
• Serious allergic reactions including anaphylaxis (Rare)
• Thyroid tumors (including MTC) (Rare)

Drug-Drug Interactions

• Other medications affecting gastrointestinal motility or blood glucose levels, such as insulin or sulfonylureas, may increase risk of hypoglycemia.
• Potential interactions with medications that are substrates of CYP enzymes are minimal due to its metabolism pathway.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take the medication exactly as prescribed, once weekly.
• Report any severe abdominal pain, persistent nausea, or vomiting.
• Be aware of symptoms of hypoglycemia and how to treat it.
• Importance of regular blood glucose monitoring.

Special Considerations

Black Box Warnings:

• Thyroid C-cell tumors, including MTC, have been reported in rodents; human risk is unknown.
• Patients should be informed of the potential risk and advised to report any symptoms of thyroid tumors.
• Use with caution in patients with a personal or family history of medullary thyroid carcinoma or MEN 2.

Genetic Factors: Rodent studies indicate potential risk, but no clear genetic factors identified in humans.

Lab Test Interference: May cause slight increases in pancreatic enzymes; routine testing recommended for pancreatitis suspicion.

Overdose Management

Signs/Symptoms: Nausea, vomiting, diarrhea, hypoglycemia; may also experience severe hypoglycemia if combined with other antidiabetic drugs.

Treatment: Supportive care, monitor blood glucose levels, and manage hypoglycemia with appropriate measures such as glucose administration.

Storage and Handling

Storage: Store in a refrigerator (36°F to 46°F / 2°C to 8°C). Do not freeze.

Stability: Stable up to 14 days at room temperature after first use; discard after the expiration date.