dulaglutide

dulaglutide

(doo-la-gloo-tide ),

Trulicity

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: glucagon like peptide 1 glp 1 receptor agonists
Pregnancy Category: C

Indications

Adjunct treatment to diet and exercise in the management of adults with type 2 diabetes mellitus; not recommended as first line therapy, as a substitute for insulin, in patients with type 1 diabetes, or for ketoacidosis.

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.

Pharmacokinetics

Absorption: 0.75 mg dose—65% absorbed following subcutaneous administration; 1.5 mg dose—47% absorbed following subcutaneous administration.
Distribution: Unknown.
Metabolism and Excretion: Degraded by protein catabolic processes.
Half-life: 5 days.

Time/action profile (↓ in HbA1c)

ROUTEONSETPEAKDURATION
subcutwithin 4 wk13 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Personal or family history of medullary thyroid carcinoma (MTC)/multiple endocrine neoplasia syndrome type 2 (MEN 2) ;Type 1 diabetes; Diabetic ketoacidosis; Severe gastrointestinal disease (including severe gastroparesis); Lactation: Avoid use; Pediatric: Not recommended.
Use Cautiously in: History of pancreatitis;History of angioedema to another GLP-1 receptor agonist; Hepatic/renal impairment; Obstetric: Use only if potential benefit justifies potential risk to fetus.

Adverse Reactions/Side Effects

Central nervous system

  • fatigue

Dermatologic

  • pruritis
  • rash

Endocrinologic

  • thyroid C-cell tumors (life-threatening)

Gastrointestinal

  • pancreatitis (life-threatening)
  • diarrhea
  • nausea (most frequent)
  • abdominal pain (most frequent)
  • ↓ appetite
  • dyspepsia
  • vomiting (most frequent)
  • constipation

Genitourinary

  • acute renal failure

Local

  • hypersensitivity reactions including anaphylaxis and angioedema (life-threatening)
  • injection site reactions

Interactions

Drug-Drug interaction

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 concomitantly administered oral medications due to delayed gastric emptying.

Route/Dosage

Subcutaneous (Adults) 0.75 mg once weekly; may be increased to 1.5 mg once weekly to obtain glycemic control.

Availability

Solution for subcutaneous injection: 0.75 mg/0.5 mL single-dose pen, 0.75 mg/0.5 mL single-dose prefilled syringe, 1.5 mg/0.5 mL single use pen, 1.5 mg/0.5 mL single-dose prefilled syringe

Nursing implications

Nursing assessment

  • Observe patient taking concurrent insulin for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety, headache, blurred vision, slurred speech, irritability).
  • If thyroid nodules or elevated serum calcitonin are noted, patient should be referred to an endocrinologist.
  • Monitor for pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting). If pancreatitis is suspected, discontinue dulaglutide; if confirmed, do not restart dulaglutide.
  • Lab Test Considerations: Monitor serum HbA1c periodically during therapy to evaluate effectiveness.
    • May ↑ lipase and pancreatic amylase.

Potential Nursing Diagnoses

Imbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
  • Subcutaneous: Administer once daily at any time of the day, without regard to food. Day of week may be changed as long as at least 72 hr before next dose. Inject into abdomen, thigh, or upper arm. Solution should be clear and colorless; do not administer solutions that are discolored or contain particulate matter.

Patient/Family Teaching

  • Instruct patient on use of pen and to take dulaglutide as directed. Follow manufacturer's instructions for pen use. 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 Patient Medication Guide before starting dulaglutide and with each Rx refill in case of changes.
  • Take missed dose as soon as remembered as long as 3 days (72 hr) until next scheduled dose. If less than 3 days until next scheduled dose, skip and take next scheduled dose.
  • Inform patient that nausea is the most common side effect, but usually decreases over time.
  • Advise patient taking insulin and dulaglutide to never mix insulin and dulaglutide together. Give as 2 separate injections. Both injections may be given in the same body area, but should not be given 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 with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp 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 hypoglycemic or hyperglycemic episodes.
  • 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 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 discontinue dulaglutide and health care professional immediately if signs of pancreatitis (nausea, vomiting, abdominal pain) 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 if signs of 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 treatment or surgery.
  • Insulin is the preferred method of controlling blood glucose during pregnancy. Counsel female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
  • Emphasize the importance of routine follow-up exams.

Evaluation/Desired Outcomes

  • Improved glycemic control.
References in periodicals archive ?
The safety and tolerability profile of the investigational dulaglutide doses was consistent with the known profile of Trulicity 1.5 mg.
In this 5-year double-blind, placebo-controlled doi: 10.1016/S0140- study conducted at 371 sites in 24 countries, 6736(19)31149-3 nearly 10,000 patients aged at least 50 years with type 2 diabetes and either a previous cardiovascular event or cardiovascular risk factors were randomly assigned to either weekly subcutaneous injection of dulaglutide (Trulicity) or placebo.
In this 5-year double-blind, doi: placebo-controlled study conducted at 10.1016/S0140-6736(19)31149-3 371 sites in 24 countries, nearly 10,000 patients aged at least 50 years with type 2 diabetes and either a previous cardiovascular event or cardiovascular risk factors were randomly assigned to either weekly subcutaneous injection of dulaglutide (Trulicity) or placebo.
A 24-week study to evaluate the efficacy and safety of once-weekly dulaglutide added on to glimepiride in type 2 diabetes (AWARD-8).
In the PIONEER programme, people treated with oral semaglutide demonstrated greater HbA1c reductions and weight loss in all completed head-to-head trials versus sitagliptin, empagliflozin, liraglutide and dulaglutide, at the end of the trials.
Tenders are invited for Supply of Dulaglutide 0.75mg !nj
He then discussed the cardiovascular safety of Dulaglutide and the cardiovascular benefits of GLP-1 in detail.
Global health care company Novo Nordisk A/S (CPH:NOVOB) reported on Thursday headline results from PIONEER 10, a phase 3a trial with oral semaglutide vs once-weekly subcutaneous dulaglutide, both in combination with one oral antidiabetic drug in Japanese adults with type 2 diabetes.
The long-acting GLP-1RAs (albiglutide, dulaglutide, exenatide once-weekly, liraglutide, and semaglutide), which have a greater effect on stimulating insulin secretion and inhibiting glucagon secretion, produce strong reduction of FPG and modest reduction of postprandial glucose (PPG).
Compared to other antidiabetic agents (sitagliptin, exenatide, liraglutide, dulaglutide, and insulin glargine), both doses of semaglutide demonstrated superior glycemic efficacy.
GLP-1 receptor agonists, such as exenatide, liraglutide, and dulaglutide, directly stimulate pancreatic beta-cells to release insulin [92].