Trulicity, known generically as dulaglutide, is a medication primarily prescribed for managing type 2 diabetes and reducing cardiovascular mortality. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. While not explicitly approved by the Food and Drug Administration (FDA) for weight loss, Trulicity has garnered attention for its potential to aid in weight management. This article delves into how Trulicity works, its effectiveness for weight loss, usage guidelines, potential side effects, and interactions, providing a comprehensive overview for those considering or currently using this medication.
What is Trulicity?
Trulicity contains the active ingredient dulaglutide, which is a human glucagon-like peptide-1 (GLP-1) receptor agonist. It is available as an injection in single-dose pens with strengths of 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg, designed for subcutaneous administration. This formulation includes inactive ingredients like citric acid anhydrous, mannitol, polysorbate 80, and trisodium citrate dihydrate.
Trulicity (dulaglutide) is a prescription antidiabetic injectable medication that belongs to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1). It is officially approved for the treatment of Type 2 diabetes in combination with diet and exercise and for the reduction of cardiovascular mortality. Eli Lilly and Company is the manufacturer of Trulicity.
GLP-1 receptor agonists have been shown to lower hemoglobin A1C, an indicator of long-term blood glucose control, by up to 1.6%. Other biological effects of GLP-1 receptor agonists related to the treatment of Type 2 Diabetes Mellitus include improved insulin sensitivity, decreased glucagon concentrations, delayed gastric emptying, increased satiety (feeling of fullness), and decreased body weight.
How Trulicity Works for Weight Loss
Trulicity mimics the natural incretin hormones produced by the body, which signal to the brain, endocrine, and gastrointestinal systems that food has been consumed. This leads to a complex cascade of hormones and neurotransmitters, effectively communicating feelings of satiety and slowing down the rate at which food leaves the stomach, making you feel fuller for longer.
Read also: Choosing Between Trulicity and Victoza
In addition, GLP-1 medications can improve blood sugar levels in people living with impaired glucose tolerance or diabetes. As explained by the manufacturer, Trulicity helps your pancreas release insulin in response to high levels of sugar in your blood after you eat and can limit how much sugar gets into your blood from your liver.
When combined with healthy lifestyle choices, like small changes to food and exercise, Trulicity has shown promise in helping people lose weight. It is particularly effective when used in conjunction with a holistic program that helps you make steady adjustments to your lifestyle to promote metabolic health.
Clinical Studies on Trulicity for Weight Loss
Several clinical studies have explored the effects of Trulicity (dulaglutide) on weight loss. Below are some of the key findings from notable studies:
AWARD-11 Clinical Trial (2018-2020)
The AWARD-11 trial was conducted between 2018 and 2020 to evaluate the effects of different doses of Trulicity on weight and glycemic control in patients with type 2 diabetes. The study compared 1.5 mg, 3 mg, and 4.5 mg doses of Trulicity over 52 weeks. Results showed that patients taking the higher doses (3 mg and 4.5 mg) experienced greater weight loss compared to those on the standard 1.5 mg dose. Specifically:
- The 4.5 mg group lost an average of 4.7 kg (10.4 lbs).
- The 3 mg group lost an average of 3.7 kg (8.2 lbs).
- The 1.5 mg group lost an average of 2.7 kg (6 lbs).
AWARD-6 Trial (2012-2014)
The AWARD-6 trial took place from 2012 to 2014, comparing Trulicity (dulaglutide) 1.5 mg with another GLP-1 medication, liraglutide (brand names Saxenda and Victoza) 1.8 mg over 26 weeks in patients with type-2 diabetes. While the primary goal was to assess blood sugar control, weight loss was also evaluated. Both medications resulted in modest weight loss:
Read also: Using Trulicity for Weight Management
- Trulicity (dulaglutide) users lost an average of 2.9 kg (6.4 lbs).
- Liraglutide users lost an average of 3.6 kg (7.9 lbs).
REWIND Study (2011-2018)
The REWIND study, conducted from 2011 to 2018, evaluated the long-term cardiovascular outcomes of Trulicity (dulaglutide) in people with type 2 diabetes, with weight loss as a secondary outcome. Over a median of 5.4 years, patients taking Trulicity experienced a modest but sustained weight loss of around 1.5 kg (3.3 lbs) compared to the placebo group.
How to Use Trulicity
This medication is injected under the skin. You will be taught how to prepare and give it. Take it as directed on the prescription label on the same day of each week. Do NOT prime the pen. Keep taking it unless your care team tells you to stop.
If you use this medication with insulin, you should inject this medication and the insulin separately. Do not mix them together. Do not give the injections right next to each other. Change (rotate) injection sites with each injection.
This medication comes with INSTRUCTIONS FOR USE. Ask your pharmacist for directions on how to use this medication. Read the information carefully. Talk to your pharmacist or care team if you have questions.
It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or care team to get one.
Read also: The Truth About Trulicity for Weight Loss
A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.
Talk to your care team about the use of this medication in children. While it may be prescribed for children as young as 10 years for selected conditions, precautions do apply.
Missed Dose
If you miss a dose, take it as soon as you can unless it is more than 3 days late. If it is more than 3 days late, skip the missed dose. Take the next dose at the normal time.
Storage
Keep out of the reach of children and pets.
- Refrigeration (preferred): Store unopened pens in a refrigerator between 2 and 8 degrees C (36 and 46 degrees F). Keep it in the original carton until you are ready to take it. Do not freeze or use if the medication has been frozen. Protect from light. Get rid of any unused medication after the expiration date on the label.
- Room Temperature: The pen may be stored at room temperature below 30 degrees C (86 degrees F) for up to a total of 14 days if needed. Protect from light. Avoid exposure to extreme heat. If it is stored at room temperature, throw away any unused medication after 14 days or after it expires, whichever is first.
To get rid of medications that are no longer needed or have expired: Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location. If you cannot return the medication, ask your pharmacist or care team how to get rid of this medication safely.
Potential Side Effects
Side effects that you should report to your care team as soon as possible:
- Allergic reactions-skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- Dehydration-increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Kidney injury-decrease in the amount of urine, swelling of the ankles, hands, or feet
- Pancreatitis-severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Thyroid cancer-new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Diarrhea
- Loss of appetite
- Nausea
- Upset stomach
This list may not describe all possible side effects. Call your doctor for medical advice about side effects.
The most common side effects of Trulicity (dulaglutide) are:
- Nausea
- Constipation
- Diarrhea
- Stomach discomfort
- Vomiting
- Decreased appetite
- Indigestion
- Fatigue
The good news is that, in most cases, these side effects will go away between 3-4 weeks after starting the medication. According to the manufacturer, Eli Lilly, 8% to 29% using Trulicity experienced some nausea, which typically occurred during the first 2 to 3 days after they took their first dose. Nausea generally subsided after the first 2 weeks, but some people experienced nausea with Trulicity beyond their second week of treatment. Less than 2% needed to stop taking Trulicity because of nausea.
Managing Side Effects
Here are some tips for reducing nausea and stomach discomfort with Trulicity:
- Eat blander foods
- Refrain from eating fatty, processed, or greasy foods
- Eat smaller meals or stick to smaller portion sizes
- Do your best to stay active
Talk to your health care provider about any side effects of Trulicity that become bothersome or that don’t go away. If you experience any allergic reaction such as anaphylaxis or shortness of breath, please seek immediate medical care.
Precautions
They need to know if you have any of these conditions:
- Eye disease caused by diabetes
- Gallbladder disease
- Have or have had pancreatitis
- Having surgery
- Kidney disease
- Liver disease
- Personal or family history of MEN 2, a condition that causes endocrine gland tumors
- Personal or family history of thyroid cancer
- Stomach or intestine problems, such as problems digesting food
- An unusual or allergic reaction to dulaglutide, other medications, foods, dyes, or preservatives
- Pregnant or trying to get pregnant
- Breastfeeding
Drug Interactions
Other medications for diabetes
Many medications may cause changes in blood sugar, these include:
- Alcohol
- Antiviral medications for HIV or AIDS
- Aspirin and aspirin-like medications
- Certain medications for blood pressure, heart disease, irregular heartbeat
- Chromium
- Diuretics
- Estrogen or progestin hormones
- Fenofibrate
- Gemfibrozil
- Isoniazid
- Lanreotide
- MAOIs, such as Carbex, Eldepryl, Marplan, Nardil, or Parnate
- Medications for allergies, asthma, cold, or cough
- Medications for mental health conditions
- Medications for weight loss
- Niacin
- Nicotine
- NSAIDs, medications for pain and inflammation, such as ibuprofen or naproxen
- Octreotide
- Pasireotide
- Pentamidine
- Phenytoin
- Probenecid
- Quinolone antibiotics such as ciprofloxacin, levofloxacin, or ofloxacin
- Some herbal dietary supplements
- Steroid medications, such as prednisone or cortisone
- Sulfamethoxazole; trimethoprim
- Testosterone or anabolic steroids
- Thyroid hormones
Some medications can hide the warning symptoms of low blood sugar (hypoglycemia). You may need to monitor your blood sugar more closely if you are taking one of these medications. These include:
- Beta blockers, such as atenolol, metoprolol, or propranolol
- Clonidine
- Guanethidine
- Reserpine
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
Important Considerations
Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.
You may need blood work done while you are taking this medication. Your care team will monitor your HbA1C (A1C). This test shows what your average blood sugar (glucose) level was over the past 2 to 3 months.
Know the symptoms of low blood sugar and know how to treat it. Always carry a source of quick sugar with you. Examples include hard sugar candy or glucose tablets. Make sure others know that you can choke if you eat or drink if your blood sugar is too low and you are unable to care for yourself. Get medical help at once.
Tell your care team if you have high blood sugar. Your medication dose may change if your body is under stress. Some types of stress that may affect your blood sugar include fever, infection, and surgery.
Do not share pens or cartridges with anyone, even if the needle is changed. Each pen should only be used by one person. Sharing could cause an infection.
Wear a medical ID bracelet or chain. Carry a card that describes your condition. List the medications and doses you take on the card.
Talk to your care team about your risk of cancer. You may be more at risk for certain types of cancer if you take this medication. Talk to your care team right away if you have a lump or swelling in your neck, hoarseness that does not go away, trouble swallowing, shortness of breath, or trouble breathing.
Make sure you stay hydrated while taking this medication. Drink water often. Eat fruits and veggies that have a high water content. Drink more water when it is hot or you are active. Talk to your care team right away if you have fever, infection, vomiting, diarrhea, or if you sweat a lot while taking this medication. The loss of too much body fluid may make it dangerous for you to take this medication.
If you are going to need surgery or a procedure, tell your care team that you are taking this medication.
Do not take this medication without first talking to your care team if you may be or could become pregnant. Your care team can help you find the option that works for you. Weight loss is not recommended during pregnancy. Maintaining healthy blood sugar levels can help reduce the risk of pregnancy complications.
Talk to your care team if you are breastfeeding. When recommended, this medication may be taken. Its use during breastfeeding has not been well studied. Lactation may help lower your blood sugar levels. Your care team may recommend changes to your treatment plan.
This medication may increase the risk of thyroid tumors or cancer. Do not take this medication if you or a family member has or have had multiple endocrine neoplasia (MEN) 2 or a type of thyroid cancer called medullary thyroid carcinoma (MTC).
Trulicity vs. Other Medications
Trulicity vs. Ozempic
Alternatives like Ozempic (semaglutide) have been compared to Trulicity. Ozempic (semaglutide) is approved with an indication for weight loss.
Trulicity vs. Victoza
Victoza (liraglutide) was compared to Trulicity in the AWARD 6 trial, and the study found that the weight loss associated with Victoza was significantly better than that associated with Trulicity.
Trulicity vs. Metformin
Metformin, a prescription diabetes drug in the sulfonylureas class, is typically the first-line treatment for Type 2 diabetics and has also been linked to weight loss, though it is not approved for it. The AWARD 3 trial showed similar rates of weight loss between Trulicity and metformin-treated patients.
Trulicity vs. Mounjaro and Zepbound
Mounjaro, in addition to its function of mimicking GLP-1, also mimics the actions of GIP and is a dual-action type 2 diabetes and weight-loss injection. The tirzepatide compound first came to market under the name Mounjaro, and it is a glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 in one single molecule. Mounjaro’s FDA approval was for diabetes only, and Zepbound came to market later with approval for weight loss. Zepbound shows superior blood glucose control and weight loss compared to Trulicity.