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Indications and Dosage
Subcutaneous
Adjunct to type 2 diabetes mellitus Adult: Initially, 0.75 mg once weekly, may increase dose up to 1.5 mg once weekly, if glycaemic control is not optimal. Missed dose: ≤3 days: Administer as soon as possible. >3 days: Skip the missed dose and wait until the next scheduled dose.
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Administration
May be taken with or without food.
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Contraindications
Personal or family history of medullary thyroid carcinoma (MTC), patient with multiple endocrine neoplasia syndrome type 2 (MEN 2).
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Special Precautions
Patient with history of hypersensitivity, pancreatitis, severe gastrointestinal disease (e.g. gastroparesis) and those at risk for developing conduction abnormalities (e.g. ischaemic heart disease, cardiomyopathies). Not intended for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Renal and hepatic impairment. Pregnancy and lactation.
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Adverse Reactions
Significant: Acute pancreatitis, severe gastroparesis, hypoglycaemia, serious hypersensitivity reactions (e.g. anaphylaxis, angioedema), tachycardia, thyroid tumours.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, constipation, dyspepsia, flatulence, abdominal pain or discomfort, GERD. General disorders and administration site conditions: Inj site pain, pruritus, erythema. Metabolism and nutrition disorders: Decreased appetite. Nervous system disorders: Fatigue. |
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Patient Counseling Information
Rotate injection sites within the same body region and use a new needle for each injection. When used in combination with other antidiabetic agents, this drug may cause hypoglycaemia, if affected, do not drive or operate machinery.
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Monitoring Parameters
Monitor serum glucose, HbA1c, renal function, signs and symptoms of pancreatitis.
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Overdosage
Symptoms: Gastrointestinal disorders (e.g. nausea vomiting), hypoglycaemia. Management: Supportive treatment.
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Drug Interactions
Increased risk of hypoglycaemia with sulfonylureas or insulin. May delay gastric emptying and reduce the rate of absorption of oral medications.
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Action
Description: Dulaglutide is an analogue of glucagon-like peptide-1 (GLP-1), an incretin hormone linked to a modified human Ig G4 fragment and act as GLP-1 receptor agonist. Activation of GLP-1 stimulates insulin release by increasing intracellular cyclic AMP (cAMP) in pancreatic beta cells and suppression of glucagon secretion in a glucose-dependent manner. It also slows gastric emptying thus reduces postprandial glucose (PPG) concentration.
Pharmacokinetics: Absorption: Absolute bioavailability: 47-65%. Time to peak plasma concentration: Approx 24-72 hours. Distribution: Volume of distribution: Approx 17-19 L. Metabolism: Undergoes degradation into amino acids by general protein catabolism pathways. Excretion: Elimination half-life: Approx 5 days. |
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Storage
Unopened preparation: Store between 2-8°C. Do not freeze. Protect from light. Once opened: Store below 30°C for up to 14 days.
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MIMS Class
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ATC Classification
A10BJ05 - dulaglutide ; Belongs to the class of glucagon-like peptide-1 (GLP-1) analogues. Used in the treatment of diabetes.
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References
Anon. Dulaglutide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/03/2018. Buckingham R (ed). Dulaglutide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018. Joint Formulary Committee. Dulaglutide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018. McEvoy GK, Snow EK, Miller J et al (eds). Dulaglutide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 05/03/2018. Trulicity Injection, Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/03/2018.
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