GLP-1 Receptor Agonist Pregnancy: Avoid — insufficient data; switch to insulin

Dulaglutide

Brand names: Trulicity

Adult dose

Dose: 0.75 mg SC once weekly. Increase to 1.5 mg SC once weekly after 4 weeks (max). Higher doses (3 mg and 4.5 mg) available.

Route: Subcutaneous injection (abdomen, thigh, or upper arm)

Frequency: Once weekly (same day each week)

Max: 4.5 mg once weekly

REWIND trial: CV outcome benefit in T2DM. Single-use auto-injector pen — no mixing required. AWARD programme demonstrated efficacy across T2DM spectrum.

Paediatric dose

Route: Subcutaneous

Frequency: Once weekly

Max: Not licensed in children

Concentration: 0.75 mg/0.5 mL or 1.5 mg/0.5 mL pen mg/ml

No established paediatric dosing

Dose adjustments

Renal

No dose adjustment required for any degree of renal impairment

Hepatic

No dose adjustment required

Clinical pearls

Once-weekly dosing improves adherence vs daily GLP-1 RAs
REWIND: reduced MACE in T2DM with more heterogeneous CV risk population vs LEADER/SUSTAIN-6
No significant renal dose adjustment — can use across eGFR range (supported by REWIND sub-analysis)
Ready-to-use auto-injector — most convenient GLP-1 RA for patients with dexterity issues

Contraindications

Personal or family history of medullary thyroid cancer
MEN-2 syndrome
Diabetic ketoacidosis

Side effects

Nausea (common, especially early)
Diarrhoea
Vomiting
Decreased appetite
Pancreatitis (rare)
Bradycardia
Injection site reactions

Interactions

Oral medications — delayed gastric emptying reduces rate of oral drug absorption
Insulin/sulfonylureas — increased hypoglycaemia risk

Monitoring

HbA1c
Weight
Blood pressure
Signs of pancreatitis
GI tolerability (especially first weeks)

Reference: BNFc; REWIND Trial (Gerstein et al, Lancet 2019); BNF; NICE NG28. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Myasthenia Gravis Activities of Daily Living (MG-ADL) Scale · Neuromuscular

Drugs

Pathways