Dulaglutide (Subcutaneous)

Along with a program of diet and exercise, dulaglutide is often prescribed for Type II Diabetes patients, and it works by stimulating the pancreas to issue more insulin for controlling blood sugar levels.

Overview

Dulaglutide is a medication made available only by prescription, and can be an effective part of a treatment program for Type II Diabetes. Belonging to a group of drugs which are referred to as incretin mimetics, dulaglutide works by causing the pancreas to produce more insulin, which then helps to manage the level of blood sugar for a patient. The insulin then works to extract sugar from the bloodstream and move it into cells where it is properly used for the production of energy needed by the body.

It is an injectable medication which must be injected just under the level of the skin, so as to be optimally effective. It is normally only used once weekly, and is generally prescribed for patients who have had little or no success with other diabetes medications. It can be taken alone, or in tandem with one of several other medications, e.g. sulfonylurea, metformin, or pioglitazone.

One of the reasons that dulaglutide is not generally a first choice for doctors attempting to treat diabetes is that in rare cases, it has caused cancerous growth of the thyroid in some animals. While no reported cases of thyroid cancer exist for humans, it is still considered to be more of a ‘last resort' medication than some other diabetes treatments are. For this reason, it is not prescribed for patients who have any kind of family history of thyroid cancer.

Condition Treated

  • Type II Diabetes

Type Of Medicine

  • Incretin mimetics

Side Effects

In addition to the intended effects which dulaglutide provides to patients being treated, some people using this medication will also experience certain side effects that range in frequency and severity. One of the most severe classifications of these side effects is an allergic reaction, and this can be identified by the symptoms which are attendant upon the condition:

  • Severe itching and skin discomfort
  • Hives and/or rashes on the skin
  • Tightness in the chest or other manifestations of breathing difficulty
  • Pronounced swelling of the facial area, possibly including the tongue, lips, and throat.

If one or more of these symptoms appear after taking dulaglutide, you should seek medical attention as soon as possible, because there is a possibility that these symptoms will worsen and become extremely dangerous.

Some symptoms and side effects experienced after taking dulaglutide fall into the category of relatively mild symptoms, and require no medical attention unless they become uncomfortable enough for an individual patient, requiring some kind of medical relief. For the most part however, side effects in this class are temporary and will subside all on their own without treatment, as your body adjusts itself to the medication.

  • General feeling of weakness or lack of strength
  • Intermittent diarrhea
  • Abnormal belching
  • Acid stomach or sour stomach
  • Loss of appetite
  • Occasional indigestion or heartburn
  • Stomach cramping or discomfort.

Another class of side effects are those which are relatively infrequent in occurrence, are mild to moderate in their severity, and are primarily manifested at the injection site:

  • Numbness in the extremities
  • Body aches and pains
  • Rashes or redness on the skin surface
  • Sensation of feeling pressure on the skin
  • Inflammation or itching
  • Unexplained lumps
  • Stinging, tingling, or prickly sensation
  • Skin tenderness
  • Bleeding or blistering
  • Burning sensation or cold sensation
  • Discoloration of the skin.

The last class of side effects includes a wide range of symptoms which have been reported by patients using dulaglutide, but for which the statistical incidence is not known:

  • Yellowish tinge to the skin or around the eyes
  • Nausea and/or vomiting
  • Difficulty with breathing
  • Change in urination habits
  • Chills or cold sweats
  • Confusion or disorientation
  • Reddening of the skin primarily in the area around the ears
  • Unexplained and rapid gain of weight
  • Twitching of various muscles
  • Lumps observed around the throat and neck
  • Decrease in appetite
  • Unexplained irritability or anxiety
  • Lethargic attitude
  • Fever and/or chills
  • Hoarseness or slurred speech
  • Irregular or fast heartbeat
  • Dizziness or disorientation
  • Skin which is cool to the touch and may be pale
  • Mood swings, often with depression
  • Seizures and/or convulsions
  • Shakiness of the hands
  • Swelling around the eyes or the nostrils
  • Stomach pains, side pains, or abdominal pains, any of which can radiate toward the back
  • Sudden increase of hunger
  • Unprovoked hostility or aggressiveness
  • Swelling of the hands, ankles, or facial area.

Dosage

A standard dosage of dulaglutide for an adult patient is considered to be somewhere in the neighborhood between .75 mg and 1.5 mg, injected once per week. Your own specific dosage will depend on several factors, including exactly what medical condition you are being treated for, your physical characteristics, how well you tolerate the medication, and other things.

Since this is an injectable medication, it is to be delivered just under the skin in the abdomen, upper arm, or thigh area. The time of day for injection does not really matter, since no time of day is any more advantageous than any other. It also does not matter whether food is taken before or after an injection, since there will probably not be any impact on your stomach.

You can change the day of your self-administered dosage if need be, as long as the last dosage was administered at least three days prior - but this should not be done frequently. If a dosage is missed or forgotten about, you can self-administer as soon as you remember to do so, provided that there are at least three days before the next regularly scheduled dosage. If there are less than three days remaining before you're scheduled for another dosage of dulaglutide, then you should skip the dosage which you've missed and wait until that next regular dosage. Once you have gotten back on schedule, the normal one-week period between dosages can be resumed.

Your doctor will fully instruct you on the proper technique for self-administration at home, after demonstrating the process in a clinical setting. This will help to reduce or eliminate all the possible mistakes you might make regarding dosage, improper injection sites, and other procedural mishaps.

If you are concurrently injecting insulin in addition to dulaglutide as part of your program of treatment, these two medications should never be mixed, but should always be administered separately. It is allowable to inject both medications in the same general area of the body, e.g. the upper arm, but the two should never be adjacent to each other.

If you are injecting in the same area on the body for two or more weeks in a row, you should be careful to use a different injection site in the area. Caution must be taken to ensure the medication is delivered just under the skin and not intravenously or into a muscle.

Before self-administering, be sure to check the dulaglutide solution to make sure there are no floating particles, and that there is no unanticipated discoloration of the solution. Both of these are signs that the medication has been corrupted, or is otherwise unusable as treatment for your condition.

If you somehow over-administer the medication and are aware that you've taken too much, either call your doctor right away or call the Poison Control Center and ask for instructions. Be prepared in either case to relate to them exactly how much medication you've taken, and what the exact time of day was.

Interactions

There are a number of interactions with other medications, with food, and with other medical conditions that are possible when you are taking dulaglutide as part of your treatment program. Because there is a good possibility that this medication will interact with others, you should prepare a complete list of all the medications you are currently taking, including other prescription drugs, over-the-counter drugs, herbal supplements, and vitamins, as well as all the dosages of each.

Your doctor will be able to review this list and determine if there is a potential for interaction with any of the medications you currently use. If there are potential conflicts, he/she may recommend that you reduce dosages of some of the medications or temporarily discontinue your usage of them while being treated with dulaglutide. This list of medications will also be very useful if you have a need to visit a healthcare clinic or an emergency room for some unanticipated medical condition. Unless your primary care doctor is there at the time you visit, any other doctor there will not be aware of your medication usage, so this list will provide all the information needed. That will allow the emergency room doctor to safely prescribe treatment for whatever medical condition brought you into the emergency room.

If you are taking any other medications for the treatment of diabetes, you should let your doctor know about this especially if you're using insulin or sulfonylureas. Since dulaglutide slows the emptying of the stomach, it will be very likely to have an impact on other medications which are intended to progress quickly through the stomach. If you're taking any drugs which require regular monitoring of blood levels, your doctor may want to personally stay aware of all your other medication usage.

There are known to be more than 600 medications which have a recognizable and known interaction with dulaglutide, with a few of the most common ones listed below:

  • Alcohol
  • Aspirin
  • Unisom sleep gels
  • Vitamin B12
  • Vitamin D3
  • Desogen
  • Eliquis
  • Omega-3 polyunsaturated fatty acids
  • Farxiga
  • Ethyl alcohol
  • Lantus
  • Senna S
  • Wellbutrin XL
  • Ventolin HFA
  • Ultram
  • Synthroid
  • Invokana
  • Multivitamins with high potency B complex, B12, and C.

There are also four medical conditions which are impacted by the use of dulaglutide, and if you have any of these, your doctor may consider alternative treatment:

  • Renal dysfunction
  • Thyroid carcinoma
  • Gastroparesis
  • Pancreatitis

Warnings

There are a few serious warnings and/or precautions which are associated with a program of treatment which calls for dulaglutide. There is an increased risk of having low blood sugar in your system, especially if you are taking another medication that can trigger low blood sugar, e.g. sulfonylurea. If you're taking this medication concurrently with dulaglutide, your doctor is likely to want to reduce the dosage of sulfonylurea, especially if you exhibit any of the following symptoms:

  • Sweating
  • Jittery feelings
  • Increased hunger
  • Irregular or pounding heartbeat
  • Abnormal irritability
  • Disorientation or confusion
  • Sudden weakness
  • Drowsiness
  • Headaches

There is a potential for dulaglutide to trigger new kidney problems or worsen existing ones, including a complete failure of your kidneys. This may even become severe enough that dialysis or a kidney transplant become necessary to restore health. Some of the most obvious signs of an impact on your kidneys will include the following:

  • Severe nausea
  • Persistent vomiting
  • Diarrhea that is chronic in nature

Some patients have reported allergic reactions to using dulaglutide, and if this happens to you, you should immediately discontinue usage of the medication and seek medical attention at the earliest possible juncture. You should never use this medication if you have previously had an allergic reaction to it or any of the ingredients used in its manufacture. Some of the most recognizable symptoms of an allergic reaction are as follows:

  • Extreme itchiness
  • Dizziness or disorientation
  • Hives and/or rashes appearing on the skin
  • Tightness in the area of the chest
  • Other difficulties with breathing
  • Pronounced swelling in the facial area, especially in the tongue, lips, or throat

If left untreated, these symptoms may worsen into a very serious situation, and have even been known to become life-threatening, so urgency is required if these symptoms appear after taking dulaglutide.

It is also possible for dulaglutide to trigger an inflammation of the pancreas, a condition known as pancreatitis. This too can degenerate into a life-threatening situation, and is another scenario which calls for urgent medical attention. One of the best indicators of pancreatitis is extreme stomach pain, accompanied by powerful vomiting episodes. Some of the medical conditions which generally preclude the usage of dulaglutide as a program of treatment include the following:

  • Pre-existing gastrointestinal disease, because dulaglutide has been associated historically with the potential for adverse gastrointestinal effects which can become extremely severe
  • Allergies to dulaglutide
  • Type I diabetes which makes you dependent upon insulin
  • Personal history or family history of medullary thyroid carcinoma
  • Personal or family history of multiple endocrine neoplasia syndrome type II.

There are no well-controlled studies which have been conducted on the usage of dulaglutide by women who are pregnant, and that makes it inadvisable to use this medication if you are pregnant, or are thinking of becoming pregnant. Studies performed on animal populations suggest that dulaglutide may have negative impacts on an unborn fetus, especially in the areas of macrosomia-related morbidity, stillbirth, and birth defects. Women who are considering pregnancy should have a thorough discussion with their doctors about the risks vs. benefits of taking dulaglutide during pregnancy.

While it is not known if there are any adverse effects from dulaglutide which are passed on to a nursing infant, it is known that the medication does pass through breast milk, which means that an infant will be ingesting trace amounts of the medication. That makes it inadvisable to breast-feed while taking this drug.

Storage

When you are self-administering this medication at home, you will need to understand and observe proper storage methods, so that the medication is not degraded in any way prior to usage. It should be refrigerated at all times until prior to usage, at a temperature between 36 degrees Fahrenheit and 46 degrees Fahrenheit.

If you have the single-dosage pens or syringes which are pre-filled, these can be kept at room temperature safely for up to 14 days, provided that the room temperature does not exceed 86 degrees Fahrenheit. These single-dosage pens or pre-filled syringes should always be discarded in a puncture-proof container after usage, so they cannot be tampered with or re-used.

This medication should never be frozen, and if you are aware that it was frozen at some point, it should be discarded and not used. It should be kept out of direct light, and stored in its original container until the time of administration. This medication should be kept out of the reach of children at all times, and if children have access to the refrigerator where dulaglutide is being stored, they should be well instructed about the importance of leaving the medication untouched. It might be advisable to procure a small, lockable mini-refrigerator which can be used exclusively for the storage of this medication, and to prevent unwanted access.

Summary

Dulaglutide is an injectable medication which must be delivered subcutaneously in the areas of the upper arm, thigh, or abdomen at a frequency of once per week. Your doctor will prescribe a dosage for your specific condition, but this will often be within the range of .75 mg to 1.5 mg, and may or may not be prescribed in tandem with other medications.

The primary medical condition which is being treated with dulaglutide is Type II Diabetes, and it is effective in helping manage this disease because it can stimulate the pancreas into greater production of insulin, which manages the level of blood sugar. With more insulin available in the body, blood sugar can be more effectively removed from the bloodstream and re-directed into the cells of the body, where it can be used as an energy source.

There are a number of other medications which dulaglutide may potentially interact with, several hundred as a matter of fact, so it will be necessary for your primary care doctor to review a list of any medications you are taking, to ensure that taking dulaglutide does not conflict with any other treatment you may be receiving.

Several medical conditions can be impacted by taking dulaglutide, and that means you should not take this medication if you have any of these pre-existing medical conditions. Included in this grouping are renal dysfunction, pancreatitis, gastroparesis, and thyroid carcinoma. Anyone who has previously had an allergic reaction to taking dulaglutide or any of the ingredients used to make it should not take this drug.