A weekly GLP-1 receptor agonist: two modified GLP-1 chains fused to part of an antibody, which keeps it in the blood for about 5 days. It lowers blood sugar, slows stomach emptying and modestly reduces appetite and weight.
Evidence. FDA-approved since 2014 as Trulicity, a weekly pen for type 2 diabetes in adults and, since 2022, children 10 and older. In REWIND (9,901 adults, median 5.4 years) heart attack, stroke or heart death fell to 12.0% from 13.4% on placebo, and lowering that risk became a labeled use in 2020. It isn’t approved for weight loss.
What it’s used for
Approved uses first, then uses tested in people, then claims that rest on animal studies or user reports.
Type 2 diabetes
LabelTrulicity is approved for adults and children 10 and older. Added to metformin for 26 weeks, HbA1c, a 3-month blood sugar average, fell 1.0–1.2 points vs a 0.1 rise on placebo.
Lowering heart attack and stroke risk
LabelApproved for adults with type 2 diabetes and heart disease or several risk factors. In REWIND (9,901 adults, median 5.4 years), heart attack, stroke or heart death: 12.0% vs 13.4% on placebo.
Kidney disease in type 2 diabetes
TrialNot an approved use: in an exploratory REWIND analysis, heavy urine protein, a 30% kidney-function drop or dialysis hit 17.1% vs 19.6% on placebo, mostly through fewer urine-protein cases.
Weight loss
TrialModest, never approved for it: in type 2 diabetes, weight fell 4.6 kg on 4.5 mg vs 3.0 kg on 1.5 mg over 36 weeks (AWARD-11). It hasn’t been developed for obesity alone.
Slowing memory and thinking decline
TrialUnproven: in an exploratory REWIND analysis of 8,828 people over 5.4 years, the main result wasn’t significant; after adjusting for baseline scores, substantial decline was 14% less likely.
Cutting alcohol use
TrialUnproven: in a secondary analysis of a 12-week smoking-cessation trial, the 151 participants who drank and finished treatment drank 29% less on dulaglutide than on placebo.
Quitting smoking
TrialNot shown: in a 12-week trial of 255 smokers also taking varenicline, 63% on dulaglutide vs 65% on placebo had quit, though weight fell 1.0 kg instead of rising 1.9 kg.
Label: an approved use. Trial: tested in people, with the result.
Approved in the US as Trulicity (BLA 125469, September 2014) for type 2 diabetes in adults and children 10 and older (2022), and to lower heart attack and stroke risk in adults with type 2 diabetes (2020). All four pen strengths are listed as marketed; dulaglutide isn’t on FDA’s drug shortage list (October 2026).
Approval history
2014US FDA: Trulicity: type 2 diabetes in adults
2014EU (EMA): Trulicity: type 2 diabetes in adults
2020US FDA: Trulicity: lowering heart attack and stroke risk in type 2 diabetes
2022US FDA: Trulicity: type 2 diabetes in children 10 and older
European Union
EMA-authorized, prescription only: Trulicity (November 2014) for type 2 diabetes in adults and children 10 and older. EMA marked its supply shortage resolved in February 2026.
United Kingdom
Prescription-only medicine licensed by the MHRA: Trulicity 0.75, 1.5, 3 and 4.5 mg pens (PLGB 14895/0259–0262) for type 2 diabetes; product information updated June 2026.
Canada
Prescription drug: Trulicity 0.75 and 1.5 mg pens marketed since 2015–2016; 3 and 4.5 mg pens approved in 2022 but not listed as marketed.
Australia
Prescription only (Schedule 4). Trulicity has current Australian product information, and the TGA reports that its long-running supply shortage has resolved.
Sport (WADA 2026)
Not banned in sportNot named on the 2026 list, and S0 does not apply to an approved drug. WADA’s 2026 Monitoring Program tracks only semaglutide and tirzepatide in this class.
Sport status follows the WADA Prohibited List in force since January 1, 2026; athletes should confirm with their anti-doping organization. Checked October 5, 2026. Status outside the US checked October 7, 2026 against EMA, MHRA, Health Canada and TGA records. By country: EU, UK, Canada, Australia. Status of every compound.
How it works
Dulaglutide is two copies of a modified GLP-1, a gut hormone, each fused to part of an antibody (an IgG4 Fc fragment), which slows its removal so one dose lasts a week. It binds and switches on the GLP-1 receptor: in the pancreas this raises insulin only when blood sugar is high and lowers glucagon, a hormone that raises blood sugar. It also slows stomach emptying. Changes to the GLP-1 part shield it from DPP-4, the enzyme that quickly breaks down natural GLP-1.
LabelBased on the product label.
Not known
Whether its thyroid C-cell tumors in rats matter for people is unknown; one trial patient had medullary thyroid cancer, with high calcitonin before treatment. How it lowered heart events in REWIND, beyond blood sugar, isn’t established.
Protocol
Label
Trulicity
0.75 mg once weekly. After 4 weeks it may go to 1.5 mg, then up in 1.5 mg steps to 3 mg and 4.5 mg (maximum), each after at least 4 weeks, only if more blood-sugar control is needed.
Trial
REWIND, Lancet 2019
1.5 mg once weekly, the dose that lowered heart attack, stroke or heart death in adults 50 and older with type 2 diabetes over a median 5.4 years.
Trial
AWARD-11, Diabetes Care 2021
Stepped up from 0.75 mg every 4 weeks to 1.5, 3 or 4.5 mg, added to metformin. At 36 weeks HbA1c fell 1.5, 1.6 and 1.8 points and weight 3.0, 3.8 and 4.6 kg.
Frequency
Once weekly
Route
Subcutaneous injection
Timing
Same day each week, any time of day, with or without food. The day can change if the last dose was at least 3 days earlier.
Cycle
Continuous. The label treats it as long-term therapy, not a cycle.
Week 15913172125
Continuous, shown over 26 weeks
Common protocols
The ways Dulaglutide is most often run, each tagged with where it comes from.
Type 2 diabetes (Trulicity)
Label
Dose
0.75 mg rising to 1.5–4.5 mg
How often
Once weekly
How long
Long-term
1.5 mg after 4 weeks if needed, then 1.5 mg steps to 3 and 4.5 mg (maximum), each after at least 4 weeks. Children 10 and older have their own label schedule.
Heart-risk reduction (REWIND)
Trial
Dose
1.5 mg
How often
Once weekly
How long
Median 5.4 years
Adults 50 and older with type 2 diabetes and heart disease or several risk factors. Heart attack, stroke or heart death: 12.0% vs 13.4% on placebo (HR 0.88).
Higher doses (AWARD-11)
Trial
Dose
3 or 4.5 mg
How often
Once weekly
How long
52 weeks
Reached in 4-week steps from 0.75 mg. At 36 weeks, 4.5 mg lowered HbA1c 1.8 points vs 1.5 on 1.5 mg, and weight 4.6 vs 3.0 kg; nausea 16.4% vs 13.4%.
Trulicity step-up schedule
Period
Dose
Weeks 1–4
0.75 mg
Weeks 5–8
1.5 mg
Weeks 9–12
3 mg
Week 13 on (maximum)
4.5 mg
Each step is optional: the label raises the dose only if more blood-sugar control is needed, after at least 4 weeks on the current dose. Children 10 and older follow a separate label schedule.
Taking it
Where it goes
Under the skin of the belly, thigh or upper arm (label). Rotate sites with each dose. With insulin, use separate injections; the same area is fine if the shots aren’t right next to each other.
If you miss a dose
Trulicity label: take a missed dose as soon as possible if the next dose is at least 3 days (72 hours) away. If less than 3 days remain, skip it and take the next dose on the usual day.
Drink enough fluids. Heavy vomiting or diarrhea can dehydrate you and injure the kidneys.
Decreased appetite 4.9–8.6% and fatigue 4.2–5.6% (label; placebo 1.6% and 2.6%)
Usually mild. Tell the prescriber if eating becomes hard.
Faster heart rate (label: up 2–4 beats per minute on average; lasting fast heartbeat 1.6% on 1.5 mg vs 0.2%)
Report a racing heart at rest or palpitations.
Low blood sugar with a sulfonylurea (label: 20–21% had readings under 54 mg/dL) or mealtime insulin (69–77%)
The label suggests lowering the sulfonylurea or insulin dose when starting.
Stop and get medical help
Severe belly pain that won’t go away (may spread to the back), face or throat swelling or trouble breathing, a lump in the neck, trouble swallowing or lasting hoarseness, or signs of dehydration such as very little urine.
By the numbers
From the trials in the Trulicity label. Side effects count everything reported, whatever the cause, so the gap between the placebo and drug columns is what the drug adds.
Side effects vs placebo
Pooled placebo-controlled trials in adults with type 2 diabetes: side effects in at least 5% on Trulicity, and more common than on placebo. Figures are the % of people.
Side effect
Placebon=568
0.75 mgn=836
1.5 mgn=834
Nausea
5.3
12.4
21.1
Diarrhea
6.7
8.9
12.6
Vomiting
2.3
6.0
12.7
Stomach pain
4.9
6.5
9.4
Lower appetite
1.6
4.9
8.6
Indigestion
2.3
4.1
5.8
Tiredness
2.6
4.2
5.6
Average time on treatment was 23.8 weeks. Low blood sugar is counted separately. Tiredness includes weakness and malaise.
36-week trial of higher doses added to metformin, with no placebo group: side effects in at least 5% in any dose group. Figures are the % of people.
Side effect
1.5 mgn=612
3 mgn=616
4.5 mgn=614
Nausea
13.4
15.6
16.4
Diarrhea
7.0
11.4
10.7
Vomiting
5.6
8.3
9.3
Indigestion
2.8
5.0
2.6
Stopping. In the placebo-controlled trials, 1.3% on 0.75 mg and 3.5% on 1.5 mg stopped because of stomach or gut side effects, vs 0.2% on placebo.
Stomach and gut side effects overall: 32% on 0.75 mg and 41% on 1.5 mg vs 21% on placebo. Severe ones: 2.2% and 4.3% vs 1.4%.
Heart rate rose 2 to 4 beats a minute on average. A fast heartbeat seen at more than 2 visits: 1.6% on 1.5 mg vs 0.2% on placebo.
Blood sugar under 54 mg/dL: 20% to 21% when taken with a sulfonylurea (78 weeks) and 69% to 77% with mealtime insulin (52 weeks).
Antibodies to dulaglutide formed in 1.6% of adults (64 of 3,907), with no clinically significant effect found on blood levels, safety or results.
Results
Results at 36 weeks in adults on metformin (1.5 vs 3 vs 4.5 mg; no placebo group), counting everyone randomized.
Measure
1.5 mgn=612
3 mgn=616
4.5 mgn=614
Change in HbA1c (points)
−1.5
−1.6
−1.8
Reached an HbA1c under 7%
50%
56%
62%
Change in fasting glucose
−45 mg/dL
−46 mg/dL
−51 mg/dL
Change in weight
−3.0 kg
−3.8 kg
−4.6 kg
Missing values were filled in statistically; people with no week-36 HbA1c count as not reaching under 7%.
Heart outcomes over a median of 5.4 years in 9,901 adults with type 2 diabetes and heart disease or risk factors (REWIND), counting everyone randomized.
Measure
Placebo
1.5 mg
Hazard ratio (95% CI)
Heart attack, stroke or heart death (main goal)
13.4%
12.0%
0.88 (0.79 to 0.99)
Heart death
7.0%
6.4%
0.91 (0.78 to 1.06)
Non-fatal heart attack
4.3%
4.1%
0.96 (0.79 to 1.16)
Non-fatal stroke
3.5%
2.7%
0.76 (0.61 to 0.95)
A hazard ratio below 1 means fewer events on the drug; when its range includes 1, the difference may be chance. Only the main goal was formally tested.
How the body handles it
Reaches the blood
65% of a 0.75 mg dose and 47% of a 1.5 mg dose
Peak level
24 to 72 hours after a dose (median 48 hours)
Steady level
Reached 2 to 4 weeks into weekly dosing
Half-life
About 5 days
Spread in the body
3.09 L central and 5.98 L peripheral (volume of distribution)
Cleared by
Thought to be broken down into amino acids like other proteins; clearance about 0.142 L an hour
Source: Trulicity prescribing information (revised 03/2026). Trials of different drugs enrolled different people, so compare across drugs with care.
Can it cause …?
The side effects people ask about most, answered one by one. Each answer says where it comes from.
Tiredness
LabelFatigue, weakness or malaise: 4.2% on 0.75 mg and 5.6% on 1.5 mg vs 2.6% on placebo in the label’s pooled trials.
Headache
Not reportedHeadache isn’t among the label’s common side effects, from placebo-controlled trials of 1,670 adults treated for about 24 weeks on average.
Nausea or vomiting
LabelNausea 12.4% and 21.1% vs 5.3% on placebo, and vomiting 6.0% and 12.7% vs 2.3%, at 0.75 and 1.5 mg; most common early and after dose increases.
Diarrhea or constipation
LabelDiarrhea 8.9–12.6% vs 6.7% and constipation 3.7–3.9% vs 0.7% on placebo. Severe stomach and gut reactions: 2.2–4.3% vs 1.4%; intestinal blockage reported after approval.
Dizziness
Not reportedDizziness isn’t among the label’s common side effects, from placebo-controlled trials of 1,670 adults treated for about 24 weeks on average.
Trouble sleeping
Not reportedTrouble sleeping isn’t listed in the label, whose placebo-controlled trials included 1,670 adults on dulaglutide.
Hair loss
LabelHair loss was added in 2025 to the reports after approval, so how often it happens is unknown. It wasn’t among the common side effects in trials.
Acne, rash or skin changes
LabelInjection-site reactions 0.5% vs 0% on placebo in adults, more in children. Allergic rash, hives or facial swelling 0.5%. Altered skin sensation (dysesthesia) reported after approval.
Water retention or swelling
LabelFluid retention isn’t a listed side effect. Facial or lip swelling occurred in allergic reactions (0.5% overall), and angioedema has been reported; the label says to stop and get help.
Joint or muscle pain
Not reportedJoint or muscle pain isn’t among the label’s common side effects, from placebo-controlled trials of 1,670 adults treated for about 24 weeks on average.
Anxiety, low mood or irritability
Not reportedAnxiety and low mood aren’t listed in the label. FDA’s 2026 review of 91 GLP-1 drug trials found no rise in depression, anxiety or suicidal thoughts.
Low or high blood sugar
LabelIt lowers blood sugar. Readings under 54 mg/dL hit 0.3–0.7% with metformin, but 20–21% with a sulfonylurea and 69–77% with mealtime insulin.
Fast heartbeat or blood pressure changes
LabelHeart rate rises 2–4 beats per minute on average; persistent fast heartbeat hit 1.6% on 1.5 mg vs 0.2% on placebo. The PR interval, a rhythm measure, lengthened slightly.
More hunger
LabelIt curbs appetite: decreased appetite 4.9% on 0.75 mg and 8.6% on 1.5 mg vs 1.6% on placebo. Weight fell 3.0–4.6 kg over 36 weeks.
Liver strain
LabelLiver strain isn’t a common side effect; raised liver enzymes, hepatitis and blocked bile flow appear among reports after approval. Serious gallbladder inflammation: 0.5% vs 0.3% in REWIND.
Kidney problems
LabelKidney injury, sometimes needing dialysis, has been reported, mostly after vomiting or diarrhea. In REWIND, new heavy urine protein was less common than on placebo.
Cancer risk
LabelCaused thyroid C-cell tumors in rats; human risk is unknown (boxed warning). One trial patient developed medullary thyroid cancer, with high calcitonin before treatment.
Label: from the prescribing information. Not reported: studied in people and not reported. A side effect that hasn’t been reported can still happen, especially with long or high-dose use. Any of these across every compound: the side-effect finder.
Who should avoid it
What its label rules out or warns about, most important first.
History of medullary thyroid cancer or MEN 2
LabelRuled out, including a family history; MEN 2 is an inherited tumor syndrome. Dulaglutide caused thyroid C-cell tumors in rats; whether it does in people is unknown.
Serious allergy to dulaglutide
LabelRuled out after a serious reaction to dulaglutide or any ingredient; anaphylaxis and throat swelling have been reported. The label urges caution after such a reaction to another GLP-1 drug.
Severe gastroparesis (very slow stomach emptying)
LabelNot recommended by the label. Dulaglutide slows stomach emptying, and severe stomach and gut reactions were more common than on placebo (4.3% vs 1.4%).
Diabetic eye disease (retinopathy)
LabelIn REWIND, eye complications were more common on dulaglutide in people with prior retinopathy (8.5% vs 6.2%); fast blood-sugar improvement can worsen it. The label advises monitoring.
Pregnancy
LabelHuman data are too limited to judge the risk; in rats and rabbits it caused fetal harm at 5–6 times human exposure. The label advises use only if the benefit justifies the risk.
Planned surgery or deep sedation
LabelRare reports describe stomach contents entering the lungs under anesthesia, because the stomach empties slowly. The label says to tell the care team beforehand; whether pausing the drug helps is unknown.
Children under 10
LabelNot approved: safety and effectiveness haven’t been established under age 10. It is approved for type 2 diabetes from age 10.
Interactions
Only interactions stated on a product label or measured in a human study are listed.
Insulin or sulfonylureas (insulin-boosting diabetes pills such as glipizide)
LabelLow blood sugar is more likely: with a sulfonylurea, 20–21% had readings under 54 mg/dL. The label advises considering lower insulin or sulfonylurea doses when starting.
Oral medicines, especially narrow-margin drugs such as warfarin
LabelDulaglutide slows stomach emptying, most after the first dose. At 1.5 mg it didn’t change absorption of tested drugs meaningfully, but experience at 3 and 4.5 mg is limited, so the label advises monitoring levels of drugs such as warfarin.
Sitagliptin
LabelTaken together, sitagliptin raised dulaglutide exposure by about 38%, which the label calls not clinically relevant.
Label: a product label rules it out, warns about it or lists the interaction. This isn’t a complete list: a pharmacist or doctor can check a specific medicine or condition. Every documented interaction, by medicine: drug interactions.
Special situations
What the label and studies say about pregnancy, breastfeeding, kidney and liver problems, age and surgery.
Pregnancy
LabelHuman data are too limited to judge the risk. In rats and rabbits, exposure caused fetal deaths, smaller fetuses and malformations at 5–6 times human exposure. The label says to use it only if the benefit justifies the risk.
Breastfeeding
LabelNo data on whether it passes into human milk or affects the baby; animal milk wasn’t tested either. The label weighs breastfeeding’s benefits against possible risks to the baby.
Kidney problems
LabelNo dose change, even in end-stage kidney disease, where exposure barely changed; the label urges caution there. A trial in moderate to severe kidney disease found no new concerns. Watch kidney function if vomiting is severe.
Liver problems
LabelDrug levels didn’t change in a clinically relevant way with liver impairment, but clinical experience is limited, so the label advises caution.
Older adults
LabelNo overall differences in safety or effectiveness after 65. In REWIND, 53% of people on dulaglutide were 65 or older and 10% were 75 or older.
Children and teens
LabelApproved for type 2 diabetes from age 10 in the US (2022) and the EU; not established under 10, and not approved for weight loss at any age.
Surgery and anesthesia
LabelIt slows stomach emptying, and rare reports describe stomach contents entering the lungs under anesthesia or deep sedation. The label says to tell the care team beforehand; whether pausing the drug helps is unknown.
5 key published human studies, with how many people took part. Animal studies aren’t listed here.
20199,901 people
Heart attack, stroke or cardiovascular death in 12.0% vs 13.4% on placebo (HR 0.88) in adults 50 and older with type 2 diabetes; most had risk factors rather than prior heart disease.
Design
Randomized double-blind placebo-controlled trial
Dose
1.5 mg weekly
Length
Median 5.4 years
Gerstein et al., Lancet 2019 (REWIND), PMID 31189511
202513,299 people
Heart attack, stroke or cardiovascular death in 13.1% on dulaglutide vs 12.2% on tirzepatide (HR 0.92) in type 2 diabetes with heart disease: tirzepatide noninferior, not superior.
Design
Randomized double-blind trial vs tirzepatide
Dose
1.5 mg weekly vs tirzepatide up to 15 mg
Length
Median about 4 years
Nicholls et al., N Engl J Med 2025 (SURPASS-CVOT), PMID 41406444
20211,842 people
At 36 weeks HbA1c fell 1.77 points on 4.5 mg vs 1.54 on 1.5 mg, and weight 4.6 vs 3.0 kg, counting everyone randomized; nausea 16.4% vs 13.4%.
Design
Randomized double-blind trial of three doses
Dose
1.5, 3 or 4.5 mg weekly, with metformin
Length
52 weeks (main result at 36)
Frias et al., Diabetes Care 2021 (AWARD-11), PMID 33397768
20199,901 people
A combined kidney outcome occurred in 17.1% vs 19.6% on placebo (HR 0.85), driven by fewer new cases of heavy protein in the urine (HR 0.77).
Design
Exploratory analysis of a randomized double-blind placebo-controlled trial
Dose
1.5 mg weekly
Length
Median 5.4 years
Gerstein et al., Lancet 2019 (REWIND kidney analysis), PMID 31189509
2018577 people
In moderate to severe chronic kidney disease, HbA1c fell as much as on insulin glargine (1.1–1.2 points at 26 weeks); kidney function declined less, and kidney failure occurred in 4% on 1.5 mg vs 8%.
Design
Open-label randomized trial vs insulin glargine
Dose
0.75 or 1.5 mg weekly, with mealtime insulin
Length
52 weeks
Tuttle et al., Lancet Diabetes Endocrinol 2018 (AWARD-7), PMID 29910024
Registered trials that are still running, or that finished without published results, most important first. Checked on ClinicalTrials.gov, October 7, 2026.
Phase 3NCT06739122
AWARD-PEDS PLUS: higher dulaglutide doses in about 55 children and teens aged 10–17 with type 2 diabetes, checking safety over 26 weeks
Recruiting since January 2025; completion expected December 2027
Phase 4NCT05390892
PRECIDENTD: a GLP-1 drug (dulaglutide, liraglutide or semaglutide) vs an SGLT2 inhibitor pill in 6,000 adults with type 2 diabetes and heart risk, counting heart, kidney and death events
Recruiting since September 2022; completion expected March 2029
Phase 1NCT07313813
How fasting time and briefly withholding dulaglutide affect food left in the stomach after a meal, checked by ultrasound, in 20 adults with type 2 diabetes; a question for anesthesia safety
Completed August 2026; no results posted or published
Phase 4NCT06324461
GLUMINS: one dulaglutide dose 1–14 days before non-cardiac surgery vs usual care in 372 adults, to prevent heart muscle injury after surgery
Recruiting since March 2024; completion expected December 2028
Phase 2/3NCT07282041
RADIANT: dulaglutide for 1 year in 130 adults with severe narrowing of brain arteries, measuring how well the brain’s blood vessels can widen
Recruiting since December 2025; completion expected December 2030
Dulaglutide’s blood-sugar trials ran 24–78 weeks, mostly at 0.75 or 1.5 mg; the 3 and 4.5 mg doses rest mainly on one 52-week trial of 1,842 adults. Heart data come from REWIND (9,901 adults, median 5.4 years), where most had risk factors rather than prior heart disease. Its kidney and memory findings were exploratory, it isn’t approved for weight loss, and the label reports limited experience in liver impairment.
How it’s supplied
Ready-made single-dose pens of 0.75, 1.5, 3 or 4.5 mg in 0.5 mL. The pen measures each dose, so there’s nothing to mix or draw up.
No mixing: each single-dose pen holds one ready-made 0.5 mL dose and is thrown away after use. With insulin, the label says to inject separately and never mix the two.
Datasheet
Half-life
about 5 daysLabelSubcutaneous, in adults; levels peak 24–72 hours after a dose (median 48 hours) and reach steady state after 2–4 weeks of weekly dosing.
Type
Protein, 275 amino acids
Molecular weight
about 63,000 g/mol (label, including sugar chains); the two protein chains alone weigh 59,669.8
Formula
C2646H4044N704O836S18 (both chains, without sugars)
Sequence
HGEGTFTSDVSSYLEEQAAKEFIAWLVKGGGA GLP-1 analog), then the linker GGGGSGGGGSGGGGSA and a 228-amino-acid modified human IgG4 Fc; two identical chains joined by disulfide bonds
Storage before use
Not a powder: single-dose pens hold a ready-made solution. Refrigerate at 2–8 °C in the carton to protect from light; never freeze, and don’t use a pen that has frozen.
After mixing or opening
If needed, each pen may be kept at room temperature up to 30 °C for a total of 14 days. Pens are used once.
Half-life: Trulicity prescribing information rev. 03/2026, section 12.3
Molecule: Trulicity label rev. 03/2026, section 11 (structure, about 63 kDa); KEGG D09889 (sequence, formula, weight); UNII WTT295HSY5
Storage:Label Trulicity prescribing information rev. 03/2026, section 16.2
Pens hold dulaglutide, a protein made in hamster ovary cells, in a preservative-free citrate solution: 0.75, 1.5, 3 or 4.5 mg in 0.5 mL. Each single-dose pen delivers its whole dose and can’t be split.
Cautions
Boxed warning for thyroid C-cell tumors seen in rats. Not for anyone with a personal or family history of medullary thyroid carcinoma or MEN 2.
Nausea, diarrhea and vomiting are common, mostly early and after dose increases. Severe stomach and gut reactions: 4.3% on 1.5 mg vs 1.4% on placebo. Not recommended with severe gastroparesis.
Pancreatitis, gallbladder disease, kidney injury from dehydration and serious allergic reactions are listed risks. It slows stomach emptying, so tell the care team before surgery or sedation.
Low blood sugar is more likely with insulin or a sulfonylurea. Diabetic eye disease can worsen, so the label advises monitoring people with retinopathy.
Questions
What is dulaglutide?
A weekly GLP-1 receptor agonist: two modified GLP-1 chains fused to part of an antibody, which keeps it in the blood for about 5 days. It lowers blood sugar, slows stomach emptying and modestly reduces appetite and weight.
How does dulaglutide work?
Dulaglutide is two copies of a modified GLP-1, a gut hormone, each fused to part of an antibody (an IgG4 Fc fragment), which slows its removal so one dose lasts a week. It binds and switches on the GLP-1 receptor: in the pancreas this raises insulin only when blood sugar is high and lowers glucagon, a hormone that raises blood sugar. It also slows stomach emptying. Changes to the GLP-1 part shield it from DPP-4, the enzyme that quickly breaks down natural GLP-1. Whether its thyroid C-cell tumors in rats matter for people is unknown; one trial patient had medullary thyroid cancer, with high calcitonin before treatment. How it lowered heart events in REWIND, beyond blood sugar, isn’t established.
Is dulaglutide FDA-approved?
Approved in the US as Trulicity (BLA 125469, September 2014) for type 2 diabetes in adults and children 10 and older (2022), and to lower heart attack and stroke risk in adults with type 2 diabetes (2020). All four pen strengths are listed as marketed; dulaglutide isn’t on FDA’s drug shortage list (October 2026).
What is the usual dulaglutide dose?
From the label (Trulicity): 0.75 mg once weekly. After 4 weeks it may go to 1.5 mg, then up in 1.5 mg steps to 3 mg and 4.5 mg (maximum), each after at least 4 weeks, only if more blood-sugar control is needed. From human studies (REWIND, Lancet 2019): 1.5 mg once weekly, the dose that lowered heart attack, stroke or heart death in adults 50 and older with type 2 diabetes over a median 5.4 years. These are the amounts sources reference, not recommendations.
How is dulaglutide given?
Ready-made single-dose pens of 0.75, 1.5, 3 or 4.5 mg in 0.5 mL, injected under the skin. Same day each week, any time of day, with or without food. The day can change if the last dose was at least 3 days earlier. The pen measures each dose, so there’s nothing to mix.
Who should avoid dulaglutide?
History of medullary thyroid cancer or MEN 2: Ruled out, including a family history; MEN 2 is an inherited tumor syndrome. Dulaglutide caused thyroid C-cell tumors in rats; whether it does in people is unknown. Serious allergy to dulaglutide: Ruled out after a serious reaction to dulaglutide or any ingredient; anaphylaxis and throat swelling have been reported. The label urges caution after such a reaction to another GLP-1 drug. Severe gastroparesis (very slow stomach emptying): Not recommended by the label. Dulaglutide slows stomach emptying, and severe stomach and gut reactions were more common than on placebo (4.3% vs 1.4%). The “Who should avoid it” section lists 4 more groups and 3 interactions.
What is the half-life of dulaglutide?
About 5 days, according to the prescribing information. Subcutaneous, in adults; levels peak 24–72 hours after a dose (median 48 hours) and reach steady state after 2–4 weeks of weekly dosing.
How should dulaglutide be stored?
Not a powder: single-dose pens hold a ready-made solution. Refrigerate at 2–8 °C in the carton to protect from light; never freeze, and don’t use a pen that has frozen. After mixing: If needed, each pen may be kept at room temperature up to 30 °C for a total of 14 days. Pens are used once.
Is dulaglutide banned in sport?
No. Not named on the 2026 list, and S0 does not apply to an approved drug. WADA’s 2026 Monitoring Program tracks only semaglutide and tirzepatide in this class.
Has dulaglutide been studied in people?
Yes. The human studies section lists 5 published studies. The largest, from 2025, included 13,299 people. Heart attack, stroke or cardiovascular death in 13.1% on dulaglutide vs 12.2% on tirzepatide (HR 0.92) in type 2 diabetes with heart disease: tirzepatide noninferior, not superior.
How long has dulaglutide been studied in people?
Trial REWIND: 4,949 adults with type 2 diabetes on dulaglutide, followed for a median 5.4 years. SURPASS-CVOT followed 6,579 on dulaglutide for about 4 years.
Does dulaglutide come in other forms, like a pill or nasal spray?
Label Only weekly injections under the skin, from single-dose pens, are approved. No tablet, nasal spray or patch form exists.
Can you drink alcohol while taking dulaglutide?
Trial The label doesn’t address alcohol. In a 12-week smoking-cessation trial, participants on dulaglutide drank 29% less than those on placebo. Heavy drinking itself raises pancreatitis risk.
Can dulaglutide be taken with semaglutide or tirzepatide?
Label Don’t combine two GLP-1 drugs. Trulicity’s label doesn’t address it directly, but the labels of Wegovy and Zepbound advise against adding any other GLP-1 drug, such as dulaglutide.
What happens if you take too much dulaglutide?
Label Per the label, overdoses in trials mainly caused mild to moderate nausea and vomiting and non-severe low blood sugar; care is supportive, with frequent glucose checks. Call Poison Help (1-800-222-1222), or emergency services for severe symptoms.
Sources
Trulicity prescribing information, rev. 03/2026 (Eli Lilly, DailyMed version published August 10, 2026)
Frias et al., dulaglutide 3.0 and 4.5 mg, AWARD-11 (Diabetes Care 2021) PMID 33397768
Drugs@FDA and FDA Purple Book: Trulicity (BLA 125469), approved September 18, 2014; heart-risk indication February 21, 2020; children 10 and older November 17, 2022 (September 2026 data)
EMA: Trulicity EPAR, authorized November 21, 2014; EMA shortage page marked resolved (updated February 17, 2026)
For how it works, who should avoid it and the limits of the evidence
Trulicity prescribing information, boxed warning and sections 1, 4, 5, 7, 8 and 12 (Eli Lilly, DailyMed, rev. 03/2026)
Glaesner et al., engineering of the Fc fusion protein LY2189265, later dulaglutide (Diabetes Metab Res Rev 2010) PMID 20503261
For uses, the side-effect questions, special situations, trials, identifiers and status outside the US
Trulicity prescribing information, boxed warning and sections 1, 2, 5, 6, 8, 10, 12, 14 and 16 (Eli Lilly, DailyMed, rev. 03/2026)
Drugs@FDA: Trulicity (BLA 125469) original approval September 18, 2014; supplement approval letters S-063 (May 28, 2025) and S-065 (March 12, 2026)
FDA Drug Safety Communication: removal of the suicidal behavior and ideation warning from GLP-1 receptor agonists (January 13, 2026)
Gerstein et al., dulaglutide and kidney outcomes in REWIND (Lancet 2019) PMID 31189509
Cukierman-Yaffe et al., dulaglutide and cognitive impairment in REWIND (Lancet Neurol 2020) PMID 32562683
Nicholls et al., SURPASS-CVOT, tirzepatide vs dulaglutide (NEJM 2025) PMID 41406444
Lengsfeld et al., dulaglutide for smoking cessation (EClinicalMedicine 2023) PMID 36874396
Probst et al., dulaglutide and alcohol consumption during smoking cessation (JCI Insight 2023) PMID 37991022
FDA Global Substance Registration System record (UNII WTT295HSY5), KEGG D09889 and WHO ATC index entry for dulaglutide
EMA medicines data and Trulicity EPAR (product information updated January 30, 2026) and EMA shortage page (updated February 17, 2026)
MHRA products database entries for Trulicity pens (PLGB 14895/0259–0262, documents dated June 26, 2026)
Health Canada Drug Product Database entries for Trulicity (checked October 8, 2026)
Australian Poisons Standard, October 2026 (dulaglutide in Schedule 4); TGA product information search for dulaglutide and TGA shortage notice for Trulicity
ClinicalTrials.gov registry entries for the trials listed (checked October 8, 2026)