Dulaglutide - Revision history

MDElliottMD: Strip Category:MedCategory marker per interface-claude 2026-05-20 hygiene order: this page is a medicine, narrative, wiki-meta page, or stylesheet rather than a class-overview category, so it should not carry the MedCategory tag. Class memberships and other tags preserved.

2026-05-19T18:00:10Z

Strip Category:MedCategory marker per interface-claude 2026-05-20 hygiene order: this page is a medicine, narrative, wiki-meta page, or stylesheet rather than a class-overview category, so it should not carry the MedCategory tag. Class memberships and other tags preserved.

← Older revision		Revision as of 18:00, 19 May 2026
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	}}		}}

	~~[[Category:MedCategory]]~~
	[[Category:GLP-1 receptor agonists]]		[[Category:GLP-1 receptor agonists]]
	[[Category:Antidiabetic medicines]]		[[Category:Antidiabetic medicines]]
	[[Category:Eli Lilly medicines]]		[[Category:Eli Lilly medicines]]

MDElliottMD: Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

2026-05-19T03:16:07Z

Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

MDElliottMD: Migrate tags to (Phase 2 of indications-to-problems rebuild)

2026-05-17T00:11:50Z

Migrate <indication> tags to <problem> (Phase 2 of indications-to-problems rebuild)

← Older revision		Revision as of 00:11, 17 May 2026
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	* Modest SBP reduction (~1–2 mmHg)<ref name="trulicity-label"/>		* Modest SBP reduction (~1–2 mmHg)<ref name="trulicity-label"/>

	\| indications = <~~indication~~ ref="diabetes-type-2" author="MDElliottMD"/>		\| indications = <problem ref="diabetes-type-2" author="MDElliottMD"/>
	<~~indication~~ ref="cv-risk-t2dm" author="MDElliottMD"/>		<problem ref="cv-risk-t2dm" author="MDElliottMD"/>

	\| dosing = <titration slug="trulicity-standard" author="MDElliottMD" title="Trulicity — standard T2DM titration">		\| dosing = <titration slug="trulicity-standard" author="MDElliottMD" title="Trulicity — standard T2DM titration">

MDElliottMD: Fix Cargo VARCHAR(300) overflow: blank structure, shorten mechanism, move chemistry/mechanism prose to PK/PD

2026-05-16T23:33:09Z

Fix Cargo VARCHAR(300) overflow: blank structure, shorten mechanism, move chemistry/mechanism prose to PK/PD

← Older revision		Revision as of 23:33, 16 May 2026
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	\| generic = Dulaglutide		\| generic = Dulaglutide
	\| brand = Trulicity		\| brand = Trulicity
	\| structure = '''Fc-fusion construct''': two identical GLP-1 analog peptides (each modified at positions 8, 22, 36 for DPP-4 resistance and reduced immunogenicity) linked to a human IgG4 Fc fragment via a small glycine-rich peptide linker. The Fc tail drives the long half-life through FcRn recycling.<ref name="glaesner2010">Glaesner W, Vick AM, Millican R et al. (2010). Engineering and characterization of the long-acting glucagon-like peptide-1 analogue LY2189265, an Fc fusion protein. ''Diabetes Metab Res Rev'' 26(4):287–96. doi:10.1002/dmrr.1080</ref>		\| structure =

	\| classes = [[GLP-1 receptor agonist]] · [[Antidiabetic medicines\|Antidiabetic]] · Fc-fusion biologic		\| classes = [[GLP-1 receptor agonist]] · [[Antidiabetic medicines\|Antidiabetic]] · Fc-fusion biologic
	\| mechanism = ~~Selective long~~-acting agonist of the [[GLP-1 receptor]]~~. The~~ Fc-~~IgG4 structure differentiates it pharmacokinetically (large protein cleared by FcRn-mediated recycling rather than albumin binding) but the receptor pharmacology is the standard GLP-1 RA profile~~.~~<ref name="glaesner2010"/>~~		\| mechanism = Long-acting agonist of the [[GLP-1 receptor]]; Fc-fusion construct.

	\| uses = [[Type 2 diabetes mellitus]] · [[Cardiovascular risk reduction]] in T2DM		\| uses = [[Type 2 diabetes mellitus]] · [[Cardiovascular risk reduction]] in T2DM
	\| starting_dose = 0.75 mg SC weekly<ref name="trulicity-label">US FDA. ''Trulicity (dulaglutide) prescribing information.'' Eli Lilly. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125469s044lbl.pdf</ref>		\| starting_dose = 0.75 mg SC weekly<ref name="trulicity-label">US FDA. ''Trulicity (dulaglutide) prescribing information.'' Eli Lilly. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125469s044lbl.pdf</ref>
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	Dulaglutide's principal clinical distinction is the [[REWIND trial\|REWIND trial]], in which dulaglutide reduced major adverse cardiovascular events by 12% in T2DM patients ''including a majority with no prior cardiovascular disease'' — making it the first GLP-1 RA to demonstrate cardiovascular benefit in ''primary'' prevention.<ref name="rewind">Gerstein HC et al. (2019). Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). ''Lancet'' 394(10193):121–30. doi:10.1016/S0140-6736(19)31149-3</ref>		Dulaglutide's principal clinical distinction is the [[REWIND trial\|REWIND trial]], in which dulaglutide reduced major adverse cardiovascular events by 12% in T2DM patients ''including a majority with no prior cardiovascular disease'' — making it the first GLP-1 RA to demonstrate cardiovascular benefit in ''primary'' prevention.<ref name="rewind">Gerstein HC et al. (2019). Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). ''Lancet'' 394(10193):121–30. doi:10.1016/S0140-6736(19)31149-3</ref>

	\| pharmacokinetics = The Fc-IgG4 fusion confers protection from renal filtration (~63 kDa, well above the glomerular cutoff) and triggers FcRn-mediated recycling, producing a terminal half-life of ~120 hours.<ref name="glaesner2010"/><ref name="trulicity-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="trulicity-label"/>		\| pharmacokinetics = '''Chemistry'''. '''Fc-fusion construct''': two identical GLP-1 analog peptides (each modified at positions 8, 22, 36 for DPP-4 resistance and reduced immunogenicity) linked to a human IgG4 Fc fragment via a small glycine-rich peptide linker. The Fc tail drives the long half-life through FcRn recycling.<ref name="glaesner2010">Glaesner W, Vick AM, Millican R et al. (2010). Engineering and characterization of the long-acting glucagon-like peptide-1 analogue LY2189265, an Fc fusion protein. ''Diabetes Metab Res Rev'' 26(4):287–96. doi:10.1002/dmrr.1080</ref>

			The Fc-IgG4 fusion confers protection from renal filtration (~63 kDa, well above the glomerular cutoff) and triggers FcRn-mediated recycling, producing a terminal half-life of ~120 hours.<ref name="glaesner2010"/><ref name="trulicity-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="trulicity-label"/>

	The large molecular size limits both injection-site dispersion and oral bioavailability — dulaglutide cannot be formulated for oral use.		The large molecular size limits both injection-site dispersion and oral bioavailability — dulaglutide cannot be formulated for oral use.

	\| pharmacodynamics = At maintenance doses:		\| pharmacodynamics = '''Receptor pharmacology'''. Selective long-acting agonist of the [[GLP-1 receptor]]. The Fc-IgG4 structure differentiates it pharmacokinetically (large protein cleared by FcRn-mediated recycling rather than albumin binding) but the receptor pharmacology is the standard GLP-1 RA profile.<ref name="glaesner2010"/>

			At maintenance doses:
	* HbA1c reduction of ~0.8–1.5 percentage points (1.5 mg/wk) and ~1.6–1.9 (4.5 mg/wk) in T2DM<ref name="award11">Frias JP, Bonora E, Nevarez Ruiz L et al. (2021). Efficacy and safety of dulaglutide 3 and 4.5 mg versus 1.5 mg in metformin-treated patients with type 2 diabetes (AWARD-11). ''Diabetes Care'' 44(3):765–73. doi:10.2337/dc20-1473</ref>		* HbA1c reduction of ~0.8–1.5 percentage points (1.5 mg/wk) and ~1.6–1.9 (4.5 mg/wk) in T2DM<ref name="award11">Frias JP, Bonora E, Nevarez Ruiz L et al. (2021). Efficacy and safety of dulaglutide 3 and 4.5 mg versus 1.5 mg in metformin-treated patients with type 2 diabetes (AWARD-11). ''Diabetes Care'' 44(3):765–73. doi:10.2337/dc20-1473</ref>
	* Weight loss of ~2–5 kg, dose-dependent<ref name="award11"/>		* Weight loss of ~2–5 kg, dose-dependent<ref name="award11"/>

MDElliottMD: Create Dulaglutide page (initial draft, MedTemplate, full inline cites)

2026-05-16T23:11:34Z

Create Dulaglutide page (initial draft, MedTemplate, full inline cites)

New page

{{MedTemplate
| generic = Dulaglutide
| brand = Trulicity
| structure = '''Fc-fusion construct''': two identical GLP-1 analog peptides (each modified at positions 8, 22, 36 for DPP-4 resistance and reduced immunogenicity) linked to a human IgG4 Fc fragment via a small glycine-rich peptide linker. The Fc tail drives the long half-life through FcRn recycling.<ref name="glaesner2010">Glaesner W, Vick AM, Millican R et al. (2010). Engineering and characterization of the long-acting glucagon-like peptide-1 analogue LY2189265, an Fc fusion protein. ''Diabetes Metab Res Rev'' 26(4):287–96. doi:10.1002/dmrr.1080</ref>
| classes = [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · Fc-fusion biologic
| mechanism = Selective long-acting agonist of the [[GLP-1 receptor]]. The Fc-IgG4 structure differentiates it pharmacokinetically (large protein cleared by FcRn-mediated recycling rather than albumin binding) but the receptor pharmacology is the standard GLP-1 RA profile.<ref name="glaesner2010"/>
| uses = [[Type 2 diabetes mellitus]] · [[Cardiovascular risk reduction]] in T2DM
| starting_dose = 0.75 mg SC weekly<ref name="trulicity-label">US FDA. ''Trulicity (dulaglutide) prescribing information.'' Eli Lilly. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125469s044lbl.pdf</ref>
| preparations = Pre-filled single-dose pen: 0.75 / 1.5 / 3 / 4.5 mg<ref name="trulicity-label"/>
| fda_max = 4.5 mg/wk SC<ref name="trulicity-label"/>
| routes = Subcutaneous (abdomen, thigh, upper arm)<ref name="trulicity-label"/>
| onset = Glycemic effect within days; near-maximal HbA1c effect by 4 weeks at any given dose<ref name="trulicity-label"/>
| duration = ~7 days (weekly dosing)<ref name="trulicity-label"/>
| halflife = ~5 days (~120 h)<ref name="trulicity-label"/>
| bioavailability = SC ~47%–65%<ref name="trulicity-label"/>
| pregnancy = Avoid. Discontinue at least 1 month before planned pregnancy. Animal data show embryofetal harm.<ref name="trulicity-label"/>
| legal = Rx-only;<ref name="trulicity-label"/> not a controlled substance
| intro = Dulaglutide is a weekly subcutaneous [[GLP-1 receptor agonist]] developed by Eli Lilly, marketed as '''[[Trulicity]]''' since September 2014.<ref name="trulicity-label"/> Structurally distinct from the acylated peptide GLP-1 RAs ([[semaglutide]], [[liraglutide]]), dulaglutide is an Fc-fusion biologic — its long half-life comes from FcRn-mediated recycling rather than albumin binding.<ref name="glaesner2010"/>

Dulaglutide's principal clinical distinction is the [[REWIND trial|REWIND trial]], in which dulaglutide reduced major adverse cardiovascular events by 12% in T2DM patients ''including a majority with no prior cardiovascular disease'' — making it the first GLP-1 RA to demonstrate cardiovascular benefit in ''primary'' prevention.<ref name="rewind">Gerstein HC et al. (2019). Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). ''Lancet'' 394(10193):121–30. doi:10.1016/S0140-6736(19)31149-3</ref>

| pharmacokinetics = The Fc-IgG4 fusion confers protection from renal filtration (~63 kDa, well above the glomerular cutoff) and triggers FcRn-mediated recycling, producing a terminal half-life of ~120 hours.<ref name="glaesner2010"/><ref name="trulicity-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="trulicity-label"/>

The large molecular size limits both injection-site dispersion and oral bioavailability — dulaglutide cannot be formulated for oral use.

| pharmacodynamics = At maintenance doses:
* HbA1c reduction of ~0.8–1.5 percentage points (1.5 mg/wk) and ~1.6–1.9 (4.5 mg/wk) in T2DM<ref name="award11">Frias JP, Bonora E, Nevarez Ruiz L et al. (2021). Efficacy and safety of dulaglutide 3 and 4.5 mg versus 1.5 mg in metformin-treated patients with type 2 diabetes (AWARD-11). ''Diabetes Care'' 44(3):765–73. doi:10.2337/dc20-1473</ref>
* Weight loss of ~2–5 kg, dose-dependent<ref name="award11"/>
* 12% relative risk reduction in MACE (REWIND)<ref name="rewind"/>
* Modest SBP reduction (~1–2 mmHg)<ref name="trulicity-label"/>

| indications = <indication ref="diabetes-type-2" author="MDElliottMD"/>
<indication ref="cv-risk-t2dm" author="MDElliottMD"/>

| dosing = <titration slug="trulicity-standard" author="MDElliottMD" title="Trulicity — standard T2DM titration">
0.75 mg SC weekly (starting and minimum effective dose)
→ 1.5 mg SC weekly × ≥4 weeks (most common maintenance)
→ 3 mg weekly × ≥4 weeks if additional HbA1c reduction needed
→ 4.5 mg weekly (max)<ref name="trulicity-label"/>

The 0.75 mg starting dose is therapeutic (unlike the non-therapeutic ramps with semaglutide and tirzepatide). Most patients escalate to 1.5 mg within the first month.
</titration>

| effects = * '''Early satiety''' (less pronounced than with semaglutide/tirzepatide at equipotent HbA1c reduction){{Citation needed}}
* '''Nausea''' — usually mild-to-moderate, peaks in first 2–4 weeks<ref name="trulicity-label"/>
* '''Diarrhea / constipation'''<ref name="trulicity-label"/>
* '''Abdominal pain'''<ref name="trulicity-label"/>
* '''Decreased appetite'''<ref name="trulicity-label"/>
* '''Injection-site reactions''' — uncommon, generally mild<ref name="trulicity-label"/>

GI tolerability is generally considered modestly better than weekly exenatide and comparable to or slightly better than weekly semaglutide at equivalent glycemic effect.{{Citation needed}}

| interactions = <pharmaInteractions/>

| pregnancy_details = Avoid. Animal embryofetal toxicity is documented.<ref name="trulicity-label"/> Discontinue at least 1 month before planned conception due to the ~5-day half-life. The pen contains no preservatives — single-dose only.

| monitoring = * Baseline: HbA1c, weight, BP, renal function, lipid panel
* Personal or family history of MTC or [[MEN2]] — '''contraindicated''', do not start<ref name="trulicity-label"/>
* Every 3 months for first year: HbA1c, weight, GI tolerability, signs of [[pancreatitis]] or [[gallbladder disease]]
* Annual: renal function, lipids
* '''Pre-procedure''': hold weekly dose ≥7 days before any planned anesthesia<ref name="kindel2024">Kindel TL et al. (2024). Perioperative GLP-1 receptor agonist safety guidance. ''Surg Obes Relat Dis'' 20(12):1183–8.</ref>

| counseling = * Use the pre-filled pen as directed; the needle is hidden — patients do not see it. This is often the preferred GLP-1 RA for needle-averse patients.{{Citation needed}}
* GI side effects peak in first 2–4 weeks, then attenuate.<ref name="trulicity-label"/>
* If a weekly dose is missed: take within 3 days; if >3 days, skip and resume on the next regular day.<ref name="trulicity-label"/>
* '''Surgery''': hold dose 7 days pre-op.<ref name="kindel2024"/>
* '''Pregnancy planning''': stop ≥1 month before trying to conceive.<ref name="trulicity-label"/>

| anecdotes = <vote slug="trulicity-pen-comfort"/>

| seealso = [[GLP-1 receptor agonist]] · [[Semaglutide]] · [[Liraglutide]] · [[Tirzepatide]] · [[Exenatide]] · [[Type 2 diabetes mellitus]]

| references = <references/>
}}

[[Category:MedCategory]]
[[Category:GLP-1 receptor agonists]]
[[Category:Antidiabetic medicines]]
[[Category:Eli Lilly medicines]]

← Older revision		Revision as of 03:16, 19 May 2026
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	\| pregnancy = Avoid. Discontinue at least 1 month before planned pregnancy. Animal data show embryofetal harm.<ref name="trulicity-label"/>		\| pregnancy = Avoid. Discontinue at least 1 month before planned pregnancy. Animal data show embryofetal harm.<ref name="trulicity-label"/>
	\| legal = Rx-only;<ref name="trulicity-label"/> not a controlled substance		\| legal = Rx-only;<ref name="trulicity-label"/> not a controlled substance
	\| intro = Dulaglutide is a weekly subcutaneous [[GLP-1 receptor agonist]] developed by Eli Lilly, marketed as '''[[Trulicity]]''' since September 2014.<ref name="trulicity-label"/> Structurally distinct from the acylated peptide GLP-1 RAs ([[semaglutide]], [[liraglutide]]), dulaglutide is an Fc-fusion biologic — its long half-life comes from FcRn-mediated recycling rather than albumin binding.<ref name="glaesner2010"/>		\| intro = Dulaglutide is a weekly subcutaneous [[GLP-1 receptor agonist]] developed by Eli Lilly, marketed as '''[[Trulicity]]''' since September 2014.<ref name="trulicity-label"/> Structurally distinct from the acylated peptide GLP-1 RAs ([[semaglutide]], [[liraglutide]]), dulaglutide is an Fc-fusion biologic, its long half-life comes from FcRn-mediated recycling rather than albumin binding.<ref name="glaesner2010"/>

	Dulaglutide's principal clinical distinction is the [[REWIND trial\|REWIND trial]], in which dulaglutide reduced major adverse cardiovascular events by 12% in T2DM patients ''including a majority with no prior cardiovascular disease'' — making it the first GLP-1 RA to demonstrate cardiovascular benefit in ''primary'' prevention.<ref name="rewind">Gerstein HC et al. (2019). Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). ''Lancet'' 394(10193):121–30. doi:10.1016/S0140-6736(19)31149-3</ref>		Dulaglutide's principal clinical distinction is the [[REWIND trial\|REWIND trial]], in which dulaglutide reduced major adverse cardiovascular events by 12% in T2DM patients ''including a majority with no prior cardiovascular disease'', making it the first GLP-1 RA to demonstrate cardiovascular benefit in ''primary'' prevention.<ref name="rewind">Gerstein HC et al. (2019). Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). ''Lancet'' 394(10193):121–30. doi:10.1016/S0140-6736(19)31149-3</ref>

	\| pharmacokinetics = '''Chemistry'''. '''Fc-fusion construct''': two identical GLP-1 analog peptides (each modified at positions 8, 22, 36 for DPP-4 resistance and reduced immunogenicity) linked to a human IgG4 Fc fragment via a small glycine-rich peptide linker. The Fc tail drives the long half-life through FcRn recycling.<ref name="glaesner2010">Glaesner W, Vick AM, Millican R et al. (2010). Engineering and characterization of the long-acting glucagon-like peptide-1 analogue LY2189265, an Fc fusion protein. ''Diabetes Metab Res Rev'' 26(4):287–96. doi:10.1002/dmrr.1080</ref>		\| pharmacokinetics = '''Chemistry'''. '''Fc-fusion construct''': two identical GLP-1 analog peptides (each modified at positions 8, 22, 36 for DPP-4 resistance and reduced immunogenicity) linked to a human IgG4 Fc fragment via a small glycine-rich peptide linker. The Fc tail drives the long half-life through FcRn recycling.<ref name="glaesner2010">Glaesner W, Vick AM, Millican R et al. (2010). Engineering and characterization of the long-acting glucagon-like peptide-1 analogue LY2189265, an Fc fusion protein. ''Diabetes Metab Res Rev'' 26(4):287–96. doi:10.1002/dmrr.1080</ref>
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	The Fc-IgG4 fusion confers protection from renal filtration (~63 kDa, well above the glomerular cutoff) and triggers FcRn-mediated recycling, producing a terminal half-life of ~120 hours.<ref name="glaesner2010"/><ref name="trulicity-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="trulicity-label"/>		The Fc-IgG4 fusion confers protection from renal filtration (~63 kDa, well above the glomerular cutoff) and triggers FcRn-mediated recycling, producing a terminal half-life of ~120 hours.<ref name="glaesner2010"/><ref name="trulicity-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="trulicity-label"/>

	The large molecular size limits both injection-site dispersion and oral bioavailability — dulaglutide cannot be formulated for oral use.		The large molecular size limits both injection-site dispersion and oral bioavailability, dulaglutide cannot be formulated for oral use.

	\| pharmacodynamics = '''Receptor pharmacology'''. Selective long-acting agonist of the [[GLP-1 receptor]]. The Fc-IgG4 structure differentiates it pharmacokinetically (large protein cleared by FcRn-mediated recycling rather than albumin binding) but the receptor pharmacology is the standard GLP-1 RA profile.<ref name="glaesner2010"/>		\| pharmacodynamics = '''Receptor pharmacology'''. Selective long-acting agonist of the [[GLP-1 receptor]]. The Fc-IgG4 structure differentiates it pharmacokinetically (large protein cleared by FcRn-mediated recycling rather than albumin binding) but the receptor pharmacology is the standard GLP-1 RA profile.<ref name="glaesner2010"/>
Line 39:		Line 39:
	<problem ref="cv-risk-t2dm" author="MDElliottMD"/>		<problem ref="cv-risk-t2dm" author="MDElliottMD"/>

	\| dosing = <titration slug="trulicity-standard" author="MDElliottMD" title="Trulicity — standard T2DM titration">		\| dosing = <titration slug="trulicity-standard" author="MDElliottMD" title="Trulicity, standard T2DM titration">
	0.75 mg SC weekly (starting and minimum effective dose)		0.75 mg SC weekly (starting and minimum effective dose)
	→ 1.5 mg SC weekly × ≥4 weeks (most common maintenance)		→ 1.5 mg SC weekly × ≥4 weeks (most common maintenance)
Line 49:		Line 49:

	\| effects = * '''Early satiety''' (less pronounced than with semaglutide/tirzepatide at equipotent HbA1c reduction){{Citation needed}}		\| effects = * '''Early satiety''' (less pronounced than with semaglutide/tirzepatide at equipotent HbA1c reduction){{Citation needed}}
	* '''Nausea''' — usually mild-to-moderate, peaks in first 2–4 weeks<ref name="trulicity-label"/>		* '''Nausea''', usually mild-to-moderate, peaks in first 2–4 weeks<ref name="trulicity-label"/>
	* '''Diarrhea / constipation'''<ref name="trulicity-label"/>		* '''Diarrhea / constipation'''<ref name="trulicity-label"/>
	* '''Abdominal pain'''<ref name="trulicity-label"/>		* '''Abdominal pain'''<ref name="trulicity-label"/>
	* '''Decreased appetite'''<ref name="trulicity-label"/>		* '''Decreased appetite'''<ref name="trulicity-label"/>
	* '''Injection-site reactions''' — uncommon, generally mild<ref name="trulicity-label"/>		* '''Injection-site reactions''', uncommon, generally mild<ref name="trulicity-label"/>

	GI tolerability is generally considered modestly better than weekly exenatide and comparable to or slightly better than weekly semaglutide at equivalent glycemic effect.{{Citation needed}}		GI tolerability is generally considered modestly better than weekly exenatide and comparable to or slightly better than weekly semaglutide at equivalent glycemic effect.{{Citation needed}}
Line 59:		Line 59:
	\| interactions = <pharmaInteractions/>		\| interactions = <pharmaInteractions/>

	\| pregnancy_details = Avoid. Animal embryofetal toxicity is documented.<ref name="trulicity-label"/> Discontinue at least 1 month before planned conception due to the ~5-day half-life. The pen contains no preservatives — single-dose only.		\| pregnancy_details = Avoid. Animal embryofetal toxicity is documented.<ref name="trulicity-label"/> Discontinue at least 1 month before planned conception due to the ~5-day half-life. The pen contains no preservatives, single-dose only.

	\| monitoring = * Baseline: HbA1c, weight, BP, renal function, lipid panel		\| monitoring = * Baseline: HbA1c, weight, BP, renal function, lipid panel
	* Personal or family history of MTC or [[MEN2]] — '''contraindicated''', do not start<ref name="trulicity-label"/>		* Personal or family history of MTC or [[MEN2]], '''contraindicated''', do not start<ref name="trulicity-label"/>
	* Every 3 months for first year: HbA1c, weight, GI tolerability, signs of [[pancreatitis]] or [[gallbladder disease]]		* Every 3 months for first year: HbA1c, weight, GI tolerability, signs of [[pancreatitis]] or [[gallbladder disease]]
	* Annual: renal function, lipids		* Annual: renal function, lipids
	* '''Pre-procedure''': hold weekly dose ≥7 days before any planned anesthesia<ref name="kindel2024">Kindel TL et al. (2024). Perioperative GLP-1 receptor agonist safety guidance. ''Surg Obes Relat Dis'' 20(12):1183–8.</ref>		* '''Pre-procedure''': hold weekly dose ≥7 days before any planned anesthesia<ref name="kindel2024">Kindel TL et al. (2024). Perioperative GLP-1 receptor agonist safety guidance. ''Surg Obes Relat Dis'' 20(12):1183–8.</ref>

	\| counseling = * Use the pre-filled pen as directed; the needle is hidden — patients do not see it. This is often the preferred GLP-1 RA for needle-averse patients.{{Citation needed}}		\| counseling = * Use the pre-filled pen as directed; the needle is hidden, patients do not see it. This is often the preferred GLP-1 RA for needle-averse patients.{{Citation needed}}
	* GI side effects peak in first 2–4 weeks, then attenuate.<ref name="trulicity-label"/>		* GI side effects peak in first 2–4 weeks, then attenuate.<ref name="trulicity-label"/>
	* If a weekly dose is missed: take within 3 days; if >3 days, skip and resume on the next regular day.<ref name="trulicity-label"/>		* If a weekly dose is missed: take within 3 days; if >3 days, skip and resume on the next regular day.<ref name="trulicity-label"/>