Dulaglutide

Definition

Dulaglutide is a glucagon-like peptide-1 receptor agonist given once weekly by subcutaneous injection, and it is the member of this class that is not a peptide. The label describes a fusion protein of two identical disulfide-linked chains, each joining a GLP-1 analogue sequence to the Fc portion of a modified human immunoglobulin G4, with an overall molecular weight of about 63 kilodaltons ^[1].

That structure is why it sits here rather than outside the index. Readers meet dulaglutide in the same sentence as semaglutide and tirzepatide, under the same three words on a provider menu, and the shared class name hides a label that was written for a different purpose.

Evidence

PubMed returns 1,322 indexed records across three name variants, of which 843 carry the Humans subject heading, 160 the clinical-trial publication type and 149 the randomized-controlled-trial type ^[2]. That is a magnitude rather than a list, and the table reporting it says so.

The largest trial in the set is a cardiovascular outcome trial. REWIND randomized 9,901 people with type 2 diabetes to weekly dulaglutide at 1.5 mg or placebo and followed them a median 5.4 years; major adverse cardiovascular events occurred in 12.0 percent of the treated group against 13.4 percent on placebo, a hazard ratio of 0.88 ^[3]. All-cause mortality did not differ, and gastrointestinal adverse events were reported by 47.4 percent against 34.1 percent ^[3].

Where the class is compared head to head, this molecule is the weaker one on weight. SUSTAIN 7 randomized 1,201 patients to semaglutide or dulaglutide at two matched dose pairs, and body weight fell 4.6 kg against 2.3 kg at the lower pair and 6.5 kg against 3.0 kg at the higher ^[4]. Both differences favored the other molecule and both were the trial's stated confirmatory endpoint.

The dose range on the current label is itself a trial result: 3.0 mg and 4.5 mg were tested against 1.5 mg in metformin-treated patients before the higher strengths existed ^[5]. A reader comparing weekly injections should treat the strength on the box as the finding, not the molecule name.

Side effects

The Trulicity label names nausea, diarrhea, vomiting, abdominal pain and decreased appetite as the most common adverse reactions, each reported in at least 5 percent of treated patients ^[9]. In the label's pool of placebo-controlled trials, gastrointestinal reactions of any kind occurred in 32 and 41 percent of patients on the two strengths studied, against 21 percent on placebo; indigestion and fatigue also cleared the 5 percent line at the higher strength ^[9].

The label carries a boxed warning for thyroid C-cell tumors: dulaglutide caused them in rats, whether it does so in humans is unknown, and the drug is contraindicated for anyone with a personal or family history of medullary thyroid carcinoma or with multiple endocrine neoplasia syndrome type 2 ^[9]. It is also contraindicated after a serious hypersensitivity reaction to dulaglutide or any component of the product ^[9].

The other warnings cover acute pancreatitis, hypoglycemia when combined with insulin or an insulin secretagogue, serious allergic reactions including anaphylaxis and angioedema, acute kidney injury from dehydration, severe gastrointestinal reactions, diabetic retinopathy complications in patients with a history of retinopathy, acute gallbladder disease, and pulmonary aspiration during general anesthesia or deep sedation ^[9]. The label does not recommend the drug for people with severe gastroparesis ^[9].

The cardiovascular outcome trial gives the same picture over years rather than weeks: in REWIND, gastrointestinal adverse events were reported by 47.4 percent of the dulaglutide group against 34.1 percent on placebo across a median 5.4 years ^[3].

Educational summary of the cited sources, not medical advice; a prescriber weighs these risks against a person’s own history.

Lawful access

The lawful supply route is the licensed product. FDA licensed dulaglutide injection under biologics license application 125469 on September 18, 2014 as a Type 1 new molecular entity, and Drugs@FDA records Trulicity in four strengths from 0.75 mg to 4.5 mg per 0.5 mL, sponsored by Eli Lilly and marketed as prescription-only ^[6].

The label is written for diabetes and for cardiovascular risk. In the version effective June 16, 2026 the product is indicated as an adjunct to diet and exercise to improve glycemic control in adults and in pediatric patients ten years of age and older with type 2 diabetes mellitus, and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors ^[1]. No weight-management indication appears anywhere in that section.

Neither compounding nor shortage arises. Dulaglutide appears in none of the three categories of the section 503A bulks list published May 14, 2026 ^[7], and FDA's drug shortage database holds no entry for it, in a query whose control on liraglutide returned eleven records with the status Current ^[8].

Related molecules

Dulaglutide is filed with the GLP-1 receptor agonists beside semaglutide, tirzepatide, liraglutide and retatrutide. It is the member a reader is least likely to have come looking for and the one a physician is most likely to reach for first, because its label is written for glycemic control and cardiovascular risk rather than for weight.

The approved peptide drugs table places this product beside the rest of the approved set, the human trial record carries the census behind the counts above, and the approved page states where compounded copies of this class now stand. The incretin pipeline tracker places the approved GLP-1 drugs beside the candidates still in trials.

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