Trulicity and Imaging Contrast Dye: What Patients and Clinicians Need to Know

Does Trulicity interact with iodinated contrast dye?

The Trulicity prescribing information handles drug interactions in a short section with two entries: oral medications, and insulin secretagogues such as sulfonylureas or insulin itself [1]. Iodinated contrast media are not named in it.

That section explains that dulaglutide delays gastric emptying and can reduce the rate at which oral medicines are absorbed. It notes that the 1.5 mg dose did not affect absorption of the tested oral drugs to a clinically relevant degree, that experience with the 3 mg and 4.5 mg doses is limited, and that drug levels of narrow-therapeutic-index oral medicines such as warfarin should be monitored [1]. The label gives no contrast-specific guidance on timing a dose around a scan.

What the label says about procedures and sedation

Trulicity carries a warning for pulmonary aspiration during general anesthesia or deep sedation. The label states that aspiration has been reported in patients receiving GLP-1 receptor agonists who underwent elective surgeries or procedures, and that patients should be instructed to inform healthcare providers of any planned surgeries or procedures [1].

Dulaglutide is injected once weekly and has a half-life of about 5 days [1].

What the label says about the kidneys

The label's acute kidney injury warning describes postmarketing reports of acute kidney injury, in some cases requiring hemodialysis, in patients treated with GLP-1 receptor agonists including Trulicity. It states that the majority of reported events occurred in patients who had gastrointestinal reactions leading to dehydration such as nausea, vomiting or diarrhea, and advises monitoring renal function in patients reporting reactions that could cause volume depletion, especially during dose initiation and escalation [1].

Gastrointestinal reactions are common on Trulicity. In the adult placebo-controlled pool, nausea occurred in 21.1% of patients on 1.5 mg versus 5.3% on placebo, vomiting in 12.7% versus 2.3%, and any gastrointestinal reaction in 41% versus 21% [1]. Severe gastrointestinal reactions were reported in 4.3% on 1.5 mg versus 1.4% on placebo, and the label states that Trulicity is not recommended in patients with severe gastroparesis [1].

Hypoglycemia with insulin or sulfonylureas

Trulicity taken with insulin or a sulfonylurea carries a higher risk of hypoglycemia, and the label says to consider reducing the dose of the insulin secretagogue or insulin when Trulicity is started [1]. In the label's hypoglycemia table, glucose below 54 mg/dL occurred in 14.7% of patients on Trulicity 1.5 mg plus insulin glargine versus 9.3% on placebo plus glargine, and in 3.3% on Trulicity 1.5 mg plus glimepiride versus 0% on placebo [1].

Alcohol and the Trulicity label

The Trulicity label contains no mention of alcohol anywhere in the prescribing information, Medication Guide, patient counseling or Instructions for Use [1].