Trulicity Vaccine Interaction Profile: What Patients and Clinicians Need to Know

What the Trulicity label actually lists

The Drug Interactions section has two parts. The first is oral medications, because dulaglutide delays gastric emptying and may slow their absorption. The second is insulin secretagogues such as sulfonylureas, and insulin itself, because of hypoglycemia risk and the option of lowering those doses when Trulicity is started [1].

The contraindications are narrow: a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, and a serious hypersensitivity reaction to dulaglutide or any product component [1].

Does delayed gastric emptying matter for a vaccine?

The label's absorption warning concerns oral medicines, not vaccines. The delay is dose-dependent, largest after the first dose and attenuated with the recommended dose escalation, and dulaglutide 1.5 mg did not affect the absorption of the tested oral drugs to a clinically relevant degree, with limited experience at 3 mg and 4.5 mg [1]. The label advises monitoring levels of narrow-therapeutic-index oral drugs such as warfarin [1].

Timing, injection sites and side effects

The label gives no instruction about scheduling a vaccine around the once-weekly Trulicity dose. Dulaglutide has a half-life of about 5 days [1]. The label says Trulicity is injected subcutaneously in the abdomen, thigh or upper arm, at any time of day, with site rotation at each dose [1]. The label's only instruction about a second injection given at the same time concerns insulin: separate injections, never mixed, same body region acceptable but not adjacent [1].

Gastrointestinal effects are among the most common adverse reactions with dulaglutide. In the adult placebo-controlled pool, nausea was reported by 5.3% on placebo, 12.4% on 0.75 mg and 21.1% on 1.5 mg, and any gastrointestinal reaction by 21%, 32% and 41% [1]. Most nausea and GI events were mild to moderate [1]. Serious hypersensitivity, including anaphylaxis and angioedema, has been reported; the label says to discontinue Trulicity, treat promptly and monitor until signs and symptoms resolve [1].