To reduce the risk of hypoglycemia when initiating dulaglutide treatment, consider reducing the dosage of concomitantly administered

• insulin secretagogues, such as sulfonylureas, or
• insulin.1

Dulaglutide delays gastric emptying and has the potential to reduce the rate of absorption of concomitantly administered oral medications. The delay in gastric emptying is dose-dependent but is attenuated with the recommended dose escalation to higher doses of dulaglutide.1

The delay in gastric emptying following the administration of a GLP-1 RA is well recognized and has been hypothesized as one of the factors contributing to BG lowering.2,3

Because dulaglutide slows gastric emptying, it may reduce the extent and rate of absorption of orally co-administered medications. Monitor drug levels of oral medications with a narrow therapeutic index, like warfarin, when concomitantly administered with dulaglutide.1

In clinical pharmacology studies, dulaglutide 1.5 mg did not affect the absorption, to any clinically relevant degree, of the tested orally administered medications that included 

• lisinopril
• metoprolol
• digoxin
• norelgestromin
• ethinylestradiol
• atorvastatin
• metformin
• acetaminophen
• S-warfarin
• R-warfarin, and
• sitagliptin.1

There is limited experience with the use of concomitant medications in clinical trials with dulaglutide doses of 3 mg and 4.5 mg.1

The co-administration of a single dose of 1.5 mg dulaglutide, with a steady-state dose of 100 mg sitagliptin, caused an increase in dulaglutide AUC and C_max of approximately 38% and 27%. This was not considered to be clinically relevant, respectively.1