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Acronyms CrCl - Creatinine clearance GLP-1 - Glucagon-Like Peptide-1 P - Drugs with pediatric dosing Dulaglutide Trulicity Trulicity Dosage forms Single-dose pen 0.75 mg/0.5 ml 1.5 mg/0.5 ml 3 mg/0.5 ml 4.5 mg/0.5 ml Comes in carton with 4 pens Dosing Type 2 diabetes Starting: 0.75 mg once weekly Maintenance: 0.75 - 4.5 mg once weekly Max: 4.5 mg once weekly Increase to next higher dose if needed at intervals of 4 weeks May administer without regard to food If a dose is missed, administer ASAP if there are at least 3 days until the next scheduled dose If less than 3 days remain before the next scheduled dose, skip the missed dose and administer the next dose on the regularly scheduled day In each case, patients can then resume their regular once weekly dosing schedule The day of weekly administration can be changed if necessary as long as the last dose was administered 3 or more days before Kidney disease No dose adjustment is recommended in patients with renal impairment including end-stage renal disease Gastrointestinal side effects may be worse in patients with kidney disease Liver disease In a study of patients with varying degrees of liver disease, no clinically relevant change in dulaglutide pharmacokinetics was observed

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This work was supported by the Wilmot Cancer Institute Predoctoral Fellowship (G.A.), Wilmot Cancer Institute Pilot Funding (I.S.H.), the American Association for Cancer Research and Breast Cancer Research Foundation (20-20-26-HARR) (I.S.H.), Breast Cancer Coalition of Rochester (I.S.H.), a Sir Henry Wellcome Postdoctoral Fellowship (M.E.K.), and a FNR-CORE grant C21/BM/15796788 (D.B.), and NIH grants R01CA269813 (I.S.H.), R37CA230042 (G.M.D), R24AA022057 (V.V.), R01AA028859 (Y.C.), AI150698 (J.M.), K01CA240533-01A1 (C.L.C.), and R01AR078000 (R.T.D.)

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