Pharmacology · GLP-1 receptor agonists
Dulaglutide !
A weekly injected GLP-1 agonist fused to an antibody fragment. It lowers glucose and cardiovascular events in type 2 diabetes.
Updated 2026-11-01
No structure with dulaglutide is available; the figure shows native GLP-1, the hormone whose sequence dulaglutide carries, bound to the human GLP-1 receptor with its Gs protein.
Mechanism of action
Dulaglutide is two modified GLP-1 chains joined to the Fc part of a human antibody. The large size slows kidney clearance and the changes block DPP-4, so one injection works for a week. It activates the GLP-1 receptor: glucose-dependent insulin release, less glucagon, slower gastric emptying and less appetite.
- Activates the GLP-1 receptor (Gs, cAMP)
- Beta cells release more insulin when glucose is high
- Glucagon falls and the stomach empties more slowly
- Appetite falls: lower glucose and weight
Pharmacokinetics
- Absorption
- Weekly subcutaneous injection, absorbed slowly.
- Metabolism
- Broken down into amino acids like other proteins.
- Half-life
- Long, which allows once-weekly injection.
Indications
- Type 2 diabetes, and to reduce major cardiovascular events in adults with type 2 diabetes Type 2 diabetes mellitus →
Adverse effects
Common
- Nausea, vomiting, diarrhea, constipation, abdominal pain (most common, mostly at the start)
- Reduced appetite
- Injection-site reactions
- Slightly faster heart rate
Contraindications
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia type 2 (MEN 2)
- Serious hypersensitivity to the drug
Key interactions
- Insulin or sulfonylureas
- Higher risk of hypoglycemia; their dose is often reduced.
- Oral drugs in general
- Slower gastric emptying can change their absorption.
What is monitored
- HbA1c and weight
- Kidney function if vomiting or diarrhea
- Symptoms of pancreatitis or gallbladder disease
Administration and safety
- Subcutaneous injection in the abdomen, thigh or upper arm, rotating sites.
- Pens are for one person only and are never shared, even with a new needle.
- The dose is raised step by step to limit nausea.
- Unopened pens are kept in the refrigerator, not frozen.
Nursing care
- Before: thyroid history (medullary carcinoma, MEN 2), pancreatitis history, kidney function.
- During: severe abdominal pain spreading to the back (pancreatitis), vomiting and dehydration.
- Teach to report a neck lump, hoarseness or trouble swallowing.
- The anesthesia team is told before surgery or endoscopy.
Pregnancy and breastfeeding
Not used in pregnancy (weight loss is not a goal and animal data showed harm); it is stopped ahead of a planned pregnancy.
Test yourself
Think of the answer, then tap the question to see it.
How is dulaglutide made long-acting?
Its GLP-1 chains are fused to an antibody Fc fragment, which slows kidney clearance, and amino-acid changes block DPP-4.
Which thyroid tumor history rules out dulaglutide?
Personal or family history of medullary thyroid carcinoma, or MEN 2.
Does dulaglutide have to be injected with a meal?
No. The weekly injection can be given at any time of day, with or without meals.
Related drugs
Related conditions
← Back to the class: GLP-1 receptor agonists
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Dulaglutide Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
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Representative model, for educational purposes only.