About This Tool

The Dulaglutide Titration Calculator is a clinical support tool designed to generate a standard dose escalation schedule for adult patients with type 2 diabetes. It follows FDA-approved prescribing guidelines to help healthcare providers plan dose increases from initiation up to the maximum recommended maintenance dose, ensuring a systematic approach to optimizing glycemic control.

Outputs Explained

After inputting the patient’s current dose and start date, the calculator generates a clear, chronological dosing schedule. The output includes:

• Dose Level: The specific dulaglutide dose in milligrams for each step of the titration (e.g., 0.75 mg, 1.5 mg, 3.0 mg, 4.5 mg).
• Titration Date: The earliest recommended date to increase to the next dose level, calculated based on a minimum 4-week interval.
• Treatment Week: A description of the treatment period for each dose (e.g., “Weeks 1-4”, “Starting Week 5”).
• Clinical Summary: A concise note indicating the next action, such as the date for the next dose increase or confirmation that the patient has reached the maximum dose.

How to Use

To generate a dosing schedule, follow these simple steps:

1. Select Start Date of Current Dose: Use the calendar to input the date the patient began (or will begin) their current dose of dulaglutide. The tool defaults to today’s date.
2. Select Current Dose: From the dropdown menu, choose the patient’s current therapy status. This includes initiating therapy (starting dose of 0.75 mg) or their current maintenance dose (0.75 mg, 1.5 mg, or 3.0 mg).

The titration schedule will automatically update based on your selections.

Dosing Overview

The standard dulaglutide titration schedule is designed to improve efficacy while managing potential gastrointestinal side effects. The recommended escalation pathway is as follows:

• Starting Dose: Therapy is initiated with 0.75 mg once weekly.
• First Escalation: After at least 4 weeks on the starting dose, the dose can be increased to 1.5 mg once weekly for additional glycemic control.
• Further Escalations: For further glycemic control, the dose can be increased in 1.5 mg increments after at least 4 weeks on the current dose, up to the maximum dose of 4.5 mg once weekly. The typical steps are 1.5 mg → 3.0 mg → 4.5 mg.

Switching Therapies

When switching a patient to dulaglutide from another antidiabetic agent, such as another GLP-1 receptor agonist, insulin, or an oral medication, careful clinical judgment is required. There are no specific dose-conversion guidelines provided in the prescribing information. Discontinuation of the previous therapy and initiation of dulaglutide at the 0.75 mg starting dose is the standard approach, but this should be individualized based on the patient’s glycemic control and risk of hypoglycemia. Always consult the full prescribing information.

Missed Dose Guidance

If a patient misses a dose of dulaglutide, the following guidance should be provided:

• If there are at least 3 days (72 hours) remaining before the next scheduled dose, the patient should administer the missed dose as soon as possible.
• If there are fewer than 3 days (72 hours) remaining before the next scheduled dose, the patient should skip the missed dose.

In either case, the patient should then resume their regular once-weekly dosing schedule on their usual day.

Safety Alerts

Dulaglutide has a boxed warning regarding the risk of thyroid C-cell tumors. It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The most common adverse reactions include nausea, diarrhea, vomiting, abdominal pain, and decreased appetite. These are most common during treatment initiation and dose escalation. This tool is not a substitute for clinical judgment or a comprehensive review of the patient’s medical history.

Frequently Asked Questions (FAQ)

What is the standard starting dose for dulaglutide?
The recommended starting dose for dulaglutide is 0.75 mg administered subcutaneously once a week.

How often should the dulaglutide dose be increased?
Dose increases should occur no sooner than every 4 weeks to allow for assessment of glycemic response and tolerability.

What is the maximum dose calculated by this tool?
The calculator generates a schedule up to the maximum recommended dose of 4.5 mg once weekly.

Why does the calculator use a 4-week interval for dose changes?
This interval is based on the prescribing information, which recommends assessing response and tolerability for at least four weeks before considering a dose escalation.

Can I increase the dose faster than every 4 weeks?
No, increasing the dose more frequently than every 4 weeks is not recommended as it may increase the incidence of gastrointestinal side effects and does not align with official guidelines.

What should be done if a patient cannot tolerate an increased dose?
If a patient experiences significant side effects after a dose increase, consideration may be given to returning to the previous lower dose. The decision to titrate should always balance glycemic goals with patient tolerability.

What does the calculator show if the patient is already on the maximum dose of 4.5 mg?
The tool does not have an option for 4.5 mg as a “current dose” because no further titration is possible. If a patient is on 3.0 mg, it will show the schedule to reach 4.5 mg. The output will indicate when the maximum dose is reached.

Does this calculator account for renal or hepatic impairment?
No. This tool generates a standard titration schedule. According to the prescribing information, no dose adjustment is recommended for patients with renal or hepatic impairment, but all clinical decisions should be individualized. Always consult the full prescribing information for specific patient populations.

References

• TRULICITY® (dulaglutide) Prescribing Information. U.S. Food and Drug Administration. Eli Lilly and Company.
• Trulicity for Healthcare Professionals. Eli Lilly and Company.
• DailyMed – DULAGLUTIDE injection, solution. National Library of Medicine.
• American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2023. Diabetes Care 2023; 46 (Suppl. 1): S140–S157.