Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes in the UK. As a GLP-1 receptor agonist, it works by slowing gastric emptying and regulating blood glucose levels. Whilst effective for diabetes control, this mechanism can affect digestion. Many patients wonder: can Trulicity cause acid reflux? Understanding the relationship between Trulicity and digestive symptoms, including gastro-oesophageal reflux, is important for managing your treatment effectively. This article explores how Trulicity may contribute to reflux symptoms, practical management strategies, and when to seek medical advice.

What Is Trulicity and How Does It Work?

Trulicity (dulaglutide) is a prescription medication licensed in the UK for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone in the body.

The medication is administered as a once-weekly subcutaneous injection, typically into the abdomen, thigh, or upper arm. Trulicity can be given at any time of day, with or without food. It helps to lower blood glucose levels through several mechanisms:

• Stimulating glucose-dependent insulin secretion from the pancreas in response to elevated blood glucose

• Suppressing glucagon release, which reduces glucose production by the liver

• Slowing gastric emptying, which moderates the rate at which food leaves the stomach

• Reducing appetite, which may contribute to weight loss

Trulicity is available in various doses (0.75 mg, 1.5 mg, 3 mg, and 4.5 mg). Treatment typically starts with 0.75 mg once weekly, with potential increases to 1.5 mg, then 3.0 mg and 4.5 mg if needed and tolerated. According to NICE guidance (NG28), GLP-1 receptor agonists like Trulicity may be considered as part of triple therapy for type 2 diabetes when a person has a BMI of 35 kg/m² or higher (or lower in certain ethnic groups), or when weight loss would benefit obesity-related comorbidities, or when insulin therapy is unacceptable.

The medication has been shown in clinical trials to effectively reduce HbA1c levels and support modest weight reduction. However, like all medications, Trulicity can cause side effects, with gastrointestinal symptoms being among the most commonly reported. It is important to note that Trulicity is not indicated for type 1 diabetes or diabetic ketoacidosis.

Why GLP-1 Medications May Affect Digestion

The connection between Trulicity and digestive symptoms, including acid reflux (gastro-oesophageal reflux), stems directly from its mechanism of action. GLP-1 receptor agonists fundamentally alter gastrointestinal motility and function, which can lead to various digestive side effects.

Delayed gastric emptying is one of the primary ways Trulicity works to control blood glucose. By slowing the movement of food from the stomach into the small intestine, the medication helps prevent rapid spikes in blood sugar after meals. However, this same mechanism can cause food and stomach acid to remain in the stomach for longer periods, potentially increasing intra-gastric pressure and the likelihood of acid reflux into the oesophagus.

Commonly reported gastrointestinal side effects of Trulicity include:

• Nausea (affecting approximately 12-21% of patients, depending on dose)

• Vomiting

• Diarrhoea

• Abdominal pain or discomfort

• Decreased appetite

• Dyspepsia (indigestion)

• Constipation

Whilst gastro-oesophageal reflux is not listed among the most frequent adverse effects in the Summary of Product Characteristics (SmPC), the delayed gastric emptying associated with GLP-1 agonists may contribute to reflux symptoms in some individuals. Most gastrointestinal side effects tend to be mild to moderate in severity and often improve over time as the body adjusts to the medication, typically within the first few weeks of treatment.

It is important to note that Trulicity is not recommended for patients with severe gastrointestinal disease, including severe gastroparesis, as it may worsen these conditions.

Managing Acid Reflux While Taking Trulicity

If you experience acid reflux symptoms whilst taking Trulicity, several practical strategies can help manage these symptoms without necessarily discontinuing your diabetes medication. It is essential to discuss any persistent or troublesome symptoms with your healthcare team.

Dietary and lifestyle modifications form the cornerstone of reflux management:

• Eat smaller, more frequent meals rather than large portions, which can reduce gastric distension

• Avoid trigger foods such as fatty or fried foods, chocolate, caffeine, alcohol, spicy foods, and acidic items (citrus, tomatoes)

• Remain upright for at least 2–3 hours after eating to allow gravity to assist digestion

• Elevate the head of your bed by 15–20 cm if you experience nocturnal reflux

• Maintain a healthy weight, as excess weight increases abdominal pressure

• Avoid tight-fitting clothing around the abdomen

• Stop smoking, as tobacco weakens the lower oesophageal sphincter

Pharmacological options may be appropriate for persistent symptoms. Over-the-counter alginate/antacid preparations (such as sodium alginate preparations like Gaviscon) can provide short-term relief by neutralising stomach acid. For more persistent symptoms, your GP may recommend:

• Proton pump inhibitors (PPIs) such as omeprazole or lansoprazole, which reduce acid production

• H2-receptor antagonists such as famotidine (availability may vary), though these are less commonly used than PPIs

If your reflux symptoms persist despite 4 weeks of optimal self-care and over-the-counter treatments, you should consult your GP for review. Your healthcare team may consider adjusting your Trulicity dose if gastrointestinal side effects are particularly troublesome. Always follow your healthcare professional's guidance regarding medication and never adjust your dose without medical supervision.

When to Speak to Your GP About Digestive Symptoms

Whilst mild digestive symptoms are common when starting Trulicity and often resolve with time, certain warning signs warrant prompt medical attention. Understanding when to seek professional advice is crucial for patient safety and optimal diabetes management.

Contact your GP or diabetes specialist nurse if you experience:

• Severe or persistent nausea and vomiting that prevents you from eating or drinking adequately, as this may lead to dehydration and potential kidney problems

• Severe abdominal pain, particularly if it is constant or radiating to the back, which could indicate pancreatitis (a rare but serious side effect)

• Difficulty swallowing (dysphagia) or pain when swallowing

• Persistent heartburn that does not respond to lifestyle modifications or over-the-counter treatments after 4 weeks

• Unintentional weight loss beyond what is expected from diabetes management

• Blood in vomit or black, tarry stools, which may indicate gastrointestinal bleeding

• Symptoms of dehydration such as dizziness, reduced urination, or extreme thirst

• Right upper abdominal pain, fever or yellowing of the skin/eyes, which may suggest gallbladder problems

Seek immediate medical attention (call 999 or attend A&E) if you develop:

• Severe, unrelenting abdominal pain

• Signs of an allergic reaction (difficulty breathing, facial swelling, severe rash)

• Symptoms of acute pancreatitis (severe upper abdominal pain radiating to the back, often with nausea and vomiting)

If you are also taking insulin or sulfonylureas (e.g., gliclazide), monitor your blood glucose levels closely during periods of poor appetite or vomiting, as you may be at risk of hypoglycaemia and may need temporary dose adjustments of these medications.

Your healthcare team can assess whether your symptoms are related to Trulicity or may have another cause requiring investigation. According to NICE guidance, urgent specialist referral should be considered for any patient with dysphagia, or those aged 55 and over with weight loss and reflux or dyspepsia symptoms.

Never stop taking Trulicity without consulting your healthcare professional, as abrupt discontinuation may affect your blood glucose control. If you suspect you are experiencing side effects from Trulicity, you can report these through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions