Trulicity (dulaglutide) is a once-weekly injectable GLP-1 receptor agonist used to manage type 2 diabetes in adults. Whilst it offers significant glycaemic and cardiovascular benefits, pancreatitis—inflammation of the pancreas—has been reported in patients taking Trulicity and other GLP-1 receptor agonists. The MHRA, EMA, and UK Summary of Product Characteristics highlight pancreatitis as a known risk. Understanding the warning signs, risk factors, and appropriate actions is essential for safe use. This article examines the link between Trulicity and pancreatitis, how to recognise symptoms, and what to do if pancreatic problems develop.

What Is Trulicity and How Does It Work?

Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes mellitus in adults. It is not licensed for type 1 diabetes or diabetic ketoacidosis. Trulicity belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that helps regulate blood sugar levels.

The mechanism of action involves several complementary effects. Trulicity stimulates insulin secretion from the pancreas in a glucose-dependent manner, meaning it only promotes insulin release when blood sugar levels are elevated. This reduces the risk of hypoglycaemia when used alone; however, the risk increases when Trulicity is combined with insulin or a sulfonylurea, and dose reductions of these medicines may be needed. Additionally, Trulicity suppresses the release of glucagon (a hormone that raises blood sugar), slows gastric emptying to reduce post-meal glucose spikes, and may promote modest weight loss by increasing satiety.

In the UK, Trulicity is available in pre-filled pens containing 0.75 mg, 1.5 mg, 3 mg, or 4.5 mg doses. The usual starting dose is 0.75 mg once weekly, which may be increased to 1.5 mg and then to 3 mg or 4.5 mg as needed and tolerated. NICE guideline NG28 supports the use of GLP-1 receptor agonists like Trulicity in specific circumstances: typically when metformin and other oral therapies have not achieved adequate glycaemic control, and when the person has a BMI of 35 kg/m² or above (adjusted for ethnicity) or when weight loss would benefit other obesity-related comorbidities. Treatment should be continued only if there is a beneficial metabolic response (a reduction of at least 11 mmol/mol [approximately 1.0%] in HbA1c and a weight loss of at least 3% of initial body weight at 6 months).

Whilst Trulicity offers significant benefits for many patients with type 2 diabetes, it is important to understand its potential adverse effects. Pancreatitis—inflammation of the pancreas—has been reported in patients taking GLP-1 receptor agonists, including Trulicity. The MHRA, EMA, and the UK Summary of Product Characteristics (SmPC) for Trulicity highlight pancreatitis as a known risk. Healthcare professionals must carefully assess individual patient suitability before prescribing, and patients should be counselled on the warning signs of pancreatitis.

If you experience any suspected side effects, you can report them via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for MHRA Yellow Card in the Google Play or Apple App Store.

Recognising Pancreatitis Symptoms Whilst Taking Trulicity

Acute pancreatitis is a serious condition characterised by sudden inflammation of the pancreas. Whilst the absolute risk remains relatively low, patients taking Trulicity should be aware of the warning signs so they can seek prompt medical attention if symptoms develop.

The hallmark symptom of pancreatitis is severe, persistent abdominal pain, typically located in the upper abdomen and often radiating through to the back. This pain may worsen after eating and is usually constant rather than intermittent. Patients frequently describe it as a deep, boring sensation.

Other important symptoms include:

• Nausea and vomiting that may be persistent and severe

• Fever and feeling generally unwell

• Abdominal tenderness and swelling

• Rapid pulse and signs of dehydration

• In severe cases, jaundice (yellowing of the skin or eyes)

It is crucial to distinguish pancreatitis from the common gastrointestinal side effects of Trulicity, such as mild nausea, which typically occur when starting treatment and often improve over time. Pancreatitis pain is characteristically severe and unrelenting, whereas common side effects are usually mild to moderate and transient.

Clinical studies and post-marketing surveillance have identified pancreatitis as an uncommon adverse reaction to GLP-1 receptor agonists. The UK SmPC for Trulicity notes that acute pancreatitis has been observed in clinical trials and post-marketing experience. Patients with a history of pancreatitis should be counselled on the symptoms, though pancreatitis can occur in individuals without prior pancreatic disease.

Diagnosis of acute pancreatitis typically requires two of the following three criteria: characteristic abdominal pain; serum lipase (or amylase) at least three times the upper limit of normal; and characteristic findings on imaging. Lipase is more specific than amylase. It is important to note that normal enzyme levels do not fully exclude early pancreatitis.

If you experience severe abdominal pain whilst taking Trulicity, do not dismiss it as a minor side effect—seek medical evaluation promptly.

What to Do If You Develop Pancreas Problems on Trulicity

If you experience severe or persistent abdominal pain whilst taking Trulicity, it is essential to seek medical attention urgently. Do not wait to see if symptoms resolve on their own, as delayed diagnosis of pancreatitis can lead to serious complications.

Immediate actions to take:

• Stop taking Trulicity and do not administer your next scheduled dose until you have been assessed by a healthcare professional

• Contact your GP urgently or call NHS 111 for advice if your GP surgery is closed

• If pain is severe, you are vomiting persistently, or you feel seriously unwell, attend your local A&E department or call 999

• Inform healthcare professionals that you are taking Trulicity, as this information is crucial for diagnosis

When you seek medical attention, your doctor will conduct a thorough assessment. This typically includes a physical examination focusing on abdominal tenderness and signs of systemic illness. Blood tests are essential and will measure pancreatic enzymes—specifically serum lipase (which is more specific than amylase)—which are typically elevated at least three times above the upper limit of normal in acute pancreatitis. Additional tests may include liver function tests, full blood count, and inflammatory markers.

Imaging investigations are used to confirm the diagnosis and assess severity. An abdominal ultrasound is usually performed first to assess for gallstones, a common cause of pancreatitis. A CT scan or MRCP may be arranged if the diagnosis remains uncertain, to assess the severity of inflammation, or to identify potential complications.

According to the UK SmPC, if pancreatitis is suspected, Trulicity should be discontinued. If acute pancreatitis is confirmed, Trulicity must not be restarted. Treatment for acute pancreatitis is primarily supportive and may require hospital admission for intravenous fluids, pain management, nutritional support, and monitoring for complications.

Your diabetes management will need to be reviewed, and alternative medications will be considered. Re-challenge with any GLP-1 receptor agonist is generally avoided, though the evidence for a class effect is not definitive. Any decision to use another GLP-1 receptor agonist should only be made under specialist endocrinology input.

Who Should Use Trulicity with Caution Due to Pancreatitis Risk?

Certain patient groups require careful consideration and counselling before starting Trulicity. The UK SmPC and NICE guidance provide clear direction on precautions.

Hypersensitivity to dulaglutide or any excipients is the only absolute contraindication listed in the SmPC. However, patients with a history of acute or chronic pancreatitis should use Trulicity with caution. If you have previously experienced pancreatitis from any cause, your healthcare provider will discuss the risks and benefits carefully. According to the SmPC, if pancreatitis is suspected during treatment, Trulicity should be discontinued; if pancreatitis is confirmed, Trulicity should not be restarted.

Patients should inform their healthcare provider if they have:

• Previous episodes of pancreatitis of any cause

• Chronic pancreatitis or ongoing pancreatic disease

• Gallstones or a history of biliary disease (which independently increases pancreatitis risk)

• Severe hypertriglyceridaemia (very high blood fat levels), as this is a known risk factor for pancreatitis

• Excessive alcohol consumption, which significantly raises pancreatitis risk

• Severe gastrointestinal disease, including severe gastroparesis, as Trulicity is not recommended in these circumstances

A thorough medical history and risk assessment should be conducted before initiating treatment. Healthcare professionals should discuss the signs and symptoms of pancreatitis with all patients starting Trulicity, ensuring they understand when to seek urgent medical attention.

For patients with multiple risk factors, alternative diabetes medications may be more appropriate. The decision to prescribe Trulicity should involve shared decision-making, weighing the cardiovascular and glycaemic benefits against the potential risks. NICE NG28 sets out clear criteria for initiating and continuing GLP-1 receptor agonists, including BMI thresholds and the requirement for a beneficial metabolic response at 6 months (HbA1c reduction of at least 11 mmol/mol and weight loss of at least 3% of initial body weight).

Regular review and monitoring are essential, and patients should be encouraged to report any new or concerning symptoms promptly. If you have concerns about whether Trulicity is suitable for you, discuss these openly with your GP or diabetes specialist nurse.

Frequently Asked Questions