Can you take Trulicity while breastfeeding? This is an important question for mothers with type 2 diabetes who wish to breastfeed their infants. Trulicity (dulaglutide) is a once-weekly injectable medication that helps control blood sugar levels by mimicking a natural hormone in the body. However, current UK guidance advises against using Trulicity during breastfeeding due to insufficient safety data. This article examines the evidence, explores why this recommendation exists, discusses alternative diabetes treatments compatible with breastfeeding, and explains when to seek medical advice to ensure both maternal health and infant safety.

What Is Trulicity and How Does It Work?

Trulicity (dulaglutide) is a prescription medicine used to improve blood sugar control in adults with type 2 diabetes mellitus. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone in the body.

The mechanism of action involves several complementary effects. Trulicity stimulates insulin secretion from the pancreas when blood glucose levels are elevated, helping to lower blood sugar after meals. Simultaneously, it suppresses the release of glucagon, a hormone that raises blood glucose levels. Additionally, Trulicity slows gastric emptying, which means food moves more slowly from the stomach into the small intestine, resulting in a more gradual rise in blood sugar levels after eating. Many patients also experience reduced appetite, which can contribute to weight loss—a beneficial effect for many individuals with type 2 diabetes, although it is important to note that Trulicity is not licensed for weight loss.

Trulicity is administered as a once-weekly subcutaneous injection using a pre-filled pen device. The recommended starting dose is 0.75 mg once weekly, which may be increased to 1.5 mg, then 3.0 mg, and up to 4.5 mg once weekly if needed for glycaemic control. It is typically prescribed alongside dietary modifications and exercise, and may be used alone or in combination with other diabetes medications such as metformin, sulfonylureas, or insulin.

Common adverse effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and abdominal discomfort, particularly when initiating treatment. These effects often diminish over time as the body adjusts to the medication. More serious but rare risks include pancreatitis, hypoglycaemia (especially when combined with insulin or sulfonylureas), and thyroid C-cell tumours observed in rodent studies (though the relevance to humans is unknown).

If you experience any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at yellowcard.mhra.gov.uk or search for MHRA Yellow Card in the Google Play or Apple App Store.

Can You Take Trulicity While Breastfeeding?

According to the UK Summary of Product Characteristics (SmPC) and NHS guidance, Trulicity should not be used during breastfeeding. It is unknown whether dulaglutide is excreted in human breast milk, and a risk to the breastfed infant cannot be excluded. Animal studies have shown that dulaglutide is present in the milk of lactating rats, but the relevance of these findings to human lactation is unclear.

Due to the lack of human data, the MHRA-approved product information advises against using Trulicity during breastfeeding. This precautionary approach is standard when safety data in breastfeeding populations are absent or insufficient.

Several factors influence the theoretical risk to a breastfed infant. Trulicity is a large protein molecule (a GLP-1 analogue fused to an IgG4 Fc domain), which might result in minimal transfer into breast milk and limited oral bioavailability if ingested by the infant. Large protein molecules are generally poorly absorbed from the infant's gastrointestinal tract and are likely to be broken down by digestive enzymes. However, without specific studies measuring dulaglutide levels in human breast milk or assessing infant exposure, these remain theoretical considerations rather than established facts.

The official guidance is clear: Trulicity is not recommended for use whilst breastfeeding. Healthcare professionals should advise patients about alternative diabetes management strategies with better-established safety profiles during lactation. If Trulicity were to be considered despite this guidance, this would be an off-label use requiring specialist oversight and careful monitoring of both mother and infant.

Safety Considerations for Breastfeeding Mothers

When considering any medication during breastfeeding, several safety principles should guide decision-making. The primary concern is whether the drug transfers into breast milk in significant quantities and, if so, whether it could affect the infant's health and development. For Trulicity specifically, the absence of human lactation data has led to the recommendation that it should not be used during breastfeeding.

Maternal health considerations are equally important. Poorly controlled diabetes poses significant health risks to the mother, including increased susceptibility to infections, delayed wound healing, and long-term complications affecting the eyes, kidneys, nerves, and cardiovascular system. Breastfeeding itself can affect blood glucose levels, as lactation requires energy and may lower blood sugar. Therefore, maintaining stable glycaemic control is essential for maternal wellbeing and the ability to care for an infant.

If a breastfeeding mother and her healthcare team decide that alternative diabetes treatments are not suitable, and Trulicity must be considered (as an off-label use), certain monitoring measures should be implemented. The mother should maintain regular blood glucose monitoring to ensure adequate diabetes control. The infant should be observed for any unusual symptoms, particularly gastrointestinal effects, and undergo regular weight checks and developmental assessments as part of routine postnatal care.

Alternative feeding options may be discussed if Trulicity is deemed essential and concerns about infant exposure remain. However, the well-established benefits of breastfeeding for both mother and infant—including nutritional advantages, immune protection, and bonding—mean that discontinuing breastfeeding should not be undertaken lightly. The decision requires careful balancing of risks and benefits.

Mothers should be advised to contact their GP or diabetes specialist if they experience signs of poor diabetes control (excessive thirst, frequent urination, unexplained weight loss, fatigue) or if their infant shows any concerning symptoms. If the mother develops symptoms suggestive of pancreatitis (severe, persistent abdominal pain), immediate medical attention is required via NHS 111, 999, or attendance at A&E, as appropriate.

Alternative Diabetes Treatments During Breastfeeding

Several diabetes medications have more established safety profiles during breastfeeding and may be considered as alternatives to Trulicity. The choice depends on the individual's diabetes control, previous treatment response, and specific clinical circumstances.

Insulin is generally considered the safest option for managing diabetes during breastfeeding. Insulin does not pass into breast milk in clinically significant amounts, and even if small quantities were present, it would be broken down in the infant's digestive system. Both short-acting and long-acting insulin formulations can be used safely. Many women who required insulin during pregnancy continue with insulin therapy postpartum. The main consideration is adjusting doses appropriately, as insulin requirements typically decrease after delivery and may fluctuate during breastfeeding.

Metformin is an oral medication widely used for type 2 diabetes and is considered compatible with breastfeeding. Studies have shown that metformin passes into breast milk in small amounts, but infant exposure is minimal and no adverse effects have been reported in breastfed infants. NICE guidance and the British National Formulary (BNF) support metformin use during lactation, making it a first-line oral option for breastfeeding mothers with type 2 diabetes.

Glibenclamide, a sulfonylurea medication, has limited transfer into breast milk and is considered acceptable during breastfeeding according to specialist lactation resources. However, there is a theoretical risk of hypoglycaemia in the infant, so careful monitoring is advised. Other sulfonylureas such as gliclazide may be used with caution and infant monitoring, though evidence is more limited.

Other medications should be avoided during breastfeeding. SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) are not recommended during breastfeeding due to potential renal effects in the developing infant. DPP-4 inhibitors (e.g., sitagliptin) lack sufficient data on breast milk transfer and infant safety and are generally not recommended during lactation.

Lifestyle modifications remain fundamental to diabetes management and are entirely compatible with breastfeeding. A balanced diet, regular physical activity (as appropriate postpartum), and maintaining a healthy weight all contribute to improved glycaemic control without medication-related concerns.

When to Speak with Your Healthcare Professional

Open communication with your diabetes care team is essential when managing diabetes during breastfeeding. You should contact your GP, diabetes specialist nurse, or consultant if you are currently taking Trulicity and are pregnant, planning to breastfeed, or have recently given birth. Ideally, discussions about diabetes management during breastfeeding should begin during pregnancy as part of antenatal care planning.

Specific situations that warrant prompt medical advice include:

• If you are taking Trulicity and wish to initiate or continue breastfeeding—your healthcare professional can review your treatment plan and discuss safer alternatives if appropriate.

• If your blood glucose control has deteriorated or become unpredictable, as this may indicate the need for treatment adjustment.

• If you experience symptoms of hypoglycaemia (low blood sugar), such as trembling, sweating, confusion, or palpitations, particularly if you are taking Trulicity alongside insulin or sulfonylureas.

• If you develop severe abdominal pain, which could indicate pancreatitis—a rare but serious potential adverse effect of GLP-1 receptor agonists requiring immediate medical assessment via NHS 111, 999, or A&E attendance.

• If you have concerns about your infant's feeding, growth, or development, or notice any unusual symptoms.

Your healthcare professional can arrange a comprehensive medication review to ensure your diabetes treatment is optimised for the breastfeeding period. This review should consider your current glycaemic control (HbA1c levels), any complications of diabetes, other medications you are taking, and your individual preferences and circumstances.

Additionally, specialist support services are available. Diabetes specialist midwives and infant feeding coordinators can provide tailored advice. The UK Drugs in Lactation Advisory Service (UKDILAS) offers evidence-based information to healthcare professionals about medication safety during breastfeeding. Your pharmacist can also provide valuable guidance about medication timing and administration.

Remember that managing diabetes effectively protects your long-term health and enables you to care for your baby. Never stop or alter prescribed diabetes medication without professional guidance, as this could result in dangerous blood glucose fluctuations.

Frequently Asked Questions