Trulicity (dulaglutide) is a once-weekly injectable medication for adults with type 2 diabetes mellitus. Each Trulicity pen contains a single dose and is designed for one-time use only. Understanding how many doses are in each pen, along with proper administration and storage, is essential for safe and effective diabetes management. This article explains Trulicity pen dosing, available strengths, correct handling procedures, and what to do if a dose is missed, helping patients and healthcare professionals optimise treatment outcomes whilst minimising risks.

Understanding Trulicity Pen Dosing and Administration

Trulicity (dulaglutide) is a once-weekly injectable medication used to improve blood glucose control in adults with type 2 diabetes mellitus. It belongs to a class of medicines called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of the naturally occurring hormone GLP-1. This mechanism stimulates insulin secretion when blood glucose levels are elevated, suppresses glucagon release, slows gastric emptying, and may promote satiety—all contributing to improved glycaemic control.

Trulicity is supplied in a pre-filled, single-dose pen injector designed for subcutaneous administration. The pen is engineered for ease of use, featuring a hidden needle and a simple push-button mechanism that delivers the medication automatically. Patients typically inject Trulicity once weekly into the abdomen or thigh for self-injection, or the upper arm if administered by another person. The injection can be administered at any time of day, with or without food. It is advisable to maintain consistency by injecting on the same day each week to establish a routine and optimise adherence. If needed, the weekly dosing day may be changed, provided at least 3 days (72 hours) elapse between doses.

The National Institute for Health and Care Excellence (NICE NG28) recommends GLP-1 receptor agonists such as Trulicity as part of a comprehensive treatment strategy for type 2 diabetes, particularly when metformin and other oral therapies have not achieved adequate glycaemic targets. Trulicity may be used alone or in combination with other glucose-lowering medications, including metformin, sulfonylureas, sodium-glucose co-transporter-2 (SGLT2) inhibitors, or insulin. Trulicity is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis. Proper understanding of dosing and administration is essential to maximise therapeutic benefit whilst minimising the risk of adverse effects.

How Many Doses Are in Each Trulicity Pen?

Each Trulicity pen contains a single dose of medication and is designed for one-time use only . After administration, the pen should be disposed of safely in a sharps container, even if it appears that some solution remains inside. This single-dose design eliminates the need for patients to measure or draw up medication, reducing the risk of dosing errors and simplifying the injection process.

The pre-filled pen delivers a fixed volume of dulaglutide solution corresponding to the prescribed dose strength. Once the injection button is pressed and held against the skin, the pen automatically delivers the entire dose. According to the manufacturer's Instructions for Use, patients should press and hold the button until they hear the second click and can see the grey plunger/indicator, then count as directed before removing the pen. This confirms that the full dose has been administered.

It is crucial that patients understand they must use a new pen for each weekly injection. Attempting to reuse a pen or share pens between individuals poses significant risks, including infection, needle-stick injury, and inaccurate dosing. The single-use design also maintains sterility and ensures the medication remains stable and effective up to the point of administration.

Patients should receive thorough training from their healthcare provider, practice nurse, or diabetes specialist nurse on how to use the Trulicity pen correctly. Many patients find it helpful to review the manufacturer's Instructions for Use, which include step-by-step diagrams and guidance. If there is any uncertainty about whether a dose has been delivered properly, patients should contact their GP or diabetes care team rather than administering an additional dose, as this could lead to overdosing and increased risk of adverse effects such as nausea or hypoglycaemia.

Available Trulicity Pen Strengths and Prescribing

Trulicity is available in the United Kingdom in four different dose strengths: 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg. Each strength is supplied as a separate pre-filled pen, colour-coded to help distinguish between doses and reduce the risk of administration errors. The choice of dose depends on individual patient factors, including baseline glycaemic control, tolerability, and treatment goals.

According to the UK Summary of Product Characteristics (SmPC), the recommended starting dose is 0.75 mg once weekly. If additional glycaemic control is required, the dose may be increased stepwise after at least 4 weeks at each dose level. The dose can be increased first to 1.5 mg, then to 3 mg, and finally to 4.5 mg once weekly, with at least 4 weeks between each dose increase. Dose escalation should be undertaken cautiously, with careful monitoring for adverse effects, particularly gastrointestinal symptoms such as nausea, vomiting, and diarrhoea, which are common with GLP-1 receptor agonists and tend to be dose-dependent.

Prescribing considerations include monitoring for signs of pancreatitis (persistent severe abdominal pain, sometimes radiating to the back), which requires immediate discontinuation if suspected. Trulicity is not recommended in patients with severe gastrointestinal disease. When initiating Trulicity in patients already taking insulin or a sulfonylurea, a reduction in the dose of these medications should be considered to reduce the risk of hypoglycaemia.

No dose adjustment is required for patients with renal or hepatic impairment, as dulaglutide undergoes general protein catabolism rather than renal excretion. However, patients should be monitored for dehydration if significant gastrointestinal adverse events occur, as this could affect renal function. Trulicity is contraindicated in patients with hypersensitivity to dulaglutide or any of the excipients. It is not recommended during pregnancy or breastfeeding, and women of childbearing potential should use contraception during treatment. Healthcare professionals should review the full prescribing information and consider individual patient circumstances before initiating or adjusting Trulicity therapy.

Proper Storage and Handling of Trulicity Pens

Correct storage and handling of Trulicity pens are essential to maintain the stability and efficacy of the medication. Unopened Trulicity pens should be stored in a refrigerator at a temperature between 2°C and 8°C. They should be kept in the original carton to protect the medication from light. Trulicity pens must never be frozen; if a pen has been frozen, it should be discarded and not used, even if it has subsequently thawed.

If refrigeration is temporarily unavailable, unopened pens may be stored at room temperature (not exceeding 30°C) for up to 14 days. Pens can be returned to the refrigerator within this 14-day period if needed. However, pens should be discarded if kept at room temperature for more than 14 days in total. Patients should plan accordingly, particularly when travelling, and may wish to use insulated travel cases or cool packs (ensuring the pen does not come into direct contact with ice or freezing elements).

Before injection, the pen should be removed from the refrigerator and allowed to reach room temperature naturally—this typically takes about 30 minutes. Injecting cold medication can cause discomfort at the injection site. Patients should check the expiry date and visually inspect the solution through the viewing window before use; it should be clear and colourless to slightly yellow. If the solution appears cloudy, discoloured, or contains particles, or if the pen has expired, it should not be used and should be returned to the pharmacy.

After use, the pen should be disposed of immediately in a sharps container, which can be obtained from GP surgeries, pharmacies, or local council services. Used pens should never be placed in household waste or recycling bins due to the risk of needle-stick injuries. The pen cap should not be replaced after injection, as this increases the risk of accidental needle-stick injury.

Patients should also be advised to keep Trulicity pens out of reach of children and to store them securely. If a pen is accidentally damaged, dropped, or appears defective, it should not be used. In such cases, patients should contact their pharmacy or healthcare provider for a replacement and guidance.

What to Do If You Miss a Trulicity Dose

If a dose of Trulicity is missed, the recommended course of action depends on how much time remains until the next scheduled dose. Patients should be counselled on this scenario during initiation of therapy to ensure they understand how to manage missed doses safely and effectively.

According to the UK Summary of Product Characteristics, if a missed dose is discovered and there are at least three days (72 hours) until the next scheduled dose, patients should administer the missed dose as soon as possible. They should then resume their regular once-weekly schedule on the originally planned day.

If there are fewer than three days until the next scheduled dose, patients should skip the missed dose entirely and administer the next dose on the regularly scheduled day. Doubling up on doses or taking two doses close together is not recommended, as this increases the risk of adverse effects, particularly gastrointestinal symptoms and potential hypoglycaemia if Trulicity is used in combination with insulin or sulfonylureas.

Patients should also be aware that they can change their weekly dosing day if needed, provided there are at least 3 days (72 hours) between doses.

To minimise the risk of missing doses, patients may find it helpful to:

• Set a weekly reminder or alarm on their mobile phone

• Mark injection days on a calendar

• Link the injection to a regular weekly activity

• Use a medication diary or diabetes management app

• Store pens in a visible location (whilst maintaining proper storage conditions)

If a patient frequently misses doses or finds adherence challenging, they should discuss this with their GP, practice nurse, or diabetes specialist team. There may be underlying barriers to adherence—such as needle anxiety, side effects, or practical difficulties—that can be addressed through additional support, education, or consideration of alternative treatment options. Consistent adherence to the once-weekly regimen is important for achieving optimal glycaemic control and reducing the risk of diabetes-related complications.

Patients should report any suspected side effects to their healthcare professional or directly to the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or via the Yellow Card app). If there is any uncertainty about missed doses or dosing schedules, patients should contact their healthcare provider for personalised advice rather than making assumptions that could compromise their diabetes management.

Frequently Asked Questions