Metformin Vs. Trulicity: Drug Comparison

Metformin is an oral medication commonly prescribed to manage blood sugar levels in individuals with type 2 diabetes. It works by decreasing glucose production in the liver, improving the body's sensitivity to insulin, and reducing the amount of sugar absorbed by the intestines. Metformin is often used as a first-line treatment due to its efficacy, safety profile, and additional benefits, such as weight stabilization and low risk of low blood sugar. Common side effects include gastrointestinal issues like nausea, diarrhea, and abdominal discomfort.

Trulicity^® (dulaglutide) is an injectable medication used to improve blood sugar control in adults and pediatric patients aged 10 years and older with type 2 diabetes, alongside diet and exercise. It acts as a glucagon-like peptide-1 (GLP-1) receptor agonist, enhancing insulin secretion, slowing gastric emptying, and reducing glucagon production. Additionally, Trulicity is indicated to reduce the risk of major adverse cardiovascular events, such as heart attack, stroke, and cardiovascular death in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors. Administered once weekly, Trulicity can be used alone or with other diabetes medications. Common side effects include gastrointestinal issues like nausea, diarrhea, and vomiting. It should be used cautiously in individuals with a history of pancreatitis​.

Biguinide

Glucagon-like peptide-1 (GLP-1) receptor agonist

Metformin hydrochloride tablets are indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus

Trulicity (dulaglutide) is indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus.

• To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors

• Typically taken orally once, twice, or three times daily

• Comes in 500 mg, 850 mg, and 1,000 mg tablets

• Typically taken as an injection once weekly

• Comes in 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg per 0.5 mL single-dose pens

For metformin hydrochloride, the most common adverse reactions (>5%) are:

• Diarrhea

• Nausea/vomiting

• Flatulence

• Weakness

• Indigestion

• Abdominal discomfort

• Headache

Most common adverse reactions (incidence ≥5%) are:

• Nausea

• Diarrhea

• Vomiting

• Abdominal pain

• Decreased appetite

• Severe renal impairment (eGFR below 30 mL/min/1.73 m²)

• Hypersensitivity to metformin

• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma

• Drug interactions: Carbonic anhydrase inhibitors, drugs that reduce metformin clearance (such as ranolazine, vandetanib, dolutegravir, and cimetidine), alcohol

• Patients with a personal or family history of medullary thyroid carcinoma or in patients with multiple endocrine neoplasia syndrome type 2

• Patients with a serious hypersensitivity reaction to dulaglutide or any of the product components

• Drug interactions: Trulicity delays gastric emptying and has the potential to reduce the rate of absorption of concomitantly administered oral medications

• Lactic acidosis: See Boxed Warning

• Vitamin B12 deficiency: Metformin may lower vitamin B12 levels

• Low blood sugar with concomitant use with insulin and insulin secretagogues

• Females and males of reproductive potential: Potential for an unintended pregnancy

• Thyroid C-cell tumors

• Pancreatitis

• Low blood sugar: Concomitant use with an insulin secretagogue or insulin may increase the risk of low blood sugar, including severe low blood sugar

• Hypersensitivity reactions

• Acute kidney injury

• Severe gastrointestinal disease

• Diabetic retinopathy complications

• Acute gallbladder disease

• Pregnancy: Should be used during pregnancy only if the potential benefit justifies the potential risk to fetus

WARNING: LACTIC ACIDOSIS

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.

Risk factors include renal impairment, concomitant use of certain drugs, age >65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information.

If lactic acidosis is suspected, discontinue metformin hydrochloride tablets and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.

WARNING: RISK OF THYROID C-CELL TUMORS

Dulaglutide causes thyroid C-cell tumors in rats. It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined.

Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors.

*This information is from the metformin hydrochloride label used by Epic Pharma, LLC. See the Full Prescribing Information for more complete information. Metformin may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient metformin.

*This information is from the label for brand name Trulicity^®. See the Full Prescribing Information for more complete information.