Is it safe to take Trulicity and metformin together?

Those who live with diabetes know how it can affect a person’s quality of life. The two types of diabetes, Type 1 and Type 2, can both make daily life more stressful. The good news is that treatment for diabetes has vastly improved over the decades. Medications are one of the best treatment options for people with diabetes because they can help regulate blood sugar levels and keep the body healthy. Two of the most popular diabetes medications are Trulicity and metformin. Both treat Type 2 diabetes, and sometimes, they’re taken together.   

Are Trulicity and metformin the same thing?

Metformin is a generic anti-diabetic medication that treats Type 2 diabetes by helping control the body’s sensitivity to insulin. It’s meant to be a part of a larger treatment plan for Type 2 diabetes that includes diet and exercise. It is a first-line treatment medication for Type 2 diabetes and can also be combined with other medications that are used to treat Type 2 diabetes.   

Trulicity is a brand-name medication that’s used to treat Type 2 diabetes in combination with a healthy diet and physical exercise. Trulicity helps lower blood sugar levels by enhancing insulin secretion. It can be used on its own or with other medications that also treat Type 2 diabetes. It also reduces the risk of major cardiovascular events such as heart attacks and strokes for Type 2 diabetics with cardiovascular risk factors.

Sometimes Trulicity can be taken at the same time as metformin, which is safe to do under the right circumstances. Let’s take a more in-depth look at Trulicity and metformin to better understand when it’s safe to take them together.  

Is Trulicity or metformin better?

The American Diabetic Association recommends metformin as the initial treatment for Type 2 diabetes. In 2014, Trulicity was introduced in the U.S. as an injection that can help improve glycemic control in adults with Type 2 diabetes. Even after Trulicity was put on the market, metformin still held its position as the initial medication of choice for Type 2 diabetes because it’s been proven to be very effective and is inexpensive. Metformin can drop HbA1C (hemoglobin) levels by as much as 1.5%, according to Johns Hopkins Medicine. The FDA still doesn’t recommend Trulicity for the initial treatment of Type 2 diabetes, but it is effective at treating the condition and has been shown to drop HbA1C levels by as much as 0.5% to 1.5% in clinical trials.        

Drug class

Metformin belongs to a group of medications called biguanides that reduce the amount of glucose that’s absorbed from food and that’s made by the liver. Metformin can be used alone or combined with other medications, including insulin. 

Trulicity is the brand name of the generic medication called dulaglutide, which belongs to a group of medications called GLP-1 receptor agonists. These types of medications treat Type 2 diabetes by stimulating the body’s natural production of insulin and by reducing the liver’s ability to make glucose. Trulicity is a non-insulin injectable that’s great for controlling blood glucose levels with a low risk of hypoglycemia. It’s not a substitute for insulin and can’t treat Type 1 diabetes mellitus. In comparison to other GLP-1 receptor agonists like Bydureon (exenatide) and Victoza (liraglutide), Trulicity is just as effective at lowering Hgb-A1c levels.        

RELATED: Compare Trulicity vs. Victoza

Standard dosages 

Metformin is available as an oral tablet in dosage strengths of 500 mg, 850 mg, and 1000 mg. It’s also available as an extended-release tablet in dosage strengths of 500 mg, 750 mg, 1000 mg, and as an oral solution with the same dosage strength options. The standard dose of metformin for Type 2 diabetes is 500 mg taken twice per day or 850 mg taken once per day with meals. The amount of metformin you’ll need to take will vary based on your unique symptoms and medical history, so it’s always a good idea to talk with a healthcare professional about which dosage strength of metformin is right for you.   

Trulicity is only available as an injection but can be given in strengths of 0.75 mg/0.5 mL, 1.5 mg/0.5 mL, 3 mg/0.5 mL, or 4.5 mg/0.5 mL per single dose pen. The recommended initial dose of Trulicity for treating Type 2 diabetes mellitus is 0.75 mg given as a subcutaneous injection once per week. A healthcare provider may increase Trulicity dosing over time for more glycemic control, but higher doses of Trulicity may cause more side effects, especially nausea. Talking with a medical professional is the best way to learn more about what dosage strength of Trulicity is right for you.        

Cost

Metformin is a relatively cheap medication that ranges in cost from about $8 to potentially over $150 without insurance. Just like with any medication, the price will go up or down depending on the quantity of tablets purchased. A great way to save money on metformin is by using a metformin coupon that could drop the amount you pay to $4.   

Trulicity is a very expensive drug, especially for people who don’t have health insurance. Without health insurance, it costs just over $1,440 for a single injection of Trulicity. Some health insurance plans may help cover the high cost of Trulicity, and online coupons like SingleCare’s Trulicity coupon could drop the price to $771.34 per injection. The manufacturer of Trulicity, Eli Lilly and Company, also offers discounts on Trulicity pens for eligible patients.    

Side effects

Metformin can cause certain side effects that are good to be aware of. Here are some of the most common side effects of metformin:  

• Nausea
• Gas
• Bloating
• Heartburn
• Constipation
• Weight loss
• Diarrhea
• Weakness
• Chills

Here are the most common side effects of Trulicity that people experience: 

• Abdominal pain
• Decreased appetite
• Nausea
• Vomiting
• Diarrhea 
• Injection-site reactions like swelling, pain, or itching 

Nausea is one of the most common side effects of Trulicity; about 8% to 29% of people who take the medication report feeling nauseous two to three days after receiving a dose. This goes away for most people after their second week of treatment, but for those who still experience some nausea after that, here are some ways to help it go away: Eat smaller meals, eat blander foods, and stop eating when you feel full.  

Although it’s rare, both Trulicity and metformin can cause more serious side effects. If you’re taking either medication and start to experience difficulty breathing, swelling of the face or throat, or hives, then you should seek medical advice right away. These are signs of an allergic reaction, which can be life-threatening without prompt treatment.   

These side effects of metformin and Trulicity are not comprehensive. A medical professional can provide you with a complete list of side effects that you might experience if you take either medication.   

Risks and restrictions

Even though metformin is very effective at treating Type 2 diabetes, it shouldn’t be taken by everyone. Metformin may not be the right medication for people who have:

• Severe renal impairment
• Acute or chronic metabolic ketoacidosis
• Kidney or liver dysfunction
• Heart failure 

Metformin comes with a boxed warning for an increased risk of getting lactic acidosis, which is a condition where excess lactic acid accumulates in the bloodstream and causes weakness, abdominal pain, diarrhea, and irregular breathing. You should seek immediate medical attention if you’re taking metformin and have any symptoms of lactic acidosis.  

There is limited data regarding whether metformin is safe for pregnant and breastfeeding women. Studies have not shown a clear enough association between metformin use during pregnancy and birth defects or miscarriages. Clinical studies have shown that metformin presents itself in breast milk, but there’s not enough data to determine how it affects breastfed infants.  

Trulicity may not be the right medication for those who have:

• A personal or family history of medullary thyroid carcinoma
• Multiple endocrine neoplasia syndrome type 2 (MEN 2) 
• Diabetic ketoacidosis 
• Pancreas problems such as pancreatitis 

Trulicity is not approved for patients younger than 18 years old.

It also has a boxed warning, but for an increased risk of getting thyroid C-cell tumors. GLP-1 receptor agonists like Trulicity have induced thyroid tumors in mice and rats at clinically relevant exposures, but it’s unknown whether or not Trulicity will cause the same thyroid C-cell tumors in humans. Therefore, people with thyroid cancer shouldn’t take Trulicity.

People who take Trulicity may also have an increased risk of pancreatitis, hypoglycemia, acute kidney injury, gastrointestinal disease, and severe stomach problems. There is limited data on how Trulicity affects pregnant and breastfeeding women, but based on animal studies, there may be risks to fetuses exposed to the drug during pregnancy. 

Pregnant women should only take Trulicity if its potential benefits outweigh its potential adverse effects, according to the manufacturer’s instructions. Your healthcare provider can give you more information on whether or Trulicity is right for you based on your medical history.     

Taking Trulicity and metformin together  

Some people with Type 2 diabetes may need Trulicity and metformin to reach their blood sugar goals. This is safe to do with a doctor’s approval. “Sometimes patients are prescribed both Trulicity and metformin because they can have a kind of synergistic effect,” says Ben Tanner, PA, founder of fastingwell.com. “Trulicity increases satiety, slows stomach emptying, and increases your body’s insulin production. Metformin generally helps modulate and smooth out your blood sugar levels (by decreasing glucose production in the liver, among other things).”    

Taking both drugs at the same time will likely mean taking a daily dose of metformin and a weekly dose of Trulicity. Your healthcare provider may change your doses of each medication based on your blood sugar goals, symptoms, and medical history. Follow your doctor’s guidelines and the manufacturer’s instructions for taking the medications, such as taking metformin with food, to ensure safety and efficacy.

Some studies, such as the AWARD-10 Study, have shown that when Trulicity is combined with metformin and an SGLT-2 inhibitor, that it can be an effective and well-tolerated medication for people with Type 2 diabetes. 

It’s important to be aware of potential side effects before taking Trulicity and metformin at the same time. “It is possible to have side effects from taking both at the same time, such as slightly low blood sugar. For that reason, it’s probably better to use a low-dose at first if you’re taking both of them together. Then you can adjust gradually, depending on how your body reacts,” says Tanner.

Talk to your healthcare provider to learn more about taking Trulicity and metformin at the same time. He or she can also tell you if there’s any reason why you shouldn’t be taking the two medications simultaneously.