Trulicity® (dulaglutide) and kidney stones

The only Trulicity® numbers on stones

Nephrolithiasis, the medical term for stones in the kidney, appears in Table 2 of the Canadian monograph under renal and urinary disorders. ^[1] That table lists treatment-emergent events, meaning anything that started or worsened during treatment, that reached at least 1% in a Trulicity® group and occurred more often than in the comparison group. It has two parts: placebo-controlled studies with about 24 weeks of average exposure, and all studies of 26 to 104 weeks, with about a year of average exposure and several active comparators. ^[1] The US adverse reaction data and the EU frequency table include no stone entry. ^[2][4]

How much weight these counts can bear

The gap between Trulicity® and placebo amounts to roughly 4 extra recorded stones per 1,000 people over about six months, built on just 22 events in total. The monograph gives no confidence interval or test of significance, and with numbers this small a handful of cases either way would change the picture. ^[1] The longer pool, where the comparison included other diabetes medicines, shows an even smaller gap. ^[1]

Treatment-emergent counts also include events unrelated to the medicine. Kidney stones are common and being overweight raises the risk, and because stones can grow for weeks or months without symptoms, one that formed before treatment can first cause pain during a trial. ^[8][10] The fair reading is that stones were recorded slightly more often on Trulicity® in these trials, without evidence that the medicine caused them, and that neither the US nor the EU regulator chose to list them.

The fluid-loss link the labels do describe

What all three regulators do warn about is fluid loss. Section 5.5 of the US label reports acute kidney injury, sometimes requiring dialysis, in people on GLP-1 medicines including Trulicity®, mostly after nausea, vomiting or diarrhoea, and asks prescribers to monitor kidney function especially at the start and after dose increases. ^[2] The EU summary lists dehydration as uncommon and asks that patients take precautions to avoid fluid depletion. ^[4] The Medication Guide tells patients that drinking fluids helps reduce the chance of dehydration, and to report nausea, vomiting or diarrhoea that does not go away. ^[3]

MedlinePlus calls low fluid intake the biggest risk factor for stones and notes they are more likely when the body makes little urine. ^[8] So although no Trulicity® document links stones to dehydration directly, the days when stomach side effects keep you from drinking are the days to be most careful. Our separate page on Trulicity® and kidney warnings covers kidney function itself.

What studies of GLP-1 medicines show

There are no published studies of kidney stones with dulaglutide specifically; our PubMed search for dulaglutide and stones returned no results. Class-level research gives some context. A Medicare cohort compared 24-hour urine collections in people with kidney stones and diabetes: 349 who had filled a GLP-1 prescription showed no significant differences from 349 matched controls in urine measures that affect stone formation, while SGLT2 inhibitors were linked to more urine and more citrate. ^[5]

In 44 people with obesity and previous stones who lost weight on GLP-1-based medicines over about a year, 24-hour urine oxalate and sulfate fell and saturation measures did not worsen, which the authors contrasted with other weight-loss methods. ^[6] A 2026 European Association of Urology review of six observational studies found SGLT2 inhibitors consistently linked with fewer stones than GLP-1 medicines or DPP-4 inhibitors, and called for trials with stones as a planned outcome. ^[7] These studies grouped several GLP-1 medicines and did not report dulaglutide separately.

How a stone could relate to Trulicity®

• Supported by the labels: Trulicity® can cause nausea, vomiting and diarrhoea, which can lead to dehydration, and dehydration is listed as an uncommon reaction in the EU. ^[2][3][4]
• Plausible but untested for dulaglutide: less urine during fluid loss could favour crystal formation, given that MedlinePlus links low urine output to stone risk. ^[8] No Trulicity® study has measured this.
• Pointing the other way: weight loss with GLP-1-based therapy was not linked to harmful urine changes in stone formers, and NIDDK notes that being overweight raises stone risk. ^[6][10]

Other causes and risk factors

MedlinePlus explains that stones form when urine holds too much of certain crystal-forming substances. Calcium stones, usually with oxalate, are most common; uric acid stones are linked to gout and some cancer treatment, struvite stones to repeated urinary infections, and cystine stones to an inherited condition. Some stone types run in families, and some medicines can form stones. ^[8]

NIDDK lists excess sodium and animal protein in the diet and being overweight among factors that raise risk, and says that people who have had a stone should find out which type it was, because prevention depends on it. ^[10] Pain from a stone can be mistaken for other belly or back problems, which is why the warning signs below matter.

Prevention advice from public sources

NIDDK calls drinking enough liquid, mainly water, the most important step for preventing stones, and suggests asking a health professional how much is right for you, especially with kidney disease. It mentions the DASH eating pattern, limiting sodium and animal protein, getting enough calcium from food rather than avoiding it, and, for calcium oxalate stones, discussing high-oxalate foods with a professional or dietitian. ^[10]

MedlinePlus adds that small stones often pass on their own, that urine may be strained so a passed stone can be tested, and that people with a history of stones may need tests and specific diet or medicine changes. ^[8] Over-the-counter pain relievers are mentioned in that context, but check with your prescriber or pharmacist first, particularly if you have kidney problems.

Trulicity® is a registered trademark of Eli Lilly and Company. PepLabo is not affiliated with or endorsed by Eli Lilly and Company.

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