Vomiting on Trulicity® (dulaglutide)

Vomiting in the US, EU and Canadian documents

The US tables count adverse reactions: Table 1 from placebo-controlled studies where people began on their final dose, Table 2 from a 36-week trial that stepped everyone up from 0.75 mg every 4 weeks. ^[1] The Canadian Table 2 counts every vomiting event during treatment, whatever its cause, so it sits alongside the US figures without being the same measure. ^[4] The EU summary adds a frequency class and a dose footnote. ^[3]

A steep step between the starting doses

In the placebo pool, the vomiting rate on 1.5 mg is more than double the rate on 0.75 mg and over five times the placebo rate, a sharper rise than nausea or diarrhoea show across the same two doses. ^[1] The EU summary reflects this with a footnote that drops vomiting one frequency class at 0.75 mg. ^[3] In the dose trial the climb from 1.5 mg to 4.5 mg was gentler, from 5.6% to 9.3%. ^[1]

The 1.5 mg figure differs between the two US tables, 12.7% against 5.6%. The trials differed in design, length and background medicines, and the label warns against setting their rates side by side; the Trulicity® nausea page walks through that comparison.

How soon, how severe, how many stopped

Vomiting follows the early pattern described for nausea. In the post hoc analysis of the higher-dose trial, new vomiting cases were most frequent soon after starting 0.75 mg and stayed at or below 2%, and severe nausea, vomiting or diarrhoea affected no more than 0.6% of participants. ^[5] Over up to 104 weeks, the EU summary describes these events as mostly mild or moderate and concentrated in the first weeks. ^[3]

Stopping because of vomiting was rare: 0.4% on 0.75 mg and 0.6% on 1.5 mg in the pooled studies, mostly within the first 4 to 6 weeks, and 0.0%, 0.8% and 1.3% on 1.5 mg, 3 mg and 4.5 mg in the 52-week study. ^[3][4] In REWIND, over a median of 5.4 years, 0.6% stopped dulaglutide for vomiting against 0.1% on placebo. ^[4]

Trials and drug-safety reports

In AWARD-6, an open-label 26-week trial of 599 adults on metformin funded by Eli Lilly, vomiting was reported by 21 people (7%) on dulaglutide 1.5 mg and 25 (8%) on liraglutide 1.8 mg daily. ^[6] A 2026 meta-analysis of 101 randomised trials, 18 of them with dulaglutide, put the class-wide risk of vomiting at about 3.6 times that of placebo; in its head-to-head network, semaglutide carried the highest risk ratio for vomiting. The abstract gives no separate dulaglutide figure. ^[7]

A study of US FDA adverse event reports from 2018 to 2022 found dulaglutide linked to stomach and bowel reports less strongly than liraglutide or semaglutide, with the lowest share of severe reports among the GLP-1 medicines it examined; most reports described events in the first month. ^[8] Voluntary reports show what people chose to report, not how often vomiting happens or whether the medicine caused it.

What lies behind it

• Supported by the label: dulaglutide delays stomach emptying, most strongly after the first doses (sections 12.1 and 12.2), and the EU leaflet names vomiting among the symptoms of delayed emptying, which are sometimes severe. ^[1][3] Reported overdoses mainly caused mild or moderate stomach effects such as nausea and vomiting (section 10), consistent with the dose link in Table 1. ^[1] The nausea page covers this mechanism in full.
• Observed, but not shown to cause vomiting: a 2025 review notes that people on GLP-1 medicines more often have food left in the stomach at endoscopy, and that long-acting forms such as dulaglutide, higher doses and the dose-raising period add to that risk. ^[9] Whether retained food explains vomiting in a given person has not been measured.
• General medical background: MedlinePlus explains that vomiting can leave you dehydrated, which can be dangerous, and treats being unable to keep fluids down as a reason for prompt care. ^[10][11]

When vomiting is not the usual side effect

MedlinePlus lists stomach flu, food poisoning, reflux, migraine, motion sickness and pregnancy among everyday causes of vomiting, and appendicitis, a blocked bowel, ulcers and poisoning among serious ones. Vomiting blood or material like coffee grounds is an emergency. ^[10]

The Trulicity® documents add their own red flags. Ongoing severe belly pain, with or without vomiting, can signal pancreatitis (section 5.2), and upper belly pain with yellow skin or eyes, fever or pale stools can point to the gallbladder; the dedicated pages cover both. ^[1][2] The EU leaflet describes bowel obstruction as a severe constipation with stomach ache, bloating or vomiting. ^[3] Diabetic ketoacidosis has been reported in insulin-dependent patients after insulin was stopped or cut quickly, and the EU leaflet lists feeling or being sick, a sweet smell on the breath and rapid weight loss among its signs; Trulicity® is not a substitute for insulin. ^[3]

Keeping fluids down

MedlinePlus suggests resting quietly while queasy, taking small sips of clear liquids often, rinsing your mouth with water after vomiting, and moving to small, bland meals once you can keep food down. ^[10][11] For dehydration it suggests sipping water or sucking on ice, choosing drinks with electrolytes, and not taking salt tablets. ^[12] The Medication Guide asks you to keep up your fluids and to contact your provider promptly if vomiting will not stop. ^[2]

Two medicine points matter here. The US label links fluid loss from vomiting to reports of acute kidney injury and asks for kidney checks, especially at the start and after dose increases; the Trulicity® kidney page covers that warning. ^[1] And if you also take metformin, MedlinePlus asks you to tell your doctor about severe vomiting or drinking much less than usual, because metformin may need to be stopped until you recover; that decision is your doctor’s. ^[14]

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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