Safety of Concurrent Use of Trulicity (Dulaglutide) and Eliquis (Apixaban)

Pharmacological Considerations

Apixaban (Eliquis) is a direct oral anticoagulant (DOAC) that is a substrate of both CYP3A4 enzymes and P-glycoprotein (P-gp)/BCRP transporters, which means its metabolism can be affected by drugs that interact with these pathways 1
Dulaglutide (Trulicity) is a GLP-1 receptor agonist that does not significantly interact with CYP3A4 or P-gp/BCRP pathways that would affect apixaban metabolism 2
Significant interactions with apixaban typically occur with medications that are moderate to strong inhibitors of both CYP3A4 and P-gp/BCRP pathways, which dulaglutide is not 1

There are no specific contraindications or warnings regarding the concurrent use of GLP-1 receptor agonists like dulaglutide with anticoagulants like apixaban in clinical guidelines 2, 3
The American Diabetes Association's Standards of Care (2025) does not list any contraindications for using GLP-1 receptor agonists with anticoagulants 2
Unlike some small-molecule inhibitors that can significantly alter apixaban levels through P-gp inhibition, GLP-1 receptor agonists like dulaglutide do not have this effect 4, 5

Regular monitoring for signs of unusual bleeding or bruising should continue as standard practice for patients on apixaban, regardless of dulaglutide use 1
Monitor for potential side effects specific to each medication, including bleeding risk for apixaban 6
Renal function should be monitored in patients on both medications, as it can affect the dosing of apixaban 6

Dulaglutide has shown benefit for renal endpoints in cardiovascular outcome trials, which may be an additional benefit in patients requiring anticoagulation 2
Dulaglutide has demonstrated cardiovascular benefits in patients with type 2 diabetes, according to the American Diabetes Association 2

No dose adjustments are required for either medication when used together 2, 1
If a patient experiences GI side effects from dulaglutide, consider dietary modifications rather than discontinuing either medication 2
For patients undergoing procedures, follow standard protocols for temporary discontinuation of apixaban; dulaglutide generally does not need to be discontinued for most procedures 2, 6