Always consider whether potential adverse effects outweigh benefits, particularly in frail patients or those with short life expectancy.
People with personal or family history of medullary thyroid cancer cannot be prescribed dulaglutide nor is it recommended in people with severe gastrointestinal disease or previous pancreatitis.5,6
Empagliflozin must be used with caution in people at high risk of diabetic ketoacidosis; for those with previous history of DKA, specialist approval is recommended.7 Caution is needed if there is a high risk of volume depletion as empagliflozin promotes glycosuria and associated osmotic diuresis.2,7
If your patient has previous severe or recurrent genitourinary infections, or is likely to be on a low carbohydrate diet and/or have significant alcohol intake, empagliflozin is not for them.3
Neither agent should be used in pregnancy, breastfeeding or in children <18 without specialist approval. Finally, dulaglutide can be used safely in patients with estimated glomerular filtration rates (eGFR) between 15 and 30mL/min, but empagliflozin cannot.6,7