Does Trulicity Cause Constipation?

Trulicity (dulaglutide) is a once-weekly injectable medication prescribed for adults with type 2 diabetes. It belongs to a class of drugs called GLP-1 receptor agonists, which mimic a natural hormone in the body that helps regulate blood sugar. While Trulicity is effective for glycemic control and even weight loss, it may come with gastrointestinal side effects, including constipation. But how common is this, and what can you do about it?

This article explores the link between Trulicity and constipation, how to know if the drug is to blame, and what steps you can take to ease discomfort without compromising your treatment.

Does Trulicity Cause Constipation?

Yes, constipation is a recognized side effect of Trulicity. It occurs in a subset of users, particularly during the early weeks of treatment or after a dose increase.

In clinical trials, constipation was reported by approximately 4% of Trulicity users, depending on the dose administered. Although it’s less common than nausea or diarrhea, it’s still significant enough to impact comfort and adherence to the medication.

The Link Between Trulicity and Constipation

Here are possible reasons why constipation happens with Trulicity use:

Fluid loss from other side effects

Trulicity is known to cause side effects such as nausea, vomiting, and diarrhea, which can lead to a loss of bodily fluids. When dehydration occurs, your colon compensates by extracting more water from the stool. This results in stools that are dry, hardened, and more difficult to eliminate.

Eating less fiber without realizing it

You may be taking in less dietary fiber than usual. Trulicity suppresses appetite and slows digestion, which can reduce the amount of food, and thus fiber, you consume overall.

Fiber, particularly the insoluble type, is vital for healthy digestion. It helps absorb water and increases stool volume, making it easier for waste to move through your intestines. Insufficient fiber can lead to smaller, drier stools that are harder to pass.

Poorly managed blood sugar

Constipation is already a common issue for individuals with diabetes. This often stems from nerve damage within the digestive tract due to chronically elevated blood sugar levels. According to research, about 24.5% of people with diabetes suffer from ongoing constipation.

Another study found that among those with type 2 diabetes, constipation was the most frequently reported gastrointestinal complaint, affecting 22.1% of patients compared to 10.3% in non-diabetic populations. Women and older adults with type 2 diabetes appear to be more vulnerable to this complication.

Managing Constipation While Taking Trulicity

Here’s what you can do:

Boost your fiber intake

Fiber has been recognized as a dietary shortfall in the US, with most people not getting enough. The 2020-2025 Dietary Guidelines for Americans recommend that women consume 28 grams of fiber daily, while men aim for 34 grams. That’s around 14 grams of fiber per 1,000 calories consumed.

Excellent sources of fiber include:

• • Whole grains – such as brown rice, oats, and quinoa
  • Legumes – like beans, lentils, and chickpeas
  • Fruits – including apples, pears, and prunes
  • Vegetables – like leafy greens, carrots, and broccoli

In addition, soluble fiber (found in psyllium husk and flaxseeds) can help stool retain moisture, making it softer and easier to pass.

Keep your body hydrated

Drinking enough fluids is essential to offset the dehydrating effects of Trulicity. According to the National Academies of Sciences, Engineering, and Medicine (NASEM), men should consume around 3.7 liters (125 ounces) of fluid per day, while women need about 2.7 liters (91 ounces). A recent study confirmed that these amounts help maintain adequate hydration, as evidenced by urine concentration levels staying under 500 mmol/kg.

Increase your physical activity

Regular movement stimulates circulation and activates the muscles in your digestive system, which helps food move more quickly through the intestines. Adults should get at least 150 minutes of moderate aerobic activity weekly and include strength training at least twice per week.

Activities such as brisk walking, swimming, or jogging can enhance bowel motility. Interestingly, a recent study found that diet alone didn’t significantly reduce the risk of constipation, but when combined with regular exercise, the likelihood of constipation dropped more noticeably.

Establish a routine for bowel movements

Getting your digestive system into a regular pattern can support better bowel habits. Try to use the bathroom around the same time each day, ideally 20 to 30 minutes after eating, when your digestive tract is most active.

Your posture matters, too. Using a toilet stool to elevate your knees above your hips creates a squatting position that aligns the rectum and can make bowel movements easier. A review of user feedback on toilet stools showed high satisfaction and reported improvements in constipation symptoms. These tools may even help reduce doctor visits and the need for laxatives, which can cause side effects if used long term.

Try probiotic supplements

Taking probiotics, particularly strains such as Lactobacillus and Bifidobacterium, can help regulate digestion and support a healthier gut. A 2020 meta-analysis found that probiotic supplements, especially those containing multiple bacterial strains, improved stool consistency, frequency, and overall digestive function in people struggling with constipation.

Use over-the-counter laxatives when needed

If lifestyle changes aren’t enough, occasional use of OTC laxatives might offer temporary relief. Types of laxatives include:

• • Osmotic laxatives (e.g., polyethylene glycol, magnesium citrate) – pull fluid into the intestines to soften stool

• • Bulk-forming laxatives (e.g., psyllium husk) – add volume to stool for easier passage

• • Stimulant laxatives (e.g., senna, bisacodyl) – trigger intestinal muscle contractions

These should be used sparingly, as relying on them long-term may result in dependency or reduced bowel function.

Consider magnesium supplements

Magnesium can help with constipation by relaxing intestinal muscles and increasing water in the colon, which helps soften stool. Different types of magnesium supplements are used to treat constipation:

• • Magnesium citrate – works rapidly and is commonly used for occasional relief

• • Magnesium hydroxide (Milk of Magnesia) – draws water into the bowel and prompts movement

• • Magnesium sulfate (Epsom salt) – used in small doses to relieve constipation, though excessive use can lead to diarrhea

• • Magnesium oxide – less absorbable but may help in mild cases

Always take magnesium with plenty of fluids. Overuse can lead to loose stools or dependency, so follow dosing instructions carefully.

Talk to your doctor about adjusting your dose

For some individuals, reducing the dose of Trulicity may help resolve constipation without compromising its effectiveness. If constipation continues to be a problem, speak with your healthcare provider to determine whether a lower dosage might be appropriate in your case.

Is Constipation from Trulicity Dangerous?

In most cases, constipation linked to Trulicity is mild and manageable. However, if it becomes severe or chronic, it can lead to complications such as:

• • Hemorrhoids from straining
  • Anal fissures
  • Fecal impaction (stool builds up too much)
  • Rectal prolapse (in rare cases)

In some cases, slowed gut motility, which can happen with medications like Trulicity, can contribute to both constipation and, in rare cases, a more serious blockage if symptoms are ignored or unmanaged.

A case report describes a 52-year-old man with diabetes who had been experiencing severe nausea and vomiting for two weeks, along with worsening abdominal pain over four days. A CT scan revealed swollen loops in part of his small intestine (proximal jejunum), suggesting a partial bowel obstruction, meaning something was starting to block the movement of contents through his intestines.

He had started taking Trulicity three weeks earlier, and his symptoms began within a week of starting the drug. After ruling out all other possible causes, the medical team concluded that Trulicity likely caused the small bowel obstruction.

He was given bowel rest and a nasogastric (NG) tube to relieve pressure and symptoms. But despite this, his condition got worse quickly. The partial blockage turned into a complete obstruction, and emergency surgery was needed.

During surgery, doctors found severe ischemia (lack of blood flow) in the small bowel, which required removing part of his intestine. After the operation, he recovered within a few days and was eventually sent home on a different diabetes medication.

In 2017, eight similar cases were documented, most requiring surgery.

When to See a Doctor

Contact your healthcare provider if you notice any of the following:

• • Ongoing or intense belly pain and bloating
  • Lack of bowel movement for more than seven days, despite self-treatment
  • Presence of blood in your stool or dark, tar-like feces
  • Unexpected weight reduction
  • Vomiting and nausea, along with constipation

Your doctor may adjust your dose, suggest a different medication, or recommend treatment to address the constipation.

The Bottom Line

Trulicity can cause constipation, especially early in treatment or after a dose change. But in most cases, it’s manageable with lifestyle adjustments and temporary interventions. If constipation persists despite your best efforts, reach out to your provider. Managing side effects is just as important as managing your blood sugar.

Frequently Asked Questions