Before starting a patient on dulaglutide, the physician screens for a contraindication based on a boxed regulatory warning shared by all GLP-1 receptor agonists. Which condition must be excluded?

• A History of pancreatitis
• B History of papillary thyroid carcinoma
• C Proliferative diabetic retinopathy
• D Personal or family history of medullary thyroid carcinoma or MEN2 ✓

Explanation

GLP-1 receptor agonists carry a boxed warning against use in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, based on rodent studies showing C-cell tumors mediated by GLP-1 receptor stimulation on thyroid C cells. Pancreatitis is a caution rather than an absolute contraindication, retinopathy relates mainly to semaglutide trials, and papillary carcinoma arises from follicular cells lacking GLP-1 receptors.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.