Table of ContentsView AllTable of ContentsOverview of ConditionsWhat Is Trulance?What Is Linzess?Dosing GuidelinesComparing EfficacyAlternative Treatment OptionsSide Effects and SafetyPotential for InteractionFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Overview of Conditions
What Is Trulance?
What Is Linzess?
Dosing Guidelines
Comparing Efficacy
Alternative Treatment Options
Side Effects and Safety
Potential for Interaction
Frequently Asked Questions
Trulance (plecanatide)andLinzess (linaclotide)are orally administered prescription medications used to treatgastrointestinal (GI) disordersthat cause constipation, includingirritable bowel syndrome with constipation (IBS-C)andCIC (chronic idiopathic constipation).
Both drugs are classified asguanylate cyclase-C agonists. Linzess capsules and Trulance tablets are available only as brand-name products.
The Food and Drug Administration (FDA) has approved Trulance to treat IBS-C and CIC.Conversely, Linzess is approved for the same uses but is also approved to treat functional constipation (FC) in children and adolescents 6-17 years old.
These two drugs are similar but are taken a little differently. Linzess must be taken on an empty stomach 30 minutes before a meal. Trulance can be taken any time of day, with or without food.
This article will discuss how each drug works, whether one works better, and what the similarities and differences are.
Igor Alecsander / Getty Images
Understanding IBS & Constipation
IBS and CIC are bothfunctional GI disorders, or FGDs, meaning that diagnostic tests don’t show visible signs of abnormality, but symptoms the individual is experiencing indicate a problem.
More specifically, IBS is a GI disorder with symptoms includingabdominal painandcramping,bloating, constipation, and/ordiarrhea.
In comparison, IBS-C is asubtype of IBS, where more than a quarter of bowel movements are hard and lumpy, and less than a quarter are loose or watery, like diarrhea.
CIC is also known as functional constipation. With this condition, abdominal pain may still occur, but it is not frequent or severe, whereas it is the predominant complaint in those with IBS-C.
This pain is the main symptom that sets CIC and IBS-C apart. Otherwise, symptoms are relatively similar between the two conditions.
Causes
Experts are still determining exactly what causes IBS. It is most likely a combination of risk factors, includingbacterial overgrowth in the small intestine,other health conditions, such asfood intolerancesor mental health disorders and genetics.
CIC is similarly poorly understood–in fact, the very word “idiopathic” in CIC indicates that the cause is poorly understood or not understood.
Theories about causes include a diet with reduced fluid orfiberintake, changes in water balance, or changes in colon muscle movements.
Among constipated people with either of these disorders, general health, mental health, and social functioning are worse than in those without GI disorders.
Unfortunately, neither condition has a cure yet, but both can be managed with diet and lifestyle changes alongside relevant medications.
Currently, Trulance is only approved to treat adults.
It can be taken at any time during the day, with or without food.
Trulance is currently the only product in the United States with the active ingredient plecanatide. Therefore, no generic alternatives exist.
Sometimes, Trulance may be used off-label (a use for which the drug was not originally FDA-approved) for constipation in children between the ages of 6-18 years old, but this should generally be avoided due to the risk of dehydration.
Due to this risk, it should never be used in children younger than 6 years old.
How Does Trulance Work?
This substance helps control the amount of fluid in your gut. Trulance mimics uroguanylin, which causes the release of more fluid into your gut, leading to softer stools and more bowel movements.
It also helps move food through your GI tract.
Trulance may start to work in as little as a week with correct daily use, but seeing the full benefits of the drug may take closer to six to 12 weeks.
Off-Label Uses
Sometimes, Trulance may be used off-label (a use for which the drug was not originally FDA-approved) for constipation in children between the ages of 6-18, but this should generally be avoided due to the risk of dehydration.Due to this risk, it should never be used in children younger than 6 years old.
Linzess is another guanylate cyclase-C agonist administered as a capsule taken orally. Like Trulance, Linzess is approved to treat IBS-C and CIC.
It is usually taken once a day on an empty stomach, at least 30 minutes before a meal.
This drug should never be used in children younger than 2 years old due to the risk of dehydration.
Linzess is the only product in the United States with the ingredient linaclotide. Therefore, no generic alternatives exist.
How Does Linzess Work?
Like Trulance, Linzess mimics naturally occurring peptides that act on GI cells and cause the release of more fluid into the gut, softening stools and making them easier to pass.
Like Trulance, it may start working as soon as a week after you begin taking it.
Maximum effects, however, may take around six to nine weeks following correct daily use.
In an off-label setting, Linzess has been used for people diagnosed withobesityoreating disorders (ED)as alaxative.
This table summarizes the differences and similarities regarding how Trulance and Linzess are dosed:
Taking Trulance or Linzess
The primary difference between consuming these medications is that Linzess must be taken on an empty stomach, at least 30 minutes before a meal, at approximately the same time each day.
Trulance, however, can be taken with or without food at any time, ideally still around the same time each day.
Linzess capsules and Trulance tablets should be swallowed whole, not crushed or chewed, whenever possible.
Furthermore, both drugs can be taken vianasogastricorgastrostomytubes or mixed with applesauce or water in people with difficulty swallowing pills.
Alternative Forms of Administration
The following outlines alternative methods of consumption for Trulance and Linzess for those who struggle to swallow oral drugs, such as tablets or capsules:
To give in applesauce:
To give in water:
To give via nasogastric or gastrostomy tube:
One study compared the results of eight Linzess and seven Trulance trials for treating IBS-C and CIC. Over 10,000 people were included in these 15 trials:
Both drugs were effective for CIC and IBS-C.
People taking Linzess (290-mcg form) were about twice as likely to report improvements as those taking placebo. Trulance (3-mg form) or Trulance (6-mg form) were about twice as likely to report improvements as those taking placebo.
People taking Linzess (72-mcg form) or Linzess (145-mcg form) were about three times more likely to report these improvements than those taking a placebo.
People taking Trulance (3-mg form) were twice as likely to report improvements.
Diarrhea was also more likely in those people taking Linzess or Trulance compared to those taking placebo.
Takeaways
The meta-analysis mentioned above did not conclude any statistically significant differences in effectiveness between Linzess and Trulance.
They work about the same to treat IBS-C and CIC and are similar in tolerability and side effects.
Overall, know that the choice between these two drugs will likely come down to discussing preference and insurance coverage with your healthcare provider.
Although medications can play a significant role in treating IBS and CIC, diet and lifestyle modifications will likely be necessary as well to control the disorders truly andprevent flare-upsas much as possible.
Some lifestyle changes that can be made to help control these disorders and relieve constipation include:
Like all drugs, Trulance and Linzess carry the potential for adverse effects.
Therefore, be sure to monitor yourself closely for the emergence of side effects that worsen over time or fail to dissipate.
The following lists the side effects associated with Trulance and Linzess.
Trulance Side Effects
Trulance may cause side effects.
Tell your healthcare provider if any of these symptoms are severe or do not go away:
Linzess Side Effects
Similarly, Linzess may cause side effects.
After you take Linzess or Trulance, a minimal amount of drug-based ingredients enter your bloodstream.
Linzess and Trulance also do not interact with cytochrome P450 inducers or substrates,enzymes responsible for many drug interactions.
Even so, ensuring your healthcare provider and pharmacist know all the medications and supplements you take is a good idea.
Summary
Trulance and Linzess are two orally administered, brand-name medications classified as guanylate cyclase-C agonists.
Trulance is a tablet that can be taken once daily with or without food, whereas Linzess is a tablet that must be taken on an empty stomach at least 30 minutes before a meal.
While both products are generally seen as similar, they carry some notable differences relating to dosing requirements, forms of administration, some differences in potential side effects, FDA-approved uses, and active ingredients.
Speak with your healthcare provider to decide which options may be better for you based on their experience, drug administration, and insurance coverage.
Store Trulance or Linzess at room temperature (68-77 F) in their original containers, in a dry place, and away from areas susceptible to high levels of moisture or humidity, such as a bathroom.Additionally, keep either drug out of reach of pets or children, if applicable.
Store Trulance or Linzess at room temperature (68-77 F) in their original containers, in a dry place, and away from areas susceptible to high levels of moisture or humidity, such as a bathroom.
Additionally, keep either drug out of reach of pets or children, if applicable.
Both of these medications have the potential to cause dehydration, especially in young children.
Young children are more at risk of dehydration from this because the drugs cause more fluid secretion in their bodies than they would in adults or older children.
Linzess has undergone enough testing to be approved for use in children as young as 6, whereas Trulance is only approved for use in adults.
It is estimated that 10–15% of adults in the United States have IBS.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Label: Trulance immediate release- plecanatide tablet.DailyMed.Label: Linzess- linaclotide capsule, gelatin coated.MedlinePlus.Linaclotide.MedlinePlus.Plecanatide.Cash BD.Understanding and managing IBS and CIC in the primary care setting.Gastroenterol Hepatol (N Y). 2018;14(5 suppl 3):3-15.MedlinePlus.Irritable bowel syndrome.Minnesota Department of Health.Irritable bowel syndrome (IBS) issue brief.Siah KT, Wong RK, Whitehead WE.Chronic constipation and constipation-predominant IBS: separate and distinct disorders or a spectrum of disease?Gastroenterol Hepatol (N Y). 2016;12(3):171-178.Shah ED, Almario CV, Spiegel BMR, Chey WD.Lower and upper gastrointestinal symptoms differ between individuals with irritable bowel syndrome with constipation or chronic idiopathic constipation.J Neurogastroenterol Motil. 2018;24(2):299-306. doi:10.5056/jnm17112National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of irritable bowel syndrome.Bharucha AE, Wald A.Chronic constipation.Mayo Clin Proc. 2019;94(11):2340-2357.Kamuda JA, Mazzola N.Plecanatide (Trulance) for chronic idiopathic constipation and irritable bowel syndrome with constipation.P T. 2018;43(4):207-232.Food and Drug Administration.FDA approves first treatment for pediatric functional constipation.Cid-Ruzafa J, Lacy BE, Schultze A, et al.Linaclotide utilization and potential for off-label use and misuse in three European countries.Therap Adv Gastroenterol. 2022;15:17562848221100946. doi:10.1177/17562848221100946Shah ED, Kim HM, Schoenfeld P.Efficacy and tolerability of guanylate cyclase-C agonists for irritable bowel syndrome with constipation and chronic idiopathic constipation: a systematic review and meta-analysis.Am J Gastroenterol. 2018;113(3):329-338. doi:10.1038/ajg.2017.495Gao R, Tao Y, Zhou C, et al.Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials.Scand J Gastroenterol. 2019;54(2):169-177. doi:10.1080/00365521.2019.1568544Cozma-Petruţ A, Loghin F, Miere D, Dumitraşcu DL.Diet in irritable bowel syndrome: what to recommend, not what to forbid to patients!.World J Gastroenterol. 2017;23(21):3771-3783. doi:10.3748/wjg.v23.i21.3771Hukkanen J.Induction of cytochrome P450 enzymes: a view on human in vivo findings.Expert Rev Clin Pharmacol. 2012;5(5):569-585. doi:10.1586/ecp.12.39American College of Gastroenterology.Irritable bowel syndrome.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Label: Trulance immediate release- plecanatide tablet.DailyMed.Label: Linzess- linaclotide capsule, gelatin coated.MedlinePlus.Linaclotide.MedlinePlus.Plecanatide.Cash BD.Understanding and managing IBS and CIC in the primary care setting.Gastroenterol Hepatol (N Y). 2018;14(5 suppl 3):3-15.MedlinePlus.Irritable bowel syndrome.Minnesota Department of Health.Irritable bowel syndrome (IBS) issue brief.Siah KT, Wong RK, Whitehead WE.Chronic constipation and constipation-predominant IBS: separate and distinct disorders or a spectrum of disease?Gastroenterol Hepatol (N Y). 2016;12(3):171-178.Shah ED, Almario CV, Spiegel BMR, Chey WD.Lower and upper gastrointestinal symptoms differ between individuals with irritable bowel syndrome with constipation or chronic idiopathic constipation.J Neurogastroenterol Motil. 2018;24(2):299-306. doi:10.5056/jnm17112National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of irritable bowel syndrome.Bharucha AE, Wald A.Chronic constipation.Mayo Clin Proc. 2019;94(11):2340-2357.Kamuda JA, Mazzola N.Plecanatide (Trulance) for chronic idiopathic constipation and irritable bowel syndrome with constipation.P T. 2018;43(4):207-232.Food and Drug Administration.FDA approves first treatment for pediatric functional constipation.Cid-Ruzafa J, Lacy BE, Schultze A, et al.Linaclotide utilization and potential for off-label use and misuse in three European countries.Therap Adv Gastroenterol. 2022;15:17562848221100946. doi:10.1177/17562848221100946Shah ED, Kim HM, Schoenfeld P.Efficacy and tolerability of guanylate cyclase-C agonists for irritable bowel syndrome with constipation and chronic idiopathic constipation: a systematic review and meta-analysis.Am J Gastroenterol. 2018;113(3):329-338. doi:10.1038/ajg.2017.495Gao R, Tao Y, Zhou C, et al.Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials.Scand J Gastroenterol. 2019;54(2):169-177. doi:10.1080/00365521.2019.1568544Cozma-Petruţ A, Loghin F, Miere D, Dumitraşcu DL.Diet in irritable bowel syndrome: what to recommend, not what to forbid to patients!.World J Gastroenterol. 2017;23(21):3771-3783. doi:10.3748/wjg.v23.i21.3771Hukkanen J.Induction of cytochrome P450 enzymes: a view on human in vivo findings.Expert Rev Clin Pharmacol. 2012;5(5):569-585. doi:10.1586/ecp.12.39American College of Gastroenterology.Irritable bowel syndrome.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
DailyMed.Label: Trulance immediate release- plecanatide tablet.DailyMed.Label: Linzess- linaclotide capsule, gelatin coated.MedlinePlus.Linaclotide.MedlinePlus.Plecanatide.Cash BD.Understanding and managing IBS and CIC in the primary care setting.Gastroenterol Hepatol (N Y). 2018;14(5 suppl 3):3-15.MedlinePlus.Irritable bowel syndrome.Minnesota Department of Health.Irritable bowel syndrome (IBS) issue brief.Siah KT, Wong RK, Whitehead WE.Chronic constipation and constipation-predominant IBS: separate and distinct disorders or a spectrum of disease?Gastroenterol Hepatol (N Y). 2016;12(3):171-178.Shah ED, Almario CV, Spiegel BMR, Chey WD.Lower and upper gastrointestinal symptoms differ between individuals with irritable bowel syndrome with constipation or chronic idiopathic constipation.J Neurogastroenterol Motil. 2018;24(2):299-306. doi:10.5056/jnm17112National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of irritable bowel syndrome.Bharucha AE, Wald A.Chronic constipation.Mayo Clin Proc. 2019;94(11):2340-2357.Kamuda JA, Mazzola N.Plecanatide (Trulance) for chronic idiopathic constipation and irritable bowel syndrome with constipation.P T. 2018;43(4):207-232.Food and Drug Administration.FDA approves first treatment for pediatric functional constipation.Cid-Ruzafa J, Lacy BE, Schultze A, et al.Linaclotide utilization and potential for off-label use and misuse in three European countries.Therap Adv Gastroenterol. 2022;15:17562848221100946. doi:10.1177/17562848221100946Shah ED, Kim HM, Schoenfeld P.Efficacy and tolerability of guanylate cyclase-C agonists for irritable bowel syndrome with constipation and chronic idiopathic constipation: a systematic review and meta-analysis.Am J Gastroenterol. 2018;113(3):329-338. doi:10.1038/ajg.2017.495Gao R, Tao Y, Zhou C, et al.Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials.Scand J Gastroenterol. 2019;54(2):169-177. doi:10.1080/00365521.2019.1568544Cozma-Petruţ A, Loghin F, Miere D, Dumitraşcu DL.Diet in irritable bowel syndrome: what to recommend, not what to forbid to patients!.World J Gastroenterol. 2017;23(21):3771-3783. doi:10.3748/wjg.v23.i21.3771Hukkanen J.Induction of cytochrome P450 enzymes: a view on human in vivo findings.Expert Rev Clin Pharmacol. 2012;5(5):569-585. doi:10.1586/ecp.12.39American College of Gastroenterology.Irritable bowel syndrome.
DailyMed.Label: Trulance immediate release- plecanatide tablet.
DailyMed.Label: Linzess- linaclotide capsule, gelatin coated.
MedlinePlus.Linaclotide.
MedlinePlus.Plecanatide.
Cash BD.Understanding and managing IBS and CIC in the primary care setting.Gastroenterol Hepatol (N Y). 2018;14(5 suppl 3):3-15.
MedlinePlus.Irritable bowel syndrome.
Minnesota Department of Health.Irritable bowel syndrome (IBS) issue brief.
Siah KT, Wong RK, Whitehead WE.Chronic constipation and constipation-predominant IBS: separate and distinct disorders or a spectrum of disease?Gastroenterol Hepatol (N Y). 2016;12(3):171-178.
Shah ED, Almario CV, Spiegel BMR, Chey WD.Lower and upper gastrointestinal symptoms differ between individuals with irritable bowel syndrome with constipation or chronic idiopathic constipation.J Neurogastroenterol Motil. 2018;24(2):299-306. doi:10.5056/jnm17112
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of irritable bowel syndrome.
Bharucha AE, Wald A.Chronic constipation.Mayo Clin Proc. 2019;94(11):2340-2357.
Kamuda JA, Mazzola N.Plecanatide (Trulance) for chronic idiopathic constipation and irritable bowel syndrome with constipation.P T. 2018;43(4):207-232.
Food and Drug Administration.FDA approves first treatment for pediatric functional constipation.
Cid-Ruzafa J, Lacy BE, Schultze A, et al.Linaclotide utilization and potential for off-label use and misuse in three European countries.Therap Adv Gastroenterol. 2022;15:17562848221100946. doi:10.1177/17562848221100946
Shah ED, Kim HM, Schoenfeld P.Efficacy and tolerability of guanylate cyclase-C agonists for irritable bowel syndrome with constipation and chronic idiopathic constipation: a systematic review and meta-analysis.Am J Gastroenterol. 2018;113(3):329-338. doi:10.1038/ajg.2017.495
Gao R, Tao Y, Zhou C, et al.Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials.Scand J Gastroenterol. 2019;54(2):169-177. doi:10.1080/00365521.2019.1568544
Cozma-Petruţ A, Loghin F, Miere D, Dumitraşcu DL.Diet in irritable bowel syndrome: what to recommend, not what to forbid to patients!.World J Gastroenterol. 2017;23(21):3771-3783. doi:10.3748/wjg.v23.i21.3771
Hukkanen J.Induction of cytochrome P450 enzymes: a view on human in vivo findings.Expert Rev Clin Pharmacol. 2012;5(5):569-585. doi:10.1586/ecp.12.39
American College of Gastroenterology.Irritable bowel syndrome.
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