Linzess or Trulance - which is better for constipation?

Key Points

• Linzess (linaclotide) and Trulance (plecanatide) are two oral prescription medications used to treat constipation.
• Linzess must be taken on an empty stomach, while Trulance can be taken with or without food.
• Both Linzess and Trulance can cause diarrhea as a side effect.
• Linzess and Trulance have similar effectiveness for constipation, but Linzess can be used in children with functional constipation while Trulance is only approved in adults.

What are Linzess and Trulance?

Linzess and Trulance are once-daily oral medications used to treat constipation. Both medications belong to the same drug class (guanylate cyclase-C agonists), but they have slightly different FDA-approved indications.

Linzess was initially approved by the FDA in 2012. It is approved to treat:

• Irritable bowel syndrome with constipation (IBS-C) in adults
• Chronic idiopathic constipation (CIC) in adults
• Functional constipation (FC) in children ages 6-17 years old

Trulance was FDA approved in 2017 to treat:

• Irritable bowel syndrome with constipation in adults
• Chronic idiopathic constipation in adults

Linzess comes as an oral tablet in 72 mcg, 145 mcg, and 290 mcg strengths. Trulance comes as an oral capsule in 3 mg only.

How do Linzess and Trulance work?

Both Linzess and Trulance are guanylate cyclase-C agonists. This means they turn on a protein called guanylate cyclase-C in the intestines, which increases cyclic guanosine monophosphate (cGMP). This is thought to reduce pain and stimulate minerals like chloride to be released into your intestines. This results in increased fluid and movement, which helps relieve constipation.

How are Linzess and Trulance taken?

The dose of Trulance is the same for both CIC and IBS-C, but the dose of Linzess is different depending on why you are taking it.

Recommended dosing for Linzess:

• IBS-C: 290 mcg by mouth once a day.
• CIC: 145 mcg by mouth once a day.
• FC: 72 mcg by mouth once a day.

The recommended dosing for Trulance for both CIC and IBS-C is 3 mg by mouth once a day.

Linzess should be taken on an empty stomach, at least 30 minutes before eating a meal. Trulance can be taken with or without food. For those who have trouble swallowing, Linzess capsules can be opened and sprinkled on applesauce or water. Trulance may be crushed into a powder and mixed with 1 teaspoon of applesauce or dissolved in water right before swallowing it.

Is Linzess or Trulance more effective for constipation?

There have not been head-to-head studies done to compare the effectiveness of Linzess with Trulance. The medications have been studied in different clinical trials. Researchers looked at changes in the normal bowel movements of participants to assess how well the medications worked. Linzess and Trulance have similar effectiveness for treating constipation.

Linzess studies

Irritable bowel syndrome with constipation (IBS-C): Linzess was studied in two clinical trials. In Study 1, patients took Linzess for 12 weeks and then were off of it for 4 weeks. In Study 2, patients took Linzess for 26 weeks.

• For at least 9 out of 12 weeks during Study 1, 20% of patients had at least 3 complete spontaneous bowel movements (CSBMs) in a given week and an increase of at least 1 CSBM from baseline compared to 6% of patients taking a placebo (no active medication). Additionally, 34% of patients taking Linzess had at least a 30% reduction in stomach pain compared to 27% of patients taking a placebo.
• For at least 9 out of 12 weeks during study 2, 18% of patients had at least 3 complete spontaneous bowel movements (CSBMs) in a given week and an increase of at least 1 CSBM from baseline compared to 5% of patients taking a placebo. Out of those taking Linzess, 39% had at least a 30% reduction in stomach pain compared to 20% of those taking a placebo.

Chronic idiopathic constipation (CIC): In 12-week treatment periods during two clinical trials, 20% (Study 1) and 15% (Study 2) of patients taking Linzess had at least 3 complete spontaneous bowel movements (CSBMs) in a given week and an increase of at least 1 CSBM from baseline for at least 9 weeks, compared to 3% and 6% of patients taking a placebo, respectively.

Functional constipation (FC): In a 12-week clinical trial including children ages 6 to 17 years old, those taking Linzess had a higher rate of spontaneous bowel movements per week compared to those taking a placebo (2.6 vs. 1.3).

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Trulance studies

Irritable bowel syndrome with constipation (IBS-C): In two 12-week clinical trials, 48% (Study 1) and 34% (Study 2) of patients taking Trulance had an increase of at least 1 CSBM per week for at least 6 out of the 12 weeks. This was compared to 35% and 28% of patients taking a placebo, respectively.

Chronic idiopathic constipation (CIC): In two 12-week clinical trials, 21% of patients with CIC taking Trulance in each study had at least 3 complete spontaneous bowel movements (CSBMs) in a given week and an increase of at least 1 CSBM from baseline in the same week for at least 9 weeks compared to up to 13% of patients taking a placebo.

How soon do Linzess and Trulance work?

In studies, patients taking Trulance for CIC saw improvements in the number of complete spontaneous bowel movements per week as early as the first week of taking it. Similarly, patients taking Linzess for CIC, IBS-C, and FC saw improvement in the first week.

How do the side effects of Linzess and Trulance compare?

Linzess and Trulance were studied in separate clinical trials. For both medications, diarrhea is the most common side effect. Diarrhea typically occurs within the first 2 weeks of taking Linzess and the first 4 weeks of taking Trulance. Call your prescriber if you develop severe diarrhea.

Linzess

The most common side effects (≥5%) of Linzess reported by people with IBS-C during clinical trials were:

• Diarrhea
• Stomach pain

Other side effects reported include gas, bloating, viral gastroenteritis, and headache.

The most common side effects (≥5%) of Linzess reported by people with CIC were:

• Diarrhea
• Stomach pain
• Gas
• Upper respiratory tract infection

Other side effects reported include sinusitis and bloating.

In studies of children with FC, 4% taking Linzess reported diarrhea compared to 2% of those taking a placebo (no active medication). Other side effects reported include nausea, stomach discomfort, and dehydration.

Trulance

Around 4% of people with IBS-C taking Trulance reported diarrhea as a side effect compared to 1% of those taking a placebo. Other side effects reported include nausea, cold-like symptoms, upper respiratory tract infection, urinary tract infection (UTI), and dizziness.

The most common side effects (≥5%) of Trulance reported by people with CIC were:

• Diarrhea

Other side effects include sinusitis, upper respiratory tract infection, bloating, flatulence, stomach tenderness, and increased liver enzyme tests.

This is not all the information you need to know about Linzess (linaclotide) and Trulance (plecanatide) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.