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Linzess vs Trulance
Introduction
For individuals with chronic idiopathic constipation (CIC) or irritable bowel syndrome with constipation (IBS-C), certain drugs that alter the amount of water in your intestines, thereby easing bowel movements, can be beneficial. Linzess and Trulance are two such drugs prescribed for these conditions. They each work by increasing fluid secretion in the intestine to help ease stool passage. Linzess, also known as linaclotide, works as a guanylate cyclase-C agonist which increases secretions into the intestines which results in increased motility and improved symptoms. On the other hand, Trulance is classified as plecanatide and shares a similar mechanism but it's designed to mimic uroguanylin — a naturally occurring hormone in your body that regulates how much fluid is sent to your bowels.
Linzess vs Trulance Side By Side
| Attribute | Linzess | Trulance |
|---|---|---|
| Brand Name | Linzess | Trulance |
| Contraindications | Cannot be taken if under 6 years of age due to risk of serious dehydration. Do not take if allergic to linaclotide. | Cannot be taken if under 6 years of age due to risk of serious dehydration. Do not take if allergic to plecanatide. |
| Cost | $450 for 30 tablets (145 mcg) | $460 for 30 tablets (3 mg) |
| Generic Name | Linaclotide | Plecanatide |
| Most Serious Side Effect | Severe diarrhea, allergic reactions | Severe diarrhea, signs of an allergic reaction |
| Severe Drug Interactions | Not specified, but interactions with certain drugs could affect how Linzess works. Some medicines may need to be stopped before starting Linzess. | Not specified, but as with Linzess, interactions with certain drugs could affect how Trulance works. Some medicines may need to be stopped before starting Trulance. |
| Typical Dose | 72–290 mcg/day, with 145 mcg/day being typical for most patients | 3 mg/day, taken orally on an empty stomach, ideally 30 minutes prior to the first meal of the day |
What is Linzess?
Linaclotide (the generic name for Linzess) was the first drug of its class, a guanylate cyclase-C agonist, which marked an important development in the treatment of chronic constipation and irritable bowel syndrome with constipation (IBS-C). Linaclotide was first approved by the FDA in 2012. It works by increasing fluid secretion into your bowel, effectively "softening" stool and making it easier to pass. It is prescribed specifically for adults who have not found relief from other treatments.
Plecanatide (the generic name for Trulance), also a guanylate cyclase-C agonist similar to Linzess but approved later in 2017, has been shown to be just as effective at treating symptoms of chronic idiopathic constipation and IBS-C. The key difference between these two medications lies within their side effect profiles: while both can cause diarrhea as a side effect, this tends to occur less frequently in those taking Plecanatide compared to those on Linaclotide.
What conditions is Linzess approved to treat?
Linzess is approved by the FDA to treat several types of gastrointestinal disorders, including:
- Chronic idiopathic constipation (CIC)
- Irritable bowel syndrome with constipation in adults (IBS-C)
- Overactive bladder and urinary tract symptoms Trulance is also used for similar conditions but has a specific approval for the treatment of irritable bowel syndrome with constipation (IBS-C) in adults.
How does Linzess help with these illnesses?
Linzess helps to manage constipation and irritable bowel syndrome with constipation (IBS-C) by increasing the amount of fluid in your intestines. It does this by binding to the guanylate cyclase-C receptor on cells lining the intestine, an action that increases intestinal fluid secretion and motility. This results in a quicker transit time for stool through the bowels, which can alleviate symptoms like stomach pain and infrequent or hard stools.
Guanylate cyclase-C is a receptor found along the length of your intestines that plays an important role in regulating fluid balance, mucus production, nutrient absorption, cell growth and repair among other things. In patients suffering from chronic idiopathic constipation (CIC) or IBS-C, it's thought that there may be a dysfunction within these processes.
Therefore, by increasing intestinal fluid secretion and motility via activation of guanylate cyclase-c receptors with Linzess use can help limit negative effects associated with CIC or IBS-C such as abdominal discomfort or bloating while improving bowel habits.
What is Trulance?
Trulance, also known as plecanatide, is a guanylate cyclase-C agonist that works by increasing the amounts of fluid and electrolytes in your intestines, making bowel movements easier. It was first approved by the FDA in 2017 to treat chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). Unlike Linzess which can sometimes cause diarrhea as a side effect, Trulance has shown less incidence of this problem. Trulance does not inhibit any neurotransmitters such as serotonin or dopamine; instead it functions mainly on the intestinal tract. The primary advantage of using Trulance over traditional medications like Linzess may be its lower risk for causing diarrhea. For those patients who are suffering from CIC or IBS-C but cannot tolerate diarrheal symptoms associated with other treatments, Trulance could be an effective alternative option.
What conditions is Trulance approved to treat?
Trulance is approved for the treatment of:
- Chronic idiopathic constipation (CIC), a condition characterized by infrequent and difficult-to-pass stools over a prolonged period.
- Irritable bowel syndrome with constipation (IBS-C), which includes abdominal discomfort along with irregular bowel movements.
How does Trulance help with these illnesses?
Trulance, like Linzess, is used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). It works by increasing the amount of water in your intestines, which can help soften stools and stimulate bowel movements. Trulance has a unique mechanism of action as it activates guanylate cyclase-C receptors located on the lining of the intestine. This leads to increased fluid secretion into the intestine and accelerated transit time for stool passage. The way Trulance specifically acts might be beneficial in patients who have not responded well or had side-effects to other typical laxatives such as Linzess. Furthermore, clinical studies suggest that Trulance may have a more predictable efficacy profile leading to less bloating compared to other drugs.
How effective are both Linzess and Trulance?
Both linaclotide (Linzess) and plecanatide (Trulance) have established histories of success in treating patients with chronic idiopathic constipation, irritable bowel syndrome with constipation, and are approved by the FDA. They act on different guanylate cyclase-C receptors in order to increase fluid secretion into the intestine and accelerate bowel movement.
The effectiveness of Linzess and Trulance was directly studied; both drugs exhibited similar efficacy in managing symptoms as well as similar safety profiles. One study showed that none of the different metrics used to measure efficacy differed significantly between patients receiving Linzess or those receiving Trulance.
A review demonstrated that Linzess is effective from the first week of treatment, has a favorable side effect profile compared to many other medications for these conditions, and it's well-tolerated even in elderly populations. It has become highly prescribed due to its effectiveness at relieving constipation-related issues without causing serious side effects. The dose showing optimal efficacy varies depending on specific patient needs but generally falls within 72-145 mcg/day range.
On the other hand, a meta-analysis indicated that Trulance seems similarly effective yet is typically considered only after other treatments have failed or produced unacceptable side effects due to its higher cost compared to first-line treatments like increased dietary fiber intake or over-the-counter laxatives. Moreover, data confirming its stand-alone treatment efficacy is less robust than for Linzess because significant research involves co-prescription alongside another drug such as lubiprostone (Amitiza). However, thanks to its unique pharmacology, Trulance may be an optimal choice for patients who did not respond well to initial treatments or need something stronger while avoiding common side effects like bloating or gas.
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At what dose is Linzess typically prescribed?
Oral dosages of Linzess range from 72–290 mcg/day, but research has indicated that 145 mcg/day is typically sufficient for treating most people with chronic idiopathic constipation and irritable bowel syndrome. For Trulance, the recommended dose is 3 mg taken orally once daily. It's important to note these medications are intended for adults only and not recommended for use in children under six years old due to risk of serious side effects. In either case, dosage adjustments should be made under a healthcare provider's supervision based on individual response and tolerance.
At what dose is Trulance typically prescribed?
Trulance treatment is typically initiated at a dosage of 3 mg/day, taken orally on an empty stomach, ideally 30 minutes prior to the first meal of the day. If well-tolerated but insufficient in managing symptoms, your healthcare provider might consider increasing the dose to a maximum of 6 mg per day. This increase should be evaluated after several weeks of consistent use at the initial dosage level. Trulance dosing does not require division throughout the day and can be administered as one single daily dose for ease and convenience.
What are the most common side effects for Linzess?
Common side effects of Linzess include:
- Diarrhea, which can be severe
- Abdominal pain or discomfort, such as bloating and gas
- Flatulence (excessive gas)
- Nausea or vomiting
- Heartburn
- A feeling of fullness in your stomach
On the other hand, Trulance may cause similar but slightly different side effects including:
- Diarrhea
- Abdominal distension (bloating)
- Increased bowel movements
- Flatulence (excessive gas)
These symptoms are less common than with Linzess. Make sure to consult a healthcare provider for more information on these medications.
Are there any potential serious side effects for Linzess?
While Linzess and Trulance are both used to treat certain types of chronic constipation, their potential side effects can vary. For Linzess, these may include:
- Allergic reactions: Although rare, some people might experience symptoms such as hives; difficulty breathing; or swelling of the face, lips, tongue or throat.
- Severe diarrhea: This is one of the most common side effects and could lead to dehydration if not managed properly. Signs of dehydration include feeling very thirsty or hot, being unable to urinate or sweating profusely.
- Blood in stools: If you notice any bleeding from your rectum or blood in your stool while taking Linzess, seek immediate medical attention.
Like with any medication, there's a small chance that you could have an unusual reaction. If you start experiencing fainting spells (syncope), irregular heartbeat (arrhythmia), tremors or hallucinations after starting this medication - although extremely unlikely - it would be important to seek immediate medical help.
Remember that many people using this medication do not have serious side effects and it's crucial to discuss any worries about potential risks with your healthcare provider before making changes to your treatment plan.
What are the most common side effects for Trulance?
While taking Trulance, one may experience the following side effects:
- Diarrhea
- Abdominal pain or discomfort
- Gas and bloating
- Headache
- Fatigue or weakness
- Dizziness
It's vital to keep in mind that every patient reacts differently to medication. If any of these symptoms become severe or persist for an extended period, it's important to contact your healthcare provider.
Are there any potential serious side effects for Trulance?
Trulance, though usually well-tolerated, can have side effects in rare cases. These may include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Severe stomach pain that could lead to serious dehydration
- Unusual dizziness and a feeling of being lightheaded
- Diarrhea that is severe or does not go away
- A sudden change in bowel habits lasting more than 2 weeks
If you experience any of these symptoms while taking Trulance, it's important to stop medication immediately and contact your healthcare provider without delay.
Contraindications for Linzess and Trulance?
Both Linzess and Trulance, along with most other medications for constipation, might exacerbate symptoms in some people. If you notice your constipation worsening or an increase in severe abdominal pain or bloody stools after taking these medications, please seek immediate medical attention.
Neither Linzess nor Trulance can be taken if you are under 6 years of age due to the risk of serious dehydration. Always inform your physician which medications you're taking; there may be interactions with certain drugs that could affect how Linzess and Trulance work. Some medicines need to be stopped for a period before starting either Linzess or Trulance to avoid harmful reactions.
If you have a known allergy to linaclotide (the active ingredient in Linzess) or plecanatide (the active ingredient in Trulance), do not take these drugs as it may lead to severe allergic reactions. Ensure that this information is clearly communicated with your healthcare provider.
How much do Linzess and Trulance cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Linzess (145 mcg) averages around $450, which works out to about $15/day.
- The price for 30 tablets of Trulance (3 mg) is approximately $460, working out to roughly $15.33/day.
Thus, on a per-day treatment basis, the costs are quite comparable between Linzess and Trulance. Please note that cost should not be your primary consideration in determining which drug is right for you; effectiveness and side effect profiles also matter significantly.
As far as generic versions go:
- Currently, there are no generic equivalents available on the market for either Linzess or Trulance. As such their prices remain relatively high compared to other medications where generics are available. Always check with your healthcare provider and pharmacist about potential ways to save money including manufacturer coupons or patient assistance programs.
Popularity of Linzess and Trulance
Linaclotide, available under the brand name Linzess, is a commonly prescribed medication used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation. In 2020, it was estimated that about 2 million people in the US were prescribed Linzess. This accounted for nearly 50% of prescriptions for this class of medications known as guanylate cyclase-C agonists. The use of linaclotide has been steadily increasing since its FDA approval in 2012.
Plecanatide, commercially known as Trulance, is another medication within this same class indicated for similar conditions. It was introduced more recently to the market compared to Linzess and was prescribed to an estimated half million people in the USA during 2020. Despite being newer on the scene, plecanatide has shown steady growth since its approval by the FDA in early 2017.
Conclusion
Both Linzess (linaclotide) and Trulance (plecanatide) are effective options for managing chronic idiopathic constipation and irritable bowel syndrome with constipation. These medications have a proven track record of usage, backed by several clinical trials demonstrating their effectiveness compared to placebo.
Their mechanisms of action differ: Linzess works by increasing fluid secretion in the intestines to facilitate easier passage of stool, while Trulance functions similarly but also enhances certain activities in the intestinal lining. Both may be used concurrently under careful medical supervision as they don't generally interact; however, individual patient circumstances always guide this decision.
Linzess is often considered a first-line treatment option due to its extended use history. Conversely, Trulance might be utilized if patients don’t respond well to initial treatments or if they need a medication that acts on an additional pathway in the gut wall.
Both drugs are available only via prescription which might represent significant costs especially for those paying out-of-pocket without insurance coverage. It's worth noting that both Linzess and Trulance require some time before effects become noticeable — typically within one week.
The side effect profile is similar between these two drugs, generally being well-tolerated with minimal adverse reactions — most commonly diarrhea. Patients should closely monitor their response when commencing treatment and seek immediate medical help if severe diarrhea occurs or other symptoms worsen.
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Refrences
- McWilliams, V., Whiteside, G., & McKeage, K. (2012, November). Linaclotide. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/11470590-000000000-00000
- Love, B. L., Johnson, A., & Smith, L. S. (2014, July 1). Linaclotide: A novel agent for chronic constipation and irritable bowel syndrome. American Journal of Health-System Pharmacy. Oxford University Press (OUP).http://doi.org/10.2146/ajhp130575
- Keto, Y., & Kosako, M. (2019). Pharmacological and clinical profile of linaclotide (Linzess<sup>®</sup>), a novel therapeutic agent for irritable bowel syndrome with constipation and chronic constipation. Folia Pharmacologica Japonica. Japanese Pharmacological Society.http://doi.org/10.1254/fpj.153.289
- Vazquez-Roque, M. I., & Bouras, E. P. (2013, February 20). Linaclotide, Novel Therapy for the Treatment of Chronic Idiopathic Constipation and Constipation-Predominant Irritable Bowel Syndrome. Advances in Therapy. Springer Science and Business Media LLC.http://doi.org/10.1007/s12325-013-0012-9
- Love, B. L. (2019, May). Plecanatide for Treatment of Chronic Constipation and Irritable Bowel Syndrome. The American Journal of Medicine. Elsevier BV.http://doi.org/10.1016/j.amjmed.2018.11.027