Amitiza alternatives: What can I take instead of Amitiza?

Compare Amitiza alternatives | Linzess | Trulance | Motegrity | Zelnorm | Movantik | Natural alternatives | How to switch meds

Constipation is a common condition defined as having fewer than three bowel movements per week or difficulty in passing stools. Constipation can be caused by lifestyle factors, medications, or gastrointestinal disorders, and for some people, it can be a chronic problem. 

Amitiza is a prescription drug used for the treatment of chronic idiopathic constipation (CIC) in adults and irritable bowel syndrome with constipation (IBS-C) in adult women. It is also used to treat constipation in adults who are taking opioids for chronic non-cancer pain. This type of constipation is known as opioid-induced constipation (OIC). The main ingredient in Amitiza is lubiprostone, a chloride channel activator that stimulates fluid secretion in the gut, leading to more frequent bowel movements. Brand-name Amitiza is manufactured by Takeda Pharmaceuticals, and a generic version containing lubiprostone is also available.

Although Amitiza is effective for treating constipation, it may not be the best choice for everyone. Some people experience troublesome adverse reactions, including nausea, diarrhea, bloating, abdominal pain, chest tightness, and headache. Serious side effects of Amitiza such as fainting, low blood pressure, shortness of breath, and severe diarrhea could also occur. In addition, the cost of Amitiza can be expensive depending on insurance coverage. For these reasons, patients may want to seek an alternative medication. 

What can I take in place of Amitiza?

Other drug treatments are available in place of Amitiza. Currently, Amitiza is the only drug in its class of chloride channel activators, so alternative medications will work in different ways to treat constipation. The table below compares Amitiza and its common alternatives by their different uses, side effects, and dosages.

Other alternatives to Amitiza

• Ibsrela (tenapanor)

Top 5 Amitiza alternatives

1. Linzess (linaclotide)

Linzess belongs to a class of drugs called guanylate cyclase C agonists. Linzess works by increasing chloride and bicarbonate secretion in the intestines, which in turn decreases gastrointestinal transit time. Linzess is approved by the U.S. Food and Drug Administration (FDA) to treat CIC and IBS-C in adults. Unlike Amitiza, which is dosed twice daily, Linzess is taken once daily at a recommended dose of 145 mcg for CIC and 290 mcg for IBS-C. 

The most common side effect of Linzess is diarrhea, which often begins within the first two weeks of starting treatment. In clinical trials, diarrhea occurred in 20% of IBS-C patients after taking Linzess compared to 3% of patients who received a placebo drug. Other common side effects include abdominal pain, gas, bloating, headache, and infections such as viral gastroenteritis, upper respiratory tract infection, and sinusitis. Linzess carries a black box warning about the risk of dehydration in children under 2 years old and is contraindicated in this population.

RELATED: Amitiza vs. Linzess | How much is Linzess without insurance?

2. Trulance (plecanatide)

Trulance is a guanylate cyclase C agonist and is used to treat CIC and IBS-C in adults. Trulance should be avoided in people under 18 years old, and it is contraindicated in children less than 6 years old due to the risk of serious dehydration. Trulance is available as a 3 mg tablet and is taken once daily.

Trulance and Amitiza have some similar side effects, but the frequencies of adverse effects can differ for each drug. Diarrhea is the most common side effect of Trulance and can occur during the first four weeks of treatment. Severe diarrhea was reported in up to 1% of patients in clinical trials and appeared most often on the first day of taking the medication. Patients who experience severe diarrhea should stop Trulance and consult their healthcare provider immediately. Amitiza can also cause diarrhea, but nausea is more common and occurs in 11.4% to 31.1% of patients, usually at a mild to moderate severity. 

3. Motegrity (prucalopride)

Motegrity is a serotonin type 4 (5-HT4) receptor agonist that treats constipation by promoting contractions and the movement of food through the intestines. It is approved for adults with CIC at a usual dosage of 2 mg once daily. Unlike Amitiza, Motegrity is not approved for the treatment of irritable bowel syndrome.

Common side effects of Motegrity include headache, abdominal pain, bloating, nausea, diarrhea, vomiting, gas, and fatigue. Motegrity can also cause serious side effects such as changes in mood and behavior, worsening depression, and thoughts of suicide. Patients who have any of these serious symptoms should stop taking Motegrity right away and contact their healthcare provider. 

4. Zelnorm (tegaserod)

Zelnorm is another Amitiza alternative that belongs to the serotonin type 4 (5-HT4) receptor agonist drug class. Zelnorm and Amitiza are both used to treat IBS-C in adult women. However, Zelnorm is only approved in women less than 65 years old, whereas Amitiza does not have an age limit for use. The recommended dosage of Zelnorm is 6 mg twice daily.

Headache, abdominal pain, nausea, diarrhea, gas, indigestion, and dizziness are common side effects of Zelnorm. Serious reactions such as stroke and heart attack have also been reported. For this reason, Zelnorm should not be used in patients who have a history of heart disease or have more than one risk factor for developing heart disease. Risk factors include active smoking, high blood pressure, high cholesterol, diabetes, age of 55 years or over, and obesity. Zelnorm is also contraindicated in patients with ischemic colitis, kidney or liver problems, bowel obstruction, gallbladder disease, sphincter of Oddi dysfunction, abdominal adhesions, or an allergy to tegaserod.

5. Movantik (naloxegol)

Movantik is approved to treat constipation caused by opioid use in adults with chronic non-cancer pain. Movantik is an opioid antagonist that blocks opioid drugs from binding to receptors in the digestive tract, thereby decreasing the constipation side effects associated with opioid use. The recommended dosage is 25 mg once daily.

Movantik most commonly causes gastrointestinal side effects such as abdominal pain, diarrhea, nausea, gas, and vomiting, but it also has more serious risks. Opioid withdrawal is a potentially severe side effect of Movantik that can manifest as sweating, chills, anxiety, irritability, and yawning. In addition, patients who are taking methadone are more likely to experience gastrointestinal withdrawal symptoms. Movantik can interact with other medications or foods. Patients should consult a healthcare professional before starting or stopping any medication during Movantik treatment to avoid harmful drug interactions.

Natural alternatives to Amitiza

In addition to prescription medications, dietary and lifestyle changes can aid in constipation relief. Eating foods high in fiber and drinking plenty of water helps soften the stool, making bowel movements easier to pass. Adults are recommended to get 22 to 34 grams of fiber a day from sources such as whole grains, beans, fruits, vegetables, and nuts. Processed foods, white breads, and meat have little fiber and should be avoided in patients looking to prevent constipation. Adapting an active lifestyle also promotes regular bowel movements by increasing the movement of food through the digestive tract. An exercise as simple as walking for 30 minutes a day is enough to improve constipation.

If changing lifestyle habits are ineffective, many over-the-counter (OTC) laxatives are also available. These agents include osmotic laxatives such as MiraLax (polyethylene glycol), stimulant laxatives such as Senokot (senna) and Dulcolax (bisacodyl), and stool softeners such as Colace (docusate). A healthcare provider can provide individualized medical advice about the best way to incorporate lifestyle changes or OTC medications into your constipation treatment. 

RELATED: 20 home remedies for constipation | 3 best IBS diets & 9 foods to avoid

How to switch to an Amitiza alternative

If Amitiza is not working to improve chronic constipation symptoms, it may be time to switch to an alternative. A healthcare provider can work with you to determine the most suitable option. Make sure to tell the provider about your symptoms, medical history, and all the medications you take, including OTC and prescription drugs and any vitamins or supplements. Stopping Amitiza is unlikely to cause withdrawal effects, but you should always consult a doctor before making any medication changes. 

It’s also important to contact your insurance provider if cost is a concern. Many prescription constipation medications are expensive, and prices can vary based on insurance coverage. SingleCare offers a prescription discount card that applies to many Amitiza alternatives, and it’s possible to save up to 80% on drug prices at participating pharmacies.