Linzess alternatives: What can I take instead of Linzess?

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

Constipation is a common condition, affecting about 16% of adults in the U.S., and 33% of adults ages 60 years and older. People with constipation may have:

• Less than three bowel movements per week
• Dry/hard/lumpy stools
• Stools that are difficult or painful to pass
• A feeling that not all of the stool has passed 

Linzess is a prescription medication used to treat adults who have irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC). Linzess is a brand-name medication made by Allergan, Inc. A generic is not available at this time. 

Linzess contains the ingredient linaclotide. It is categorized in a drug class called guanylate cyclase-C agonists. Linzess works by increasing the movement of food and waste through the intestines. In animal studies, Linzess also decreased abdominal pain. 

In some cases, patients may be looking for an alternative constipation treatment to Linzess. Sometimes, certain side effects of Linzess may be too bothersome—common side effects include diarrhea, stomach pain, gas, headache, bloating, and upper respiratory infection— or a serious side effect could occur, such as severe diarrhea or an allergic reaction. 

On the other hand, the price may be too high due to insurance plans. Whatever the reason, there are other prescription drugs available to people with IBS-C or CIC. 

What can I take in place of Linzess?

In the table below, we look at Linzess, as well as common alternatives to Linzess. All of the drugs listed are prescription constipation medications approved by the U.S. Food and Drug Administration (FDA). 

Trulance (plecanatide)

Like Linzess, Trulance is in the guanylate cyclase-C agonist class of prescription constipation drugs. If the reason you are looking for a Linzess alternative is due to side effects or an allergic reaction, then Trulance would not be a good alternative, because it is very similar to Linzess and it is very likely you would have the same reaction. 

Trulance is indicated to treat IBS-C or CIC in adults. Trulance should not be used in children under 18 years old. It has a black box warning, stating that it is not approved in children under age 18. In animal studies of young mice, one dose of Trulance caused deaths due to dehydration. For that reason, Trulance is contraindicated in children under 6 years old. However, it should not be used in any child under 18 years old due to a lack of safety and efficacy data. Trulance also should not be used in patients with gastrointestinal (GI) obstruction. 

The dosage of Trulance is 3 mg by mouth daily. The most common side effects are diarrhea and allergic reactions. Patients who experience severe diarrhea should consult their provider right away.  

Amitiza (lubiprostone)

Amitiza is in a drug class called chloride channel activators. It is approved to treat CIC in adults, IBS-C in women 18 years and older, and opioid-induced constipation (OIC) in adults with chronic non-cancer pain. 

The dosage for IBS-C is 8 mcg twice daily, and the dosage for CIC or OIC is 24 mcg twice daily. Common side effects include stomach-related problems like nausea (taking Amitiza with food can help nausea), vomiting, diarrhea/loose stools, bloating, pain, gas, and indigestion. Other common side effects can include headache, URI, sinus infection, UTI, dizziness, swelling of the extremities, joint or back pain, fatigue, and shortness of breath. 

Patients who experience severe diarrhea should stop taking Amitiza and contact their healthcare provider right away. Amitiza may cause fainting and low blood pressure—patients who experience these signs and symptoms should stop taking Amitiza and contact their provider. Amitiza can also cause shortness of breath, usually within an hour of the first dose, and generally resolving within three hours. However, it may continue to occur with future doses. Patients who experience shortness of breath should consult their provider. Amitiza should not be used in patients with GI obstruction. 

Lactulose

Lactulose is known as an osmotic laxative. It is available in solution form, as well as in a powder form that is mixed with water. The dosage depends on which formulation is being used. Lactulose is used to treat chronic constipation. The most common side effects are nausea, vomiting, gas, cramping, and bloating. Lactulose cannot be used in people who require a low galactose diet. Lactulose should be used with caution in people with diabetes.

Motegrity (prucalopride)

Motegrity is a serotonin-4 (5-HT4) receptor agonist and is used to treat CIC in adults. The usual dosage is 2 mg by mouth daily. Common side effects may include stomach problems like abdominal pain, nausea, vomiting, diarrhea, bloating, and gas. Headache, dizziness, and fatigue are also common side effects. 

Patients taking Motegrity must be monitored for suicidal thoughts and behavior or worsening depression. Patients and their caregivers/families should be aware of this possibility. If the patient experiences mood or behavior changes or suicidal thoughts or behavior, the patient should stop taking Motegrity right away and contact the healthcare provider. Motegrity should not be used in patients with intestinal perforation or obstruction. 

Zelnorm (tegaserod)

Zelnorm is a serotonin-4 (5-HT4) receptor agonist used to treat IBS-C in adult women under 65 years old. It is not approved to treat men with IBS-C. The dosage is 6 mg twice daily. 

Common side effects include stomach problems like pain, diarrhea, nausea, gas, and indigestion. Headache, dizziness, and anemia may also occur. 

Zelnorm can also cause many serious reactions including:

• Heart problems like stroke, heart attack, or cardiovascular death
• Hepatitis
• Severe diarrhea
• Severe allergic reaction
• Suicidal thoughts and behavior
• Intestinal ischemia/mesenteric ischemia
• Ischemic colitis
• Gallbladder inflammation

According to the prescribing information, because of these potential serious effects, Zelnorm cannot be used in people with:

• A history of heart attack, stroke, mini-stroke, or chest pain
• A history of ischemic colitis or any form of intestinal ischemia
• A history of bowel obstruction, gallbladder disease, abdominal adhesions, or suspected sphincter of Oddi dysfunction
• Severe kidney impairment or end-stage renal disease
• Moderate or severe liver impairment
• An allergy to tegaserod

Zelnorm was approved by the FDA in 2002, but withdrawn from the market in 2007 due to concerns about serious cardiovascular risk. After this, the drug was available to certain patients on a limited basis through a special program. In 2019, Alfasigma USA, Inc., announced their acquisition of Zelnorm from Sloan Pharma. In March 2019, Zelnorm was approved by the FDA for reintroduction to the market to treat adult women under 65 years old with IBS-C. 

Natural alternatives to Linzess

Often, people who take prescription medication for constipation have already exhausted over-the-counter (OTC) stool softeners or various laxatives—saline laxatives such as magnesium, osmotic laxatives such as Miralax, stimulant laxatives such as Dulcolax (bisacodyl), or bulk-forming laxatives such as psyllium. 

Dietary and lifestyle modifications can help constipation and can be used in combination with prescription medication. Including plenty of fiber and water in your diet can help prevent constipation. There are many sources of fiber, including fruits (especially berries, apples, and pears), vegetables (such as broccoli, avocado, and artichokes), whole grains, nuts, and seeds. Regular exercise, such as walking after a meal, can help keep the bowels moving. A registered dietician can be a helpful source for dietary changes that can help constipation. Your healthcare provider or GI specialist (doctor of gastroenterology) are the best sources to turn to for medical advice on prescription medication for constipation. 

How to switch to a Linzess alternative

If you are interested in switching to a Linzess alternative, you can:

• Reach out to your insurance plan if the price is a concern. Ask which Linzess  alternatives are covered, and what your cost would be, taking the deductible into consideration, if applicable 
• Call your healthcare provider. Your healthcare provider may want you to see you in person before switching your medication. You should discuss all of your medical conditions and history, as well as alternative medications, and their potential drug interactions and adverse effects, with your provider. 

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