Trulance alternatives: What can I take instead of Trulance?

In this article:

• Trulance alternatives
• Linzess
• Miralax
• Constulose
• Amitiza
• Motegrity
• Natural alternatives
• How to switch

In this article

• Trulance alternatives
• Linzess
• Miralax
• Constulose
• Amitiza
• Motegrity
• Natural alternatives
• How to switch

Trulance (plecanatide) is an oral tablet available by prescription for the treatment of chronic idiopathic constipation (CIC), which arises from unknown causes or in the setting of irritable bowel syndrome with constipation (IBS-C). Taking a once-daily pill for constipation may seem convenient, but the cost or adverse effects could have you looking for alternatives. Fortunately, there is another option within the guanylate cyclase-C agonist drug category, like Trulance, and there are effective and less expensive options outside the category as well, 

What can I take in place of Trulance?

Linzess (linaclotide) is the first drug that comes to mind when considering an alternative to Trulance. It falls within the same drug class, guanylate cyclase-C agonists. These brand-name drugs increase intestinal fluid secretion and transit, thereby increasing bowel movements.

Osmotic laxatives are more common than the guanylate cyclase agonists and have several class members, including generic options. Miralax (polyethylene glycol) is quite popular, but lactulose is also used. Other than osmotic laxatives, Amitiza (lubiprostone) provides an alternative and has dosing regimens for both CIC and IBS-C, while Motegrity (prucalopride) has Food and Drug Administration (FDA) approval for CIC. Delving into the details of these options may help with medical decision-making.

Top 5 Trulance alternatives

The following are some of the most common alternatives to Trulance.

1. Linzess

If Trulance is not covered on your health insurance formulary or requires too steep of a copay, Linzess is another guanylate cyclase-C agonist drug approved by the FDA for both CIC and IBS-C, and it is possible Linzess could be listed on the formulary instead of Trulance. The effectiveness of the two drugs is similar, as is the rate of diarrhea, their most common side effect. They don’t have any identified drug interactions, and they both are contraindicated in the setting of bowel obstruction. A potentially important distinction is that patients typically notice benefits by 4 weeks with Trulance or by 8 to 12 weeks with Linzess.

2. Miralax

Miralax is available in brand and generic versions of polyethylene glycol (PEG) over-the-counter, without a prescription, making it a convenient and less costly alternative to Trulance. Also, unlike Trulance and Linzess, Miralax can be used in children. Based on studies of young mice, The FDA has placed a boxed warning on Trulance about the risk of dehydration from severe diarrhea side effects in children.

Miralax is an osmotic laxative that draws water into the intestine. It is a powder mixed with water or other liquid, such as juice or tea. Although it is not FDA-approved for CIC or IBS-C, there is support for its use in these settings, including a study of patients with IBS-C that showed superiority to placebo for relief of constipation but not abdominal pain.

3. Constulose

Lactulose products, such as Constulose or generic versions, present another cost-saving option compared to Trulance. Constulose is a liquid form of lactulose, and Kristalose is a powder form. Both work by providing the gastrointestinal tract with disaccharides that are not digested and keeping water and electrolytes in the bowel. Two unfortunate side effects of lactulose products are bloating and gassiness. This fact and lesser efficacy, when studied in comparison to PEG, have pushed lactulose down the list of preferred options.

4. Amitiza

Amitiza (lubiprostone) is another proven alternative to Trulance, and it has been approved for use in patients with either CIC or IBS-C. By activating chloride channels in the intestinal tract, it includes fluid secretion into the bowels. No comparison studies are available to conclude which is more effective. Regarding side effects, nausea was its most common adverse reaction.

A reason for changing to Amitiza could be financial. When using a SingleCare discount card, generic Amitiza may cost as low as $35 for 60 24 mcg tablets, which is a one-month supply. The discounted price of Trulance is $480 for 30, 3 mg tablets, which is much less than its $820 retail price but still significantly more than lubiprostone.

5. Motegrity

Approved for CIC and constipation associated with opioid use, Motegrity derives its effectiveness from stimulating 5-hydroxytryptamine receptors and thereby increasing neurotransmitters that control intestinal movement. The mechanism of action sounds impressive. However, studies have not investigated it for IBS-C, and in CIC, PEG was shown in one study to have similar efficacy.

Natural alternatives to Trulance

Unsurprisingly, fiber and prunes are two natural alternatives to pharmaceuticals like Trulance, and they have proof. Fiber from fruits, vegetables, and legumes is a reasonable place to start when looking for help. Still, according to a practice guideline, psyllium, available as the supplement Metamucil, is the most proven fiber option for constipation. Coupling lots of water and fiber intake is important for its utility. The downside is that fiber can cause flatulence and bloating, so patients may need to take it slow when starting.

How to switch to a Trulance alternative

Options for replacing Trulance are diverse. Within its own drug class, among simple osmotic laxatives, from laxatives with novel mechanisms, or with natural alternatives, effective treatment can be found for chronic idiopathic constipation or irritable bowel syndrome with constipation. Deciding whether to change and picking among the available alternatives requires the medical advice of your healthcare provider. The wrong choice could have you feeling stuck without relief, but the guidance of a medical professional will hopefully get you moving in the right direction.