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Key takeaways
Trulance (plecanatide) and Linzess (linaclotide) are both used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). They act as guanylate cyclase-C receptor agonists to increase fluid in the intestines and promote bowel movements.
Trulance, a newer medication taken with or without food, differs from Linzess, which must be taken on an empty stomach. Both are available only by prescription and are not recommended for individuals under 18 years of age.
While Trulance and Linzess share similar efficacy and safety profiles, Trulance may cause fewer common side effects, making it a potentially preferable option for some patients. However, a healthcare provider should make the choice between drugs based on the individual’s condition.
Both medications are relatively expensive as brand-name drugs without generic versions available, and insurance coverage may vary, impacting the cost for patients, though discount programs may help reduce expenses.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Trulance (plecanatide) and Linzess (linaclotide) are two drugs that can be used for the treatment of irritable bowel syndrome (IBS). Both of these drugs promote bowel movement by increasing the amount of fluid in the intestines. On a biochemical level, Trulance and Linzess act as agonists of guanylate cyclase-C receptors in the gut. This, in turn, increases fluid load, softens stool textures, and speeds up the transit of food.
Trulance and Linzess have also been indicated in the treatment of chronic idiopathic constipation (CIC). This is the type of constipation that does not have a known cause.
Both of these constipation-relieving medications require a doctor’s visit and a prescription. Trulance and Linzess are also contraindicated in children under 6 years of age. They are not recommended for anyone younger than 18 years of age.
What are the main differences between Trulance and Linzess?
Although both Trulance and Linzess act on the guanylate cyclase-C receptors, they have different generic names and active ingredients. Trulance is the brand name for plecanatide whereas Linzess is the brand-name for linaclotide.
Trulance is a newer drug than Linzess and can be taken with or without food. Linzess is usually taken on an empty stomach 30 minutes before breakfast. While Trulance is available as a 3 mg oral tablet, Linzess is available as an oral capsule in different strengths.
| Main differences between Trulance and Linzess | ||
|---|---|---|
| Trulance | Linzess | |
| Drug Class | Guanylate cyclase-C agonist | Guanylate cyclase-C agonist |
| Brand/Generic status | No generic version available | No generic version available |
| Generic Name | Plecanatide | Linaclotide |
| Generic Form Availability | Not available | Not available |
| What form(s) does the drug come in? | 3 mg oral tablet | 72, 145, 290 mcg oral capsules |
| What is the standard dosage? | With or without food, once a day. | Should be taken on an empty stomach, once a day. |
| How long is the typical treatment? | Long term depending on your doctor’s prescription | Long term depending on your doctor’s prescription |
| Who typically uses the medication? | Adults 18 years and older | Adults 18 years and older |
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Conditions treated by Trulance and Linzess
Linzess and Trulance have been approved for use in chronic constipation and the constipation-dominant type of irritable bowel syndrome (IBS-C). Through their actions on the local intestinal receptors, both of these drugs promote fluid secretion and an increased transit of food through the gut.
These prescription-medications are not laxatives. They do not provide instant relief from constipation. Results are typically observed after a week of treatment with Trulance and Linzess. They are generally safe for long-term use.
Trulance and Linzess may sometimes be used off-label in the treatment of opioid-induced constipation (OIC) caused by drugs like morphine. Other off-label indications include ulcerative colitis.
| Condition | Trulance | Linzess |
| Irritable bowel syndrome with constipation | Yes | Yes |
| Chronic idiopathic constipation | Yes | Yes |
| Opioid-induced constipation | Off-label | Off-label |
| Ulcerative Colitis | Off-label | Off-label |
Is Trulance or Linzess more effective?
Trulance is a newer drug compared to Linzess. However, the efficacy of both of these medications is more or less equal.
Improvement in the frequency of bowel movements is seen as early as 1 week with a long-term sustained effect. Along with an increased frequency of bowel movements, these medications also improve the quality of the stool including the stool texture and consistency.
The effectiveness of Trulance in one clinical trial was found to be more pronounced in the treatment of chronic idiopathic constipation. Compared to placebo, Trulance was also shown to be effective in treating irritable bowel syndrome.
Currently, there are few comparative studies between Linzess and Trulance in terms of their efficacy but both of them are much more effective than placebo drugs to relieve constipation. One systematic review found that Trulance and Linzess have similar efficacy and safety. There were no significant differences in the occurrence of side effects such as diarrhea.
The decision on the drug of choice can only be determined by a doctor. After a complete evaluation, the doctor will prescribe the best drug tailored to an individual’s overall condition.
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Coverage and cost comparison of Trulance vs. Linzess
Trulance was approved in 2017 as a brand-name only medication. It is currently manufactured by Synergy Pharmaceuticals. There is currently no generic version available. Medicare and most insurance plans may not cover Trulance. The average cash price of Trulance can be over $500. Using a SingleCare discount card may help bring the cost down under $400. While it is still an expensive drug, using a discount card can bring the price down when insurance can’t cover it.
Linzess was approved in 2012 and is only available as a brand-name medication. Like other guanylate cyclase-C agonists, Linzess can be quite expensive with an average retail cost over $500. Fortunately, some Medicare and insurance plans may cover it. Even with insurance, you may be able to save more with a SingleCare discount card which can reduce the cost to around $400.
RELATED: How much is Linzess without insurance?
| Trulance | Linzess | |
| Typically covered by insurance? | No | No |
| Typically covered by Medicare? | No | No |
| Standard dosage | 3 mg tablets | 72, 145, 290 mcg capsules |
| Typical Medicare copay | $70-$474 | $19-$482 |
| SingleCare cost | $389.+ | $403.38 |
Common side effects of Trulance vs. Linzess
The most common side effect associated with using Trulance or Linzess is diarrhea. Due to the nature of their work, these drugs primarily cause gastrointestinal side effects. According to their FDA drug labels, Trulance may have fewer common side effects compared to Linzess. The main side effect of Trulance is diarrhea.
Other than diarrhea, Linzess can cause other common side effects such as bloating, flatulence, and abdominal pain.
In rare cases, Trulance and Linzess can cause severe diarrhea. In these cases, your doctor will recommend the immediate discontinuation of the drug. In children, these medications may cause severe dehydration. Therefore, they are not recommended in children.
| Trulance | Linzess | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Diarrhea | Yes | 5% | Yes | 20% |
| Abdominal pain | Yes | <2% | Yes | 7% |
| Bloating | Yes | <2% | Yes | 2% |
| Flatulence | Yes | <2% | Yes | 4% |
| Headache | No | – | Yes | 4% |
This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Trulance), DailyMed (Linzess)
Drug interactions of Trulance vs. Linzess
There are a few drug interactions with Trulance. It is generally regarded as safe to take with other drugs. However, one medication, in particular, has the potential to interact with Trulance. Idelalisib is indicated in the treatment of certain blood cancers such as chronic leukemia.
Idelalisib, when taken with Trulance, can cause severe, life-threatening diarrhea. It’s important to contact your health care provider immediately if you experience symptoms of this drug interaction.
Apart from idelalisib, there are no other significant drug interactions with Trulance. It does not interfere with the cytochrome P450 enzyme complex nor does it affect other cell transporters.
Linzess, on the other hand, has a longer list of potential drug interactions compared to Trulance. This drug has the potential to interact with a number of medications such as levothyroxine, bisacodyl, psyllium, magnesium hydroxide, and omeprazole.
| Drug | Drug Class | Trulance | Linzess |
| Idelalisib | Phosphoinositide 3-kinase inhibitor | Yes | Not reported |
| Levothyroxine | Thyroid hormone | Not reported | Yes |
| Bisacodyl | Stimulant laxative | Not reported | Yes |
| Psyllium | Fiber laxative | Not reported | Yes |
| Magnesium hydroxide | Saline laxative | Not reported | Yes |
| Omeprazole | Proton pump inhibitor | Not reported | Yes |
This is not a complete list of drug interactions. Please consult your doctor before taking these medications.
Warnings of Trulance vs. Linzess
Both Trulance and Linzess have the potential to cause serious side effects, especially diarrhea and dehydration.
In children younger than 6 years of age, these medications have the risk of causing severe dehydration. Their safety and efficacy have not been well-established in children younger than 18 years, which is why both Trulance and Linzess are contraindicated in pediatric patients. Dehydration may occur as a result of increased stimulation of the guanylate cyclase-C receptors that boosts intestinal motility and fluid secretion at a higher-than-normal rate.
Those with gastrointestinal blockage (obstruction) should avoid taking Trulance or Linzess. Talk to a doctor to determine if you have a gastrointestinal blockage before taking either medication.
Diarrhea is another common side effect and risk that can occur with the use of both Trulance and Linzess. Profuse diarrhea can not only cause dehydration but also electrolyte disturbances in the body. This may require further treatment if it is not corrected appropriately.
Trulance and Linzess have not been studied in women who are pregnant or breastfeeding. They should only be used after evaluating the potential risk of birth defects.
Frequently asked questions about Trulance vs. Linzess
What is Trulance?
Trulance is a prescription medication that is approved in the treatment of constipation-predominant irritable bowel syndrome (IBS-C) and chronic idiopathic constipation (CIC). It is a guanylate cyclase-C receptor agonist that increases intestinal movement. Trulance is safe to use in patients older than 18 years of age. It comes in an oral tablet form with relief typically seen within a week of use.
What is Linzess?
Linzess is an older drug that acts in the same way as Trulance. It is a guanylate cyclase-C receptor agonist that increases transit in the gut and relieves constipation. For this reason, Linzess has been approved for irritable bowel syndrome-C and chronic constipation. It is a prescription drug available in an oral capsule form.
Are Trulance and Linzess the same?
No. Despite belonging to the same drug class, these drugs come in different dosage forms. Trulance is a newer drug that can be taken with or without food. Linzess should be taken on an empty stomach 30 minutes before breakfast.
Which is better–Trulance or Linzess?
Trulance and Linzess have similar efficacy and safety. However, Linzess may be associated with a higher incidence of diarrhea, bloating, and gas. For this reason, Trulance may be preferred over Linzess.
Can I use Trulance or Linzess while pregnant?
It is not yet known whether Trulance or Linzess are safe to take during pregnancy or lactation. You should consult a physician before taking these medications when pregnant or breastfeeding.
Can I use Trulance or Linzess with alcohol?
Drug interactions of Trulance or Linzess with alcohol are not well-established. There is a possibility that drinking alcohol with these medications can increase the risk of adverse events.
Is Amitiza better than Linzess?
Compared to once-daily Linzess, Amitiza (lubiprostone) needs to be taken twice daily. Amitiza may also have more common side effects compared to Linzess. In addition to diarrhea, Amitiza has the potential to cause nausea, indigestion, and dry mouth.
What is the generic version of Linzess?
There is currently no generic version of Linzess available on the market.
Which is better for constipation–Linzess or Trulance?
Both Trulance and Linzess have been shown to be comparable in efficacy and safety. One medication may be preferred over the other depending on price and insurance coverage. Trulance is also a newer drug with fewer reported common side effects.
Will Linzess make you lose weight?
Weight changes may be possible when taking Linzess. Linzess has been reported to cause weight loss or weight gain.