Understanding Linzess 290 mcg

In this article:

• Uses
• What to expect when taking it
• 145 mcg vs. 290 mcg
• Usage instructions
• Cost
• Alternatives

In this article

• Uses
• What to expect when taking it
• 145 mcg vs. 290 mcg
• Usage instructions
• Cost
• Alternatives

Linzess (linaclotide) is an FDA-approved prescription medication used to treat different types of chronic constipation, including irritable bowel syndrome with constipation (IBS-C), chronic idiopathic constipation (CIC), and functional constipation (FC). The guanylate cyclase-C (GC-C) helps soften stool, encourage more frequent and complete bowel movements, and alleviate abdominal pain. The typical dosage strengths of Linzess are 72 mcg, 145 mcg, and 290 mcg taken orally once daily. Your prescribed dosage strength will depend on the condition being treated. 

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Linzess 145 mcg (30 capsules)

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$499.63

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Get free coupon

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What is Linzess 290 mcg used for?

The maximum dose of Linzess is 290 micrograms (mcg) taken once daily. This high dose is typically prescribed for adults with irritable bowel syndrome with chronic constipation (IBS-C) to relieve abdominal pain and constipation. 

Other common symptoms of IBS-C include:

• Hard, dry, or lumpy stools
• Incomplete bowel movements
• Straining during bowel movements
• Bloating
• Flatulence (gas) 

“I consider it when patients haven’t responded to standard laxatives or fiber,” says Sarah Bonza, MD, MPH, FAAFP, a family medicine physician, founder of Bonza Health, and hospitalist physician at Fairfield Medical Center in Lancaster, Ohio. “It’s not usually the first-line drug, but it can be helpful for those with persistent symptoms.”

Omar Khokhar, MD, a gastroenterologist at Illinois GastroHealth in Bloomington, Illinois, also adds that in addition to fiber, he typically prescribes Linzess when traditional methods like eating more fruits and engaging in exercise have been unsuccessful. “Prescribing Linzess over others depends on a number of factors,” he says. “In my experience, insurance coverage usually determines which agent is used.”

What to expect when taking it

Like any medication, Linzess can cause mild to severe side effects.

Below are the most common side effects of the anti-constipation drug:

• Diarrhea
• Stomach pain
• Swelling or feeling of fullness or pressure in the abdominal area
• Gas
• Headache 

Some patients claim to experience rapid weight loss while taking Linzess. However, Dr. Bonza says this isn’t quite the case. “While patients may claim to lose some weight, it’s due to fluid shifts from diarrhea, so what they are actually losing is water weight,” she says. “It is not a weight loss medication.”

More serious side effects include:

• Unusual or severe abdominal pain
• Black sticky or bright red stools
• Severe diarrhea
• Dizziness or fainting spells
• Severe allergic reactions, including hives, rash, itching, swelling of the lips, throat, or tongue, shortness of breath, or difficulty breathing
• Fast heartbeat
• Extreme thirst
• Dry mouth or skin
• Sunken eyes

If you experience any of these symptoms, seek immediate evaluation with your healthcare provider or at the emergency room.

Linzess 290 mcg is very effective in treating symptoms of IBS-C. A randomized, double-blind, placebo-controlled trial found that a daily dose of Linzess 290 over 26 weeks significantly reduced abdominal and bowel symptoms associated with the chronic condition.

Another randomized, double-blind, placebo-controlled trial had similar results, with patients with IBS-C reporting less abdominal pain and discomfort after taking 290 mcg of Linzess daily for 12 weeks.

Linzess 145 mcg vs. 290 mcg

While there’s currently no research that compares the different strengths, Linzess 145 mcg is prescribed to treat chronic idiopathic constipation (CIC), while Linzess 290 mcg is prescribed for IBS-C. CIC is a long-term constipation that is not caused by an underlying medical condition. While some people may be able to take the lower dose of 72 mcg to treat CIC, those with IBS-C must take the highest or maximum dose of the anti-constipation medication—290 mcg—to relieve symptoms. It is the only recommended dose to treat IBS-C. 

If you have questions or concerns about the best dose of Linzess for your symptoms, please consult your healthcare provider. 

How to take Linzess 290 mcg

Follow your healthcare provider’s instructions when taking Linzess 290 mcg to get the best results.

Below are some tips and best practices for taking Linzess 290 mcg:

• Take pill on empty stomach with bottled water: “I advise my patients to take it on an empty stomach, at least 30 minutes before the first meal,” Dr. Bonza says. If you take the medication with food—particularly fatty or greasy foods—you may increase the risk of gastrointestinal (GI) side effects, such as gas, abdominal pain, and diarrhea. If you have trouble swallowing the capsule, you can take it apart and mix the drug with a teaspoon of applesauce.
• Don’t alter the medication: “I encourage taking the medication as it is, and that there is no need for crushing or chewing the pill,” Dr. Bonza says. Exceptions apply if you have a nasogastric feeding tube, as Linzess capsules can be administered by emptying their contents into the tubing.
• Avoid double-dosing: If you miss a dose, it’s best to skip it and take the next dose at the regular time. Don’t double-up on pills to make up for the missed dose.
• Monitor your symptoms: Keep track of your IBS-C symptoms while taking Linzess. If you’re not seeing any improvement, notify your healthcare provider. A benefit of Linzess is that no tapering (process of medication withdrawal) is required. “It can be stopped if not tolerated (e.g., having diarrhea or more than three watery loose bowel movements in 24 hours),” Dr. Bonza says. 
• Prepare for possible side effects: As previously mentioned, Linzess may cause side effects, such as bloating, diarrhea, gas, and stomach pain. While these are typical, if you experience allergic reactions or other severe side effects, please notify your healthcare provider or seek immediate medical attention if it’s an emergency.
• Store Linzess capsules properly: They should be stored at room temperature, in a tightly closed original prescription bottle, and in a dry place. Keep the dessicant (drying agent) packet in the bottle.
• Be aware of drug interactions or contraindications: Medications like anticholinergics and antidiarrheals may decrease the effectiveness of Linzess. Breastfeeding, pregnancy, GI obstruction, hypersensitivity to active ingredients, and children under 2 years of age are contraindications for the prescription drug.

“It’s important to know that the results aren’t instant,” Dr. Khokhar says. “Taking it daily results in the best overall impact.”

Because Linzess 290 mcg is the only dose for IBS-C, you won’t need to titrate or gradually adjust your dose over time.

When you pick up your prescription from the pharmacy, you should receive a Medication Guide (MedGuide), which provides instructions on how to take Linzess 290 mcg. If you still have questions about how and when to take Linzess, please consult your pharmacist or healthcare provider for medical advice.

How much does Linzess 290 mcg cost?

If you don’t have insurance or are underinsured, Linzess can cost about $750 per month for 30 capsules. With a SingleCare coupon, you could get the anti-constipation medication for as low as $515 per 30, 290 mcg capsules.

According to the drug’s manufacturer, AbbVie, 98% of Americans with commercial insurance are covered for Linzess, with many patients paying only $30 for a 30-day, 60-day, or 90-day prescription. Medicaid recipients may receive 100% coverage for Linzess, with typical out-of-pocket costs ranging from $0 to $10 per month. Approximately 84% of Medicare Part D beneficiaries pay $0 to $50 per month for their prescription. 

While most commercial and federal health insurance plans cover Linzess, processes such as prior authorization are typically required by insurance companies. “They usually want to see documentation of previously failed therapies,” Dr. Khokhar says. “Be sure to tell your doctor everything you’ve tried.”

Prior authorization is a health insurance company’s approval process that’s required before covering certain medications, medical services, treatments, or equipment. This process helps insurers determine whether a treatment is medically necessary, safe, and cost-effective. 

If you need assistance paying for Linzess 290 mcg, AbbVie’s myAbbVie Assist Program is available to people who are uninsured, underinsured, or have coverage through Medicare. If you are eligible, you may be able to receive the medication at no cost.

You can also consult your healthcare provider to explore other savings options on Linzess 290 mcg. 

Linzess 290 mcg alternatives

If you’re unable to get coverage for Linzess 290 mcg or can’t tolerate the dosage strength, you and your healthcare provider can explore alternative options for treating IBS-C, including:

• Amitiza (lubiprostone): A chloride channel activator approved to treat IBS-C in women 18 years and older. 
• Israel (tenapanor): A sodium/hydrogen exchanger 3 (NHE3) inhibitor that treats IBS-C in adults. 
• Trulance (plecanatide): A guanylate cyclase-C agonist approved to treat IBS-C in adults, but is unsafe for pediatric patients under 6 years of age due to the serious risk of dehydration.

Because there’s no need to taper off Linzess, once you and your healthcare provider decide on an alternative, you can easily switch over without experiencing any adverse reactions.

“I advise going back to your provider and communicating the side effects you feel so you can be given alternatives,” Dr. Bonza says. “The choice depends on tolerance and insurance coverage.”