What to know about Linzess and coffee

In this article:

• Linzess and coffee
• Coffee and other IBD meds
• Best practices for taking Linzess
• The bottom line

In this article

• Linzess and coffee
• Coffee and other IBD meds
• Best practices for taking Linzess
• The bottom line

Tens of millions of people start their day with coffee without a second thought—many even find it difficult to have any thoughts at all before their first cup. But if you’re taking prescription drugs on a regular basis, such as Linzess (the brand name for linaclotide), you may be wondering if you need to rethink your morning joe.

“Linzess is an oral medication that is approved by the Food and Drug Administration for the treatment of irritable bowel syndrome with constipation (IBS-C) as well as chronic idiopathic constipation (CIC),” says Robert Isfort, MD, a gastroenterologist with Gastro Health in Cincinnati, OH. Linzess pulls more electrolyte sodium and water into the intestines, which softens stool, allowing for more regular and complete bowel movements.

Fortunately for coffee drinkers taking Linzess, there is no interaction between Linzess and coffee; it’s totally safe to drink. Here, we’ll explain why this is the case, plus share more about coffee and IBS symptoms.

Can you drink coffee with Linzess?

“You can drink coffee and other forms of caffeine while taking Linzess,” Dr. Isfort says. “There are no direct interactions between caffeine and this medicine.” In fact, the medication tends to keep to itself in your intestine. “Linzess is relatively unique in that it is minimally absorbed into systemic circulation, mostly staying within the GI tract where it exerts its effect,” explains Aaron Emmel, Pharm.D., founder and program director at Pharmacy Tech Scholar, an online education service for pharmacists. “This means that the potential for drug-drug and drug-nutrient interactions is low.”

For this reason, our experts recommend following the FDA’s general guidelines on caffeine consumption if you’re taking Linzess: stick below 400 milligrams of caffeine (or roughly two to three 12-ounce cups of coffee) per day.

While Linzess and caffeine don’t interact directly, they could combine to increase the likelihood of severe diarrhea, abdominal pain, and bloating. Linzess treats IBS-C, or IBS, with constipation (as opposed to IBS-D, or IBS with diarrhea), but one of the most common side effects is diarrhea. “In patients who develop diarrhea as a side effect of Linzess, coffee and other caffeine-containing drinks could increase the amount of diarrhea or loose stools,” says Dr. Isfort. “Coffee increases the movement of the digestive system, which is called peristalsis.” While this can treat constipation by increasing motility (making you poop), it can also worsen diarrhea and stomach pain.

Indeed, a 2021 study published in Frontiers in Nutrition found that coffee drinkers were more likely to have IBS than non-coffee drinkers, and those who had the highest coffee intake (over 107 milligrams per day) were 47% more likely to have IBS than those with the lowest intake (less than 69 milligrams per day). “Patients should trial limiting caffeine to see if it is associated with improvement in symptoms,” suggests Dr. Emmel. “This is especially true for patients with IBS-D.”

The bottom line: A cup of coffee or caffeine will not directly influence how effective Linzess is at treating your IBS, but it does have the ability to worsen your symptoms on its own.

Does coffee interact with other IBS medications?

“Most medications used for irritable bowel syndrome will not have a direct interaction with coffee or other forms of caffeine,” says Dr. Isfort. So even if you’re taking caffeine pills, you should be okay. Besides Linzess, Trulance (the brand name for plecanatide) works the same way to treat IBS-C and CIC and has a very low risk of drug or food interactions. The same goes for Amitiza (the brand name for lubiprostone), another common IBS medication. Ibsrela (the brand name for tenapanor), also used to treat IBS-C, works via a different mechanism but is also very minimally absorbed and, therefore, has a very low risk of interactions.

But when you’re looking at all the different types of IBS medication, there are a few exceptions. “Lotronex (alosetron) is a medication used to treat severe IBS with diarrhea symptoms; this medication has a significant interaction with caffeine, and the combination should be avoided,” notes Dr. Emmel. Caffeine can increase the levels of alosetron in the blood, increasing your risk of serious side effects. “Hyoscyamine is an antispasmodic that may increase the risk of increased heart rate when used with caffeine,” Dr. Emmel adds.

Check with your healthcare provider before using over-the-counter laxatives like MiraLax or probiotics with Linzess.

Best practices for taking Linzess

To ensure that Linzess is working for you, Dr. Isfort recommends the following best practices:

• Take Linzess on an empty stomach. “Linzess is best taken in the morning, about 30 minutes before eating breakfast,” says Dr. Isfort. “Taking the medication on an empty stomach helps to prevent the unwanted side effects of diarrhea.” Your best bet is to take it before your first meal of the day with a full glass of water.
• If you forget to take it, go low-fat. “If Linzess is taken after eating a meal, particularly a meal high in fat, diarrhea is more common,” Dr. Isfort says. So if you do forget to take the medicine before you eat, keep your meal low in fat to avoid side effects.
• Give it time. Linzess isn’t going to cure your IBS right away. “When starting Linzess, many patients will experience mild diarrhea or softer stools for 1 to 2 weeks,” Dr. Isfort explains. “As the body gets used to the effect of the medication, the loose or more frequent stools typically stop.”

The bottom line

Linzess does not directly interact with caffeine, so you don’t need to give up your coffee habit if your healthcare provider prescribes the medication. That said, caffeine can make diarrhea worse, so if you’re experiencing diarrhea as a side effect of Linzess (it is the most common one, especially in the first couple weeks of taking the drug), it may be more severe if you are also drinking a lot of coffee. However, as with any medical condition and prescription, every person is different. The best way to determine the IBS treatment that will work best for you is to seek medical advice from your healthcare provider to create an optimized, personalized plan.