Linzess pros and cons: Is it right for you?

In this article:

• How Linzess works
• Benefits of Linzess
• Drawbacks of Linzess
• Why is Linzess dangerous for certain patients?
• Who is Linzess best for?
• Who should avoid Linzess or use it with caution?
• Tips for patients considering Linzess

In this article

• How Linzess works
• Benefits of Linzess
• Drawbacks of Linzess
• Why is Linzess dangerous for certain patients?
• Who is Linzess best for?
• Who should avoid Linzess or use it with caution?
• Tips for patients considering Linzess

Constipation affects almost everyone from time to time, but what happens when it becomes chronic and starts to impact your quality of life? That’s when your healthcare provider might talk to you about Linzess (linaclotide). This brand-name prescription medication is approved to treat adults who have irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). It is also approved to treat functional constipation (FC) in children ages 6–17. Linzess is considered safe and effective, but there are side effects and risks. It’s essential to discuss the pros and cons of Linzess with your prescriber before starting this constipation treatment. 

How Linzess works

Linzess relieves constipation by helping the body have more frequent and complete bowel movements, but it works differently from conventional laxatives. 

Linaclotide, the active ingredient in Linzess, activates cell receptors that stimulate intestinal fluid secretion, thus softening stool and lubricating the intestine for easier passage. This relieves constipation itself, as well as the associated abdominal pain and pressure. In animal studies, linaclotide also slowed pain-sensing nerve activity in the intestines—but that effect hasn’t been proven in humans. 

 

Benefits of Linzess

The main benefit of Linzess is that it offers relief for many people with chronic constipation. “Linzess is approved for adults with IBS-C or chronic idiopathic constipation who haven’t responded to diet changes, fiber, or over-the-counter options,” says Supriya Rao, MD, a quadruple board-certified physician in internal medicine, gastroenterology, obesity medicine, and lifestyle medicine. 

Specific Linzess benefits include:

• Faster, more frequent bowel movements: A more lubricated intestine helps stool move more smoothly and quickly through the gastrointestinal (GI) tract.
• Improved stool consistency: People with constipation often have lumpy or hard stools. By increasing intestinal fluid secretion, Linzess can help soften stool consistency.
• More comfortable bowel movements: With a lubricated intestine and softer stool, bowel movements become less strained.
• Reduced abdominal pain: More frequent bowel movements can alleviate painful abdominal bloating, and Linzess might even directly relieve this pain by suppressing intestinal pain signals. 
• Convenience: Linzess is a once-daily oral medication, which may be more convenient and comfortable than enemas, topical lubricants, or bulk-forming laxatives that must be mixed with water.
• No risk of addiction: Linzess is not habit-forming, so if necessary, this medication can be discontinued without fear of withdrawal symptoms (though constipation may return). 
• May be safe while pregnant or breastfeeding: It is critical to discuss this with your personal healthcare provider before continuing any Linzess dosage while pregnant or nursing. There may be safer options to treat constipation during pregnancy. Limited data suggest that Linzess is likely safe to take while breastfeeding. Your healthcare provider will help you weigh the risks and benefits of taking Linzess during pregnancy or breastfeeding.

It’s important to understand that Linzess is only beneficial for people experiencing chronic constipation. It is not intended to relieve occasional constipation, and it is not recommended for IBS with diarrhea.

RELATED: How long does it take Linzess to work?

Drawbacks of Linzess

Linzess is not right for everyone. These are the Linzess drawbacks to consider:

• Side effects: Common Linzess side effects include diarrhea, stomach pain, bloating, gas, and headaches. Serious side effects such as allergic reaction, severe diarrhea, and dehydration are signs that the medication should be discontinued. Seek medical attention if you are experiencing severe side effects from Linzess.
• Long-term commitment: Linzess is not a cure for constipation. It is effective when taken as directed; however, symptoms may return after missed doses or if Linzess is discontinued.
• Not suitable for everyone: Linzess is not intended to treat chronic constipation in children under 6 years of age. The prescribing information also warns against use in people with gastrointestinal obstructions, such as bowel blockages.

Talk to your healthcare provider about the risks versus benefits of Linzess before starting this medication. While it is an effective treatment for chronic constipation, it isn’t the best choice for everyone.

Why is Linzess dangerous for certain patients?

Linzess has a boxed warning (the strongest warning required by the FDA) for a risk of serious dehydration in patients ages 2 years and younger. It can also cause severe diarrhea, which leads to dehydration, in adolescents and adults. 

It’s important to know that the FDA has deemed Linzess safe when taken as indicated. Be aware of the risk of dehydration and monitor for signs, such as thirst, dry lips, and decreased urination frequency. Stop the medication immediately and seek personalized medical advice if severe diarrhea occurs. 

RELATED: Linzess alternatives

Who is Linzess best for?

Linzess is best for adults with IBS-C or CIC who haven’t found relief with lifestyle changes or over-the-counter constipation treatments. Dr. Rao suggests that, whenever possible, lifestyle interventions should be attempted first. 

Linzess might be right for you if you have tried diet changes, fiber supplements, and OTC treatments and are still experiencing difficult and infrequent (three or fewer times per week) bowel movements.

Who should avoid Linzess or use it with caution?

The following groups should completely avoid Linzess:

• Patients with an allergy to linaclotide, the active ingredient in Linzess
• Children ages 2 years and under
• Patients with intestinal or bowel blockages 

And patients in these groups should use Linzess with extra caution:

• Patients taking other constipation medications (in case of drug interactions)
• Patients with an increased risk of dehydration
• Patients with an increased risk of diarrhea
• Patients with cognitive impairment who might not recognize early signs of dehydration

Only a healthcare provider familiar with your full medical history, medical conditions, and other medications can determine whether it is safe for you to take Linzess.

Tips for patients considering Linzess

If you are considering Linzess, it may be helpful to know that there are ways to make Linzess more tolerable and reduce the risk of serious side effects such as severe diarrhea and dehydration. 

Follow dosage instructions

Linzess is available in 72 microgram (mcg), 145 mcg, or 290 mcg capsules. If possible, you should swallow your daily dose of Linzess whole and chase it down with water. 

“Linzess is best taken first thing in the morning, on an empty stomach, with a full glass of water,” Dr. Rao says. She emphasizes the importance of taking it at the same time each day and explains that taking Linzess with food can cause diarrhea and cramping in some patients.

The Linzess medication guide includes special instructions for patients who have trouble swallowing meds and for those with a feeding tube. When a patient is unable to swallow, the Linzess capsule can be opened and the contents (tiny beads) can be poured into one teaspoon of room-temperature applesauce or 1 ounce of water, then immediately swallowed. 

Stay hydrated

Linzess can cause dehydration, so it’s important to drink enough fluids while on this prescription drug.

“Water recommendations—historically, the ‘golden rule’ of six to eight cups per day for adults—have been more recently updated to nine cups per day for women and 13 cups per day for men,” says Maureen Ashbarry, RD, LD, CDN, a registered dietitian in New York. She adds that water, orange juice, electrolyte sports drinks, and even bone broth can all help replace fluids lost from diarrhea. “Electrolyte packets may be needed to help stay hydrated,” Dr. Rao says. 

Monitor for dehydration

Your body can become dehydrated from severe diarrhea, even if you are drinking plenty of water. Anyone taking Linzess (or their caregiver) should stay vigilant for signs of dehydration.

Dr. Rao and Ashbarry recommend watching out for these red flags:

• Frequent thirst
• Lightheadedness after standing
• Urinating less frequently than usual
• Dark-colored urine
• Dry mouth that doesn’t improve with sips of water
• General weakness 
• Confusion or dizziness
• Low blood pressure and changes in heart rate

Tell a healthcare professional if you or someone you’re caring for starts showing signs of dehydration while taking Linzess. 

Try the BRAT diet

Ashbarry recommends temporarily eating a BRAT (bananas, rice, applesauce, and toast) diet to manage gastrointestinal side effects from Linzess. On the other hand, she suggests avoiding fried, fatty, or greasy food, which can aggravate diarrhea. 

RELATED: 5 ways to save money on Linzess

Bottom line

Linzess is an effective treatment for chronic constipation. It can significantly improve the quality of life for people with IBS-C or CIC. However, it should only be taken if adequate diet and lifestyle changes have been tried first. Dr. Rao also emphasizes the importance of discussing Linzess’ pros and cons with your healthcare provider. 

Starting Linzess comes with an increased risk of severe diarrhea that leads to dehydration. Fortunately, this may be preventable. “The most important nutrition point I advise my patients who are starting Linzess and shifting from managing constipation to managing diarrhea is to continue, continue, continue drinking plenty of water,” Ashbarry says.