Trulance vs. Linzess: Which constipation medication works best?

In this article:

• Key differences
• Conditions treated
• Side effects
• Interactions and warnings

In this article

• Key differences
• Conditions treated
• Side effects
• Interactions and warnings

Trulance (plecanatide) and Linzess (linaclotide) are two drugs that can be used for the treatment of irritable bowel syndrome with constipation (IBS-C). Both of these drugs promote bowel movements 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 stool. Due to their mode of action, the primary side effect of each medication is diarrhea, which is typically more frequent with Linzess.

Trulance and Linzess are also indicated in the treatment of chronic idiopathic constipation (CIC). This type of constipation has no known cause. Trulance and Linzess may sometimes be used off-label in the treatment of opioid-induced constipation (OIC) caused by drugs like morphine. 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 ag,e and they are also not recommended for anyone younger than 18 years of age. 

Both Linzess and Trulance can be quite expensive if not covered by insurance, which is usually the case. Read on to learn more about each medication and how you can lower the cost of each using SingleCare coupon cards.

 Trulance vs. Linzess: Which is better?

Trulance is a newer drug compared to Linzess, with Linzess being FDA approved in 2012 and Trulance in 2017. However, the efficacy of both of these medications is more or less equal.

Improvement in the frequency of bowel movements is observed as early as 1 week, followed by a sustained long-term effect. Along with an increased frequency of bowel movements, these medications also improve the quality of the stool, including the stool texture and consistency. They can also improve abdominal pain as a secondary effect.

The effectiveness of Trulance in one clinical trial was found to be more pronounced in the treatment of chronic idiopathic constipation. Compared to a placebo, Trulance was also shown to be effective in treating irritable bowel syndrome with constipation.

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 healthcare provider. After a comprehensive evaluation, the doctor will prescribe the most suitable medication tailored to an individual’s overall condition.

Trulance vs. Linzess: Insurance coverage and cost comparison

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 many private insurance plans may not cover Trulance. The average cash price of Trulance can be over $500. Using a SingleCare discount card may help lower the cost to under $400. While it is still an expensive drug, using a discount card can help lower the price when insurance does not 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 of more than $500. Fortunately, some Medicare and private insurance plans may cover it. Even with insurance, you can save more with a SingleCare discount card, which can reduce the cost to around $400.

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 how they work, these drugs primarily cause gastrointestinal side effects. According to their FDA drug labels, Trulance may have fewer common side effects compared to Linzess. In studies, diarrhea occurred in 20% of patients taking Linzess and 5% in patients taking Trulance. Abdominal pain occurred in 7% of patients taking Linzess, and less than 2% of patients taking Trulance. Bloating and flatulence occurred in 2% and 4% of Linzess users, respectively, while each occurred in less than 2% of patients taking Trulance. Headache did not occur in patients taking Trulance, but did occur in 4% of Linzess users. Source: DailyMed (Trulance), DailyMed (Linzess)

In addition to diarrhea, Linzess and Trulance can cause other common side effects, including bloating, flatulence, and abdominal pain.

In rare cases, Trulance and Linzess can cause severe diarrhea. In these cases, your healthcare provider will recommend the immediate discontinuation of the drug. In children, these medications may cause severe dehydration. Therefore, they are not recommended in children and, in fact, both drugs have a black box warning to avoid use in pediatric patients. 

Trulance vs. Linzess interactions and warnings

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. 

Trulance and Linzess have not been studied in women who are pregnant or breastfeeding. They should only be used in pregnancy after evaluating the potential risks vs benefits, and only after discussing this with your doctor. 

Those with gastrointestinal blockage (obstruction) should avoid taking Trulance or Linzess. 

There are 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. 

While both Trulance and Linzess can be very effective for patients with IBS with constipation and chronic idiopathic constipation, their use should be monitored by your prescribing provider. Always check with your healthcare provider to determine the best treatment for you and your specific symptoms and conditions.