Trulance vs. Linzess: Similarities and Differences

Medically reviewed by Lindsay Cook, PharmD

Trulance (plecanatide) and Linzess (linaclotide) are orally administered prescription medications used to treat gastrointestinal (GI) disorders that cause constipation, including irritable bowel syndrome with constipation (IBS-C) and CIC (chronic idiopathic constipation).

Both drugs are classified as guanylate cyclase-C agonists. Linzess capsules and Trulance tablets are available only as brand-name products.

The Food and Drug Administration (FDA) has approved Trulance to treat IBS-C and CIC. Conversely, Linzess is approved for the same uses but is also approved to treat functional constipation (FC) in children and adolescents 6-17 years old.

These two drugs are similar but are taken a little differently. Linzess must be taken on an empty stomach 30 minutes before a meal. Trulance can be taken any time of day, with or without food.

This article will discuss how each drug works, whether one works better, and what the similarities and differences are.

Understanding IBS & Constipation

IBS and CIC are both functional GI disorders, or FGDs, meaning that diagnostic tests don’t show visible signs of abnormality, but symptoms the individual is experiencing indicate a problem.

More specifically, IBS is a GI disorder with symptoms including abdominal pain and cramping, bloating, constipation, and/or diarrhea.

In comparison, IBS-C is a subtype of IBS, where more than a quarter of bowel movements are hard and lumpy, and less than a quarter are loose or watery, like diarrhea.

CIC is also known as functional constipation. With this condition, abdominal pain may still occur, but it is not frequent or severe, whereas it is the predominant complaint in those with IBS-C.

This pain is the main symptom that sets CIC and IBS-C apart. Otherwise, symptoms are relatively similar between the two conditions.

Causes

Experts are still determining exactly what causes IBS. It is most likely a combination of risk factors, including bacterial overgrowth in the small intestine, other health conditions, such as food intolerances or mental health disorders and genetics.

CIC is similarly poorly understood–in fact, the very word “idiopathic” in CIC indicates that the cause is poorly understood or not understood.

Theories about causes include a diet with reduced fluid or fiber intake, changes in water balance, or changes in colon muscle movements.

Among constipated people with either of these disorders, general health, mental health, and social functioning are worse than in those without GI disorders.

Unfortunately, neither condition has a cure yet, but both can be managed with diet and lifestyle changes alongside relevant medications.

What Is Trulance?

The FDA approves Trulance to treat both IBS-C and CIC. It is a guanylate cyclase-C agonist and comes as a tablet taken by mouth.

Currently, Trulance is only approved to treat adults.

It can be taken at any time during the day, with or without food.

Trulance is currently the only product in the United States with the active ingredient plecanatide. Therefore, no generic alternatives exist.

Sometimes, Trulance may be used off-label (a use for which the drug was not originally FDA-approved) for constipation in children between the ages of 6-18 years old, but this should generally be avoided due to the risk of dehydration.

Due to this risk, it should never be used in children younger than 6 years old.

How Does Trulance Work?

Trulance works by mimicking the action of a peptide called uroguanylin that naturally occurs in the body.

This substance helps control the amount of fluid in your gut. Trulance mimics uroguanylin, which causes the release of more fluid into your gut, leading to softer stools and more bowel movements.

It also helps move food through your GI tract.

Trulance may start to work in as little as a week with correct daily use, but seeing the full benefits of the drug may take closer to six to 12 weeks.

Off-Label Uses

Sometimes, Trulance may be used off-label (a use for which the drug was not originally FDA-approved) for constipation in children between the ages of 6-18, but this should generally be avoided due to the risk of dehydration.

Due to this risk, it should never be used in children younger than 6 years old.

What Is Linzess?

Linzess is another guanylate cyclase-C agonist administered as a capsule taken orally. Like Trulance, Linzess is approved to treat IBS-C and CIC.

In 2023, Linzess became the first drug approved by the FDA to treat pediatric functional constipation in children and adolescents 6-17 years old.

It is usually taken once a day on an empty stomach, at least 30 minutes before a meal.

This drug should never be used in children younger than 2 years old due to the risk of dehydration.

Linzess is the only product in the United States with the ingredient linaclotide. Therefore, no generic alternatives exist.

How Does Linzess Work?

Like Trulance, Linzess mimics naturally occurring peptides that act on GI cells and cause the release of more fluid into the gut, softening stools and making them easier to pass.

It may also help with pain by reducing the sensitivity of pain-sensing nerves.

Like Trulance, it may start working as soon as a week after you begin taking it.

Maximum effects, however, may take around six to nine weeks following correct daily use.

Off-Label Uses

In an off-label setting, Linzess has been used for people diagnosed with obesity or eating disorders (ED) as a laxative.

Dosing Guidelines

This table summarizes the differences and similarities regarding how Trulance and Linzess are dosed:

Taking Trulance or Linzess

The primary difference between consuming these medications is that Linzess must be taken on an empty stomach, at least 30 minutes before a meal, at approximately the same time each day.

Trulance, however, can be taken with or without food at any time, ideally still around the same time each day.

Linzess capsules and Trulance tablets should be swallowed whole, not crushed or chewed, whenever possible.

Furthermore, both drugs can be taken via nasogastric or gastrostomy tubes or mixed with applesauce or water in people with difficulty swallowing pills.

Alternative Forms of Administration

The following outlines alternative methods of consumption for Trulance and Linzess for those who struggle to swallow oral drugs, such as tablets or capsules:

To give in applesauce:

1. Place one teaspoonful of room-temperature applesauce into a clean container.

2. Open the Linzess capsule or crush the Trulance tablet to a powder.

3. Sprinkle the entire contents onto the applesauce.

4. Consume the entire contents immediately. Do not store the applesauce mixture for later use.

To give in water:

1. Pour approximately 30 milliliters (mL) of room-temperature bottled water into a clean cup.

2. Open the Linzess capsule or crush the Trulance tablet to a powder.

3. Sprinkle the entire contents into the water.

4. Gently swirl to mix for at least 20 seconds.

5. Swallow the entire mixture immediately.

6. Add another 30 mL of water to any medication remaining in the cup, swirl for 20 seconds, and swallow immediately.

7. Do not store the mixture for later use.

To give via nasogastric or gastrostomy tube:

1. Open the Linzess capsule, crush the Trulance tablet to a powder, and empty it into a clean container with 30 mL of room-temperature bottled water.

2. Mix by gently swirling for at least 20 seconds.

3. Draw up the mixture into an appropriately sized syringe and quickly dispense the syringe contents into the tube at about 1 milliliter per second.

4. Add another 30 mL of water to any medication remaining in the container and repeat the process.

5. After administering the mixture, flush the tube with 10 mL of water.

Comparing Efficacy

One study compared the results of eight Linzess and seven Trulance trials for treating IBS-C and CIC. Over 10,000 people were included in these 15 trials:

Both drugs were effective for CIC and IBS-C.

In treating IBS-C, effectiveness was measured by the reported improvement in abdominal pain combined with increased bowel movements.

People taking Linzess (290-mcg form) were about twice as likely to report improvements as those taking placebo. Trulance (3-mg form) or Trulance (6-mg form) were about twice as likely to report improvements as those taking placebo.

In treating CIC, effectiveness was measured by a reported number of increased bowel movements per week for most weeks of the trial.

People taking Linzess (72-mcg form) or Linzess (145-mcg form) were about three times more likely to report these improvements than those taking a placebo.

People taking Trulance (3-mg form) were twice as likely to report improvements.

Diarrhea was also more likely in those people taking Linzess or Trulance compared to those taking placebo.

Takeaways

The meta-analysis mentioned above did not conclude any statistically significant differences in effectiveness between Linzess and Trulance.

They work about the same to treat IBS-C and CIC and are similar in tolerability and side effects.

Overall, know that the choice between these two drugs will likely come down to discussing preference and insurance coverage with your healthcare provider.

Alternative Treatment Options

Although medications can play a significant role in treating IBS and CIC, diet and lifestyle modifications will likely be necessary as well to control the disorders truly and prevent flare-ups as much as possible.

Some lifestyle changes that can be made to help control these disorders and relieve constipation include:

• Quit smoking, as tobacco is known to irritate the digestive tract and cause bloating, cramping, and gas.

• Stay hydrated, as maintaining plenty of fluids in your gut keeps stools softer and more accessible to pass and also helps replace lost fluids from any diarrhea you may experience.

• Exercise as regularly as possible since this may help relieve constipation.

• Avoid typical trigger foods and drinks, such as fried and fatty foods, carbonated beverages, processed foods containing sugar or fat substitutes, and alcohol.

Side Effects and Safety

Like all drugs, Trulance and Linzess carry the potential for adverse effects.

Therefore, be sure to monitor yourself closely for the emergence of side effects that worsen over time or fail to dissipate.

The following lists the side effects associated with Trulance and Linzess.

Trulance Side Effects

Trulance may cause side effects.

Tell your healthcare provider if any of these symptoms are severe or do not go away:

• Stomach bloating

• Gas

• Mild diarrhea

• Nausea

• Dizziness

Linzess Side Effects

Similarly, Linzess may cause side effects.

Tell your healthcare provider if any of these symptoms are severe or do not go away:

• Diarrhea

• Stomach pain

• Swelling or feeling of fullness or pressure in the stomach area

• Gas

• Headache

Potential for Interaction

After you take Linzess or Trulance, a minimal amount of drug-based ingredients enter your bloodstream.

Linzess and Trulance also do not interact with cytochrome P450 inducers or substrates, enzymes responsible for many drug interactions.

Even so, ensuring your healthcare provider and pharmacist know all the medications and supplements you take is a good idea.

Summary

Trulance and Linzess are two orally administered, brand-name medications classified as guanylate cyclase-C agonists.

Both treat IBS-C and CIC by causing the release of more fluid into your gut, making stools softer and easier to pass. They may also help with abdominal pain by reducing the sensitivity of pain-sensing nerves.

Trulance is a tablet that can be taken once daily with or without food, whereas Linzess is a tablet that must be taken on an empty stomach at least 30 minutes before a meal.

While both products are generally seen as similar, they carry some notable differences relating to dosing requirements, forms of administration, some differences in potential side effects, FDA-approved uses, and active ingredients.

Both are effective in treating constipation caused by IBS-C or CIC, but neither shows significantly better results than the other.

Speak with your healthcare provider to decide which options may be better for you based on their experience, drug administration, and insurance coverage.

Frequently Asked Questions

How do I store Linzess or Trulance?

Store Trulance or Linzess at room temperature (68-77 F) in their original containers, in a dry place, and away from areas susceptible to high levels of moisture or humidity, such as a bathroom.

Additionally, keep either drug out of reach of pets or children, if applicable.

Do Trulance or Linzess cause dehydration in children?

Both of these medications have the potential to cause dehydration, especially in young children.

They work by increasing the release of fluid into the gut, which makes stools softer and more accessible to pass but also leaves your body with less fluid.

Young children are more at risk of dehydration from this because the drugs cause more fluid secretion in their bodies than they would in adults or older children.

Linzess has undergone enough testing to be approved for use in children as young as 6, whereas Trulance is only approved for use in adults.

What is the prevalence of IBS within the United States

It is estimated that 10–15% of adults in the United States have IBS.

Read the original article on Verywell Health.