Linzess (linaclotide) is a medication prescribed for adult patients suffering from irritable bowel syndrome with constipation and chronic idiopathic constipation. This FDA-approved drug belongs to the guanylate cyclase-C Agonists class, which acts locally in the intestine.

About 7%–20% of Americans suffer from gastrointestinal disorders, including chronic idiopathic constipation and irritable bowel syndrome with constipation. The two disorders lead to unpleasant symptoms, like abdominal discomfort, bloating, and constipation, which can significantly affect a person’s quality of life.

Lifestyle and dietary changes may help. However, medications are often needed to relieve symptoms. One such medication is Linzess (linaclotide), an FDA-approved prescription treatment for both IBS-C and chronic idiopathic constipation in adults.

Chronic idiopathic constipation (CIC) involves infrequent bowel movements, hard stools, straining, bloating, and abdominal discomfort. Irritable bowel syndrome with constipation (IBS-C) causes similar symptoms, alternating constipation and diarrhea. For patients with CIC or IBS-C, Linzess increases stool frequency and improves consistency. It also reduces abdominal pain and bloating.

How Does It Work?

Linzess drug works by activating guanylate cyclase-C receptors on intestinal epithelial cells. This increases the production of cyclic GMP, a signaling molecule that stimulates the secretion of chloride, bicarbonate, and water into the intestinal lumen. The increased fluid in the intestines softens stools, improves motility, and eases bowel movements.

Linzess also reduces pain and discomfort by decreasing the activity of visceral nerves in the gut. Unlike laxatives, which induce bowel movements through irritation, Linzess alleviates constipation by normalizing bowel function.

Preparation and Administration Instructions

It is essential to follow the instructions provided by your physician when taking Linzess. Here are step-by-step instructions for taking Linzess properly, including different administration options:

  • It’s advisable to take Linzess on an empty stomach for at least 30 minutes before consuming your first meal, as taking it with food can decrease its effectiveness.
  • If you miss a dose, skip it and take your following regularly scheduled amount. Do not take two doses simultaneously to make up for a missed one.
  • Do not crush, chew, or open the Linzess capsules. Swallow them whole.

Oral Administration

Adults with swallowing difficulties may open the capsule and take it with either applesauce or water as follows:

With Applesauce

  1. Place one teaspoon of room-temperature applesauce in a clean container.
  2. Open the Linzess capsule.
  3. Sprinkle the beads onto the applesauce. Please don’t chew the beads.
  4. Swallow the entire mixture immediately. Please don’t forget to store this for later use.

With Water

  1. mix the beads in 30 mL cup of clean water after breaking the capsule, preferably at room temperature.
  2. Stir gently for about 20 seconds.
  3. Drink the entire mixture immediately.
  4. If there are any remaining beads, add another 30 mL water, shake, and drink immediately. Please don’t forget to store any mixture for later use.

Administration via Nasogastric or Gastrostomy Tube

  1. Empty the beads from the capsule into a container containing 30 mL of room-temperature water.
  2. Gently swirl to mix for 20 seconds.
  3. Draw the mixture into a catheter-tipped syringe.
  4. Apply steady pressure to dispense contents into the tube.
  5. Repeat the process with 30 mL more water if beads remain.
  6. After administration, flush the tube with at least 10 mL of water.

Precautions

Most patients tolerate Linzess quite well, but there are some precautions and warnings to know before starting this medication. Here are some of them:

  • Dehydration: There’s a severe dehydration risk in children under six. Linzess should not be used in this age group as it may cause dehydration and death due to increased fluid secretion. The use of Linzess in patients aged 6 to 17 is also not recommended as its safety and effectiveness have yet to be established.
  • Diarrhea: In 2% of patients taking 145 and 290 mcg doses of Linzess, this medication can cause severe diarrhea. It’s the most common side effect and can lead to dizziness, fainting, electrolyte abnormalities, and hospitalization requiring IV fluids. If severe diarrhea occurs, stop Linzess and rehydrate.
  • Pregnancy: It is unknown whether Linzess is safe for use during pregnancy or if it will harm an unborn baby. Researchers have done no clinical trials to see what the drug does on a pregnancy. So, consult your doctor if you are pregnant or planning to be pregnant before taking Linzess.  It is uncertain whether it is safe to breastfeed while taking Linzess. However, Linzess does not transfer into breast milk, indicating that a breastfed infant is unlikely to be exposed to the drug. Also, it is unclear whether Linzess impacts the production of breast milk. Therefore, you must consult your doctor before beginning Linzess treatment if you are breastfeeding or planning to do so.
  • Allergies: Linzess may cause allergic reactions in people sensitive to linaclotide or any of the inactive ingredients in the medication. Consult a doctor immediately if you experience an allergic reaction such as rash, hives, swelling, or difficulty breathing.

Warnings

  • Do not use Linzess in patients with a known gastrointestinal obstruction, as it may worsen the condition and cause serious complications.
  • Linzess can cause hematochezia (blood in stool) or rectal bleeding. Notify your doctor if this occurs.
  • Do not take Linzess with food or within 30 minutes of eating, as this may reduce its absorption and effectiveness.
  • Avoid crushing or chewing the capsule or its contents. Ingest the whole tablet to ensure its intended effects.
  • Do not consume alcohol when using Linzess because it can aggravate some side effects, including diarrhea, dehydration, and low blood pressure.
  • Linzess may also interact with drugs that act on the GI tract, such as antacids, laxatives, opioids, and antibiotics. Tell your doctor about all medications you are taking before starting Linzess.

Side Effects

Some people who take Linzess may have side effects. The most frequent adverse event is diarrhea, noted in approximately 20% of the patients with CIC and 16% of patients with IBS-C.

Common Side Effects

Common side effects of taking Linzess include:

  • Abdominal pain
  • Gas
  • Bloating
  • Headache and nausea.

These side effects are usually mild to moderate and decrease over time as the body adjusts to the medication.

Rare but Severe Side Effects

Some rare but serious side effects of Linzess include:

  • Severe diarrhea
  • Dehydration
  • Electrolyte imbalance
  • Low blood pressure
  • Fainting
  • Kidney problems
  • Allergic reactions.

It is best to seek medical attention if you have any adverse side effects. In some cases, discontinuing medication may also be required. Please contact your doctor right away for evaluation and guidance.

Drug Interactions

Many drug interactions with Linzess are possible, especially with medications affecting the GI tract or nutrient absorption. Please always let doctors know of all pills before starting Linzess and follow dosage instructions carefully. Here are some examples of drugs that can have an impact:

  • Antacids: They should be taken at least 4 hours before or after Linzess, as they can neutralize stomach acid needed for Linzess absorption.
  • Laxatives: These increase the risk of diarrhea/dehydration with Linzess. Use laxatives sparingly and only per doctor’s instructions if needed.
  • Opioid Pain Medications: Such medication may counteract Linzess by slowing gut motility. Dose adjustments or alternative pain relief may be required.
  • Antibiotics: Some antibiotics can disrupt intestinal bacteria that Linzess acts upon, so monitor symptoms closely if also taking antibiotics.
  • Oral Contraceptives: Due to reduced absorption, oral contraceptives may be less effective when taken with Linzess. Use backup birth control if taking both.

Dosage and Strengths

Linzess medication has three strengths: 72 mcg, 145 mcg, and 290 mcg. You can take any of the three doses based on the condition you’re treating and how your body responds to the medication. If you experience side effects on the higher strength, your doctor may recommend taking a lower power.

CIC Dosage

Patients with chronic idiopathic constipation are advised to start with an initial dosage of 145mcg once daily. You should take medicine on an empty stomach about 30 minutes before your first meal for best results.

The 145mcg dose is the maximum dosage for treating CIC. Patients who experience side effects from taking the total quantity can take a lower amount of 72mcg, which most patients can tolerate and still get results.

IBS-C Dosage

In the case of irritable bowel syndrome with constipation, the sole FDA-approved dosage is 290 mcg once a day. That’s because a higher dosage strength is necessary to alleviate abdominal pain and discomfort associated with IBS-C.

Just like with CIC dosage, take Linzess 30 minutes before the day’s first meal on an empty stomach. It’s, however, not advised for individuals under 18 or those with a known or suspected bowel obstruction to take this medication.

Linzess Use In Specific Populations

Administering Linzess to pregnant/nursing women, children under 6, and the elderly requires particular caution and monitoring due to insufficient safety data and potential risks. Human studies in pregnancy are lacking despite animal studies showing no fetal harm from Linzess.

Regardless, animal studies do not always predict human response. So only use Linzess during pregnancy if the potential benefits outweigh potential fetal risks and only under close monitoring by your doctors.

Whether Linzess transfers into human breastmilk or impacts breastfed infants or milk production is unknown. Animal studies showed Linzess in rat milk, but human relevance is uncertain. So, please be careful when administering Linzess to nursing mothers.

Linzess is contraindicated in children under six due to the risk of severe dehydration and death seen in animal studies. It is approved to treat functional constipation in ages 6-17 based on adequate controlled trials in adults and children six years and older. The recommended pediatric dosage is 72 mcg orally once daily.

Elderly patients do not require dosage adjustment solely due to age. However, patients above 60 may be more sensitive to diarrhea and require close monitoring for adverse reactions.

Dose adjustments are also unnecessary for patients with mild-moderate hepatic or mild-severe renal impairment. That’s because there are no studies of Linzess pharmacokinetics and safety in severe hepatic impairment.

Cost and Availability of Linzess In America

The cost of lines in the United States is high without insurance coverage. GoodRx reports that a 30-day supply of 145 mcg Linzess capsules costs $502.68 at retail price, without insurance.

However, the company offers coupons to lower costs to around $407 at certain pharmacies. Using insurance, prescription drug plans, and manufacturer co-pay assistance programs can also significantly reduce out-of-pocket expenses, with some eligible patients paying as little as $30 per month.

MyRx Outlet offers affordable Linzess for citizens of the United States through its trusted prescription fulfillment service. Find discounted prices of Linzess through our licensed pharmacies in Canada and the United Kingdom.

Linzess Alternatives

For those finding Linzess too expensive or ineffective, alternatives do exist:

Prescription Medications

You can use prescription medications such as lubiprostone, plecanatide, Resotran, and eluxadoline, but they may work differently than Linzess to treat chronic constipation and IBS-C. Doctors should advise on the pros and cons of these drugs individually.

Over-the-counter Laxatives

You can use over-the-counter laxatives such as bisacodyl, senna, psyllium, polyethylene glycol, and glycerin. These can ease constipation by stimulating bowel movements, making stools softer, or increasing liquid in the intestines.

However, these may not be adequate for Long-term medical use or IBS-C patients and may have side effects such as cramps, bloating, and dehydration.

Diet and Lifestyle Adjustments

Diet and lifestyle adjustments like increased fiber intake, adequate hydration, regular exercise, stress management, and establishment of a bowel routine can help improve bowel function and reduce medication needs. However, these changes take a considerably longer time to work.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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