Hello and welcome back to the Pelvic Empowerment IBS Series!
My name is Tori and I am doctor of physical therapy who specializes in pelvic dysfunction,
which means I treat things that can go wrong
around the pelvis—and this includes bowel dysfunction.
Last year I decided to try my best to unpack what I have learned about IBS in a video series,
and today I want to add a requested eighth installment to that series that investigates
and compares Linzess and Trulance—two drugs that can be used to manage constipation dominant IBS.
In today’s video, we’ll first discuss what these drugs are and how they work, we’ll then
briefly talk about their history, compare prices, and mention drug interactions worth considering,
we’ll then discuss and compare side-effects, and we’ll end by comparing their efficacy.
As always, you can check the description below for timestamps, links to any studies
or resources mentioned in this video, and links to all of the previous videos in this series.
Let’s begin by talking about what Linzess and Trulance are,
and how they work to relieve constipation.
Generally speaking, similar drugs tend to belong to the same class. For example, Aspirin and
Motrin are well known similar drugs. Both drugs are commonly used to relieve pain and reduce
fever. While the main active ingredient in these drugs is different—in Aspirin, the main active
ingredient is acetylsalicylic acid, in Motrin, the main active ingredient is ibuprofen—they both
belong to the same CLASS of drugs—they are both NSAIDs, or nonsteroidal anti-inflammatory drugs.
In the same vein, Linzess and Trulance are similar drugs that belong to the same
class. They have different active ingredients—in Linzess, the active ingredient is linaclotide,
where in Trulance, the active ingredient is plecanatide—but they both belong to
the same class of drugs—they are both guanylate cyclase-C agonists.
So, now we know what Linzess and Trulance are. Linzess is linaclotide,
Trulance is plecanatide, and they are both guanylate cyclase-C agonists—great,
but how do they affect the intestines—how do they work to manage constipation dominant IBS?
Think about what happens in the intestines when we eat and digest food. When you eat food,
it goes into your mouth, down your esophagus, into your stomach, and then into your intestines
before entering your rectum and eventually exiting your anus as a bowel movement.
Let’s imagine the intestines as a singular, muscular tube. In a healthy GI system,
when food enters the intestines, they rhythmically contract and relax to
propel that food and eventually waste or stool though them towards the rectum. This
rhythmic contraction is called peristalsis, and it looks very much like when a snake eats a mouse.
Regular, healthy bowel movements depend on adequate filling of that tube, and a soft
consistency of the food/stool mixture inside of that tube. When the tube is adequately filled, the
stretching of the tube stimulates the intestinal muscles to perform peristalsis. When the tube is
adequately filled with a soft food/stool mixture, those muscles have something easy to “grip” as
they rhythmically contract—resulting in a regular, healthy bowel movement.
However, when someone is constipated, the intestinal muscles are often clenched around
dry, hard, impacted stool. This usually translates to slow transit
time—the muscles aren’t simulated to contract nor do they have something easy to grip, so it
takes a while for the stool to make its way through the intestines—this can also
mean abdominal pain, bloating, and harder bowel movements.
So how do Linzess and Trulance affect the
intestines and help manage constipation dominant IBS?
These drugs essentially accomplish three things in the intestines:
They increase the amount of fluid in the intestines
Which softens the stool in the intestines And speeds up intestinal transit
Think about what adding more fluid to hard dry stool in that singular muscular tube we
imagined earlier would do. That increased fluid would soften, break apart, and push through dry,
hard, impacted stool. It would also take up more space and gently stretch the intestines,
which stimulates peristalsis. And, it would give the intestinal muscles something easier
to “grip” as they contract and relax, resulting in a faster transit time and softer bowel movements.
There are also some animal studies that suggest Linzess and Trulance may
help ease abdominal pain, but this hasn’t been proven in humans yet.
Both of these drugs need to be taken daily—Linzess should be taken on an
empty stomach about 30 minutes before consuming food, and Trulance can be taken
with or without food—and both drugs can take about 1-3 weeks to start working.
Now that we’ve talked about what the drugs are and how they work,
let’s compare the two in terms of history, price,
and drug interaction considerations before finally discussing potential side-effects and efficacy.
Linzess was approved in 2012 as the first guanylate cyclase-C agonist on the market.
Trulance was approved 5 years later in 2017. Both drugs are prescription drugs,
meaning you need a physician to prescribe them to you. There is currently no generic version of
either drug available, which means they are rather expensive and, unfortunately, not usually covered
by insurance. Both drugs usually cost around $500 for a 30 day supply,
although sometimes certain deals and discounts can help get the cost below $400.
It is important to talk with your physician about other medicines that
you are taking—both prescription and OTC—as both drugs, according to the
national library of medicine, have drug interactions that are worth considering.
Linzess can potentially interact with levothyroxine,
which is a thyroid medication, bisacodyl, which is a stimulant laxative, psyllium husk,
a stool bulker and the main ingredient in Metamucil, magnesium hydroxide, which
is found in Milk of Magnesia, and Omeprazole, a proton pump inhibitor used to treat acid-reflux.
Trulance, on the other hand, has only one known drug interaction worth mentioning.
And that is with Idelalisib, which is used to treat certain blood cancers.
It’s also important to be aware of the potential side-effects of these
drugs, so that if you start taking one or the other and notice new symptoms,
you can figure out if those symptoms are because of the drug, and then you
can decide whether or not those side-effects are worth the potential benefits of the drug.
According to the the national library of medicine,
both Linzess and Trulance are known to cause diarrhea—this is most frequently reported
side-effect of both drugs. Some people who experience this side-effect are okay with it,
because diarrhea feels better than constipation to them, others feel the diarrhea is too intense.
Both of these drugs can also cause abdominal pain,
bloating, flatulence, and Linzess has been known to cause headaches in some people.
So, we know how both drugs work. We know that both drugs need to be taken daily, Linzess on
an empty stomach 30 minutes before eating, Trulance with or without food. We know that
they are both comparable in price, and that, while both have drug interactions
worth considering, Linzess has more drug interactions than Trulance. And we also
know that both drugs come with a host of potential side-effects. Let’s finally
consider efficacy and try to answer the question, “which drug is better?”
The literature doesn’t seem to support one drug over the other as being more effective. This
2018 systematic review found that the drugs were similar in both safety and efficacy,
and that there really are no significant differences in the occurrences of side-effects,
such as diarrhea. There are other studies that suggest that Trulance
means less potential for diarrhea, but this review suggests that those studies’ findings
are likely due to a difference in the definition of diarrhea used in their trials.
So, since the literature wasn’t much help in comparing the efficacy of the two drugs,
I turned to online patient reviews, collected both good and bad reviews of each drug,
and pulled out similar experiences in both categories to present for your consideration.
Let’s start with Linzess. Commonalities in good reviews about Linzess include:
that it takes 1-3 weeks for the medicine to start working, and that those 1-3 weeks
can be uncomfortable, but are worth it later that you may need to play with dosage to figure
out what works best for you body that, regardless of the dosage,
whether or not its makes you go can be hit or miss, so being by a bathroom when
you take it in case it words is helpful finally, I’ve read that some people space
out their medicine, and take Linzess every other day or every two days. Others have better success
when they take it at night instead of first thing in the morning. Of course, tweaking the
medication in this way would be something you’d need to discuss with your prescribing physician,
but it may be a helpful option for you as it has seemed to help others
Commonalities bad reviews about Linzess include:
Intense, unpredictable diarrhea that makes keeping a routine challenging
worsening of hemorrhoids due to the diarrhea fatigue as a difficult side-effect,
which wasn’t one of the official side-effects we talked about earlier
and, finally, that it worked for a couple of months and then stopped working
Let’s turn to Trulance now. Commonalities good reviews about Trulance include:
again, that it may take 1-3 weeks for the medicine to start working, and that those 1-3 weeks can
be uncomfortable but are worth it later that it does give those who take it good
but loose bowel movements, but that is much more comfortable than the constipation and bloat they
experience without the medication I read a number of reviews stating
that Trulance works best in tandem with a healthy diet—some mention
FODMAPs, others mention high-fiber and that it decreases abdominal pain
Finally, commonalities bad reviews about Trulance include:
intense, unpredictable diarrhea that makes keeping a routine challenging
And worsening of
hemorrhoids due to the diarrhea—just like Linzess And weight-gain is also mentioned as a
negative side effect, which wasn’t one of the official side-effects we talked about earlier
And, of course, some people leave negative reviews for Trulance and claim that Linzess is better,
while others leave negative reviews for Linzess and claim that Trulance is better.
The tough thing about drugs in general is that there is no such thing as a good
drug. Drugs have side-effects, and drugs affect different people differently. I
think the best thing you can do if you’re considering either or both of these drugs,
is to approach their use as a trial for your symptom management, and be armed with as much
knowledge and information about the drug as possible. That way you aren’t attached
to a specific outcome, and you can recognize what’s normal, what’s a potential side-effect,
what options you have to alter how you’re using the drug, and ultimately decide if the
drug’s benefits are worthwhile for you and your unique, individual GI system.
On that note, thank you all so, so much for watching! I am honored to be creating this
series for you—and do still intend on making more videos! I want to cover other treatment options
for IBS like Viberzi, fecal transplants, and alternative medicine. I’d also like to make videos
investigating IBS and its relationship to anxiety, sleep, and exercise. But! If you have a different
IBS-related topic you want me to cover in this series, please let me know in the comments below!
If you found this video helpful please like it and share it. Feel free to comment requests or
anything else below, I try really hard to read and respond to all of my comments,
Don’t forget to check meowt on instagram and, finally, please subscribe to my
channel for more content about not only pelvic things, but also life things.
Thank you so much again for watching. I hope you have a wonderful rest of your day,
and I will see you in the next video. Bye!