From the Guidelines
Linzess (linaclotide) is recommended at a dosage of 290 mcg once daily for irritable bowel syndrome with constipation (IBS-C) and 145 mcg once daily for chronic idiopathic constipation (CIC). The capsule should be taken on an empty stomach at least 30 minutes before the first meal of the day to maximize effectiveness, as food can decrease the efficacy of the medication 1. Patients should swallow the capsule whole and not crush or chew it. Linzess works by increasing intestinal fluid secretion and accelerating transit time through the gut, which helps relieve constipation and associated symptoms. It typically begins working within the first week of treatment, though some patients may experience relief within days. Common side effects include diarrhea, abdominal pain, and flatulence. If diarrhea becomes severe, patients should contact their healthcare provider as dosage adjustment may be necessary. Linzess is contraindicated in patients under 18 years of age and those with known or suspected mechanical gastrointestinal obstruction. Treatment is typically ongoing for these chronic conditions, with regular follow-up to assess effectiveness and manage any side effects. According to the AGA clinical practice guideline, linaclotide is recommended for use in patients with IBS-C, with a strong recommendation and high certainty in the evidence of effects 1.
Some key points to consider when prescribing Linzess include:
- The medication should be taken on an empty stomach to maximize effectiveness
- Patients should be advised to swallow the capsule whole and not crush or chew it
- Common side effects include diarrhea, abdominal pain, and flatulence
- Dosage adjustment may be necessary if diarrhea becomes severe
- Linzess is contraindicated in patients under 18 years of age and those with known or suspected mechanical gastrointestinal obstruction
- Treatment is typically ongoing for these chronic conditions, with regular follow-up to assess effectiveness and manage any side effects. The American Gastroenterological Association (AGA) recommends the use of linaclotide for the management of CIC, with a studied dose of 145 and 290μg daily 1.
It's also important to note that the American Gastroenterological Association-American College of Gastroenterology clinical practice guideline recommends the use of fiber supplementation, osmotic laxatives, and stimulant laxatives for the management of CIC, in addition to linaclotide 1. However, the use of these medications should be individualized based on patient-specific factors and medical history. Overall, Linzess is a effective treatment option for patients with IBS-C and CIC, and should be used in accordance with the recommended dosage and treatment approach.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
- 1 Recommended Dosage Irritable Bowel Syndrome with Constipation (IBS-C) in adults The recommended dosage of LINZESS is 290 mcg orally once daily. Chronic Idiopathic Constipation (CIC) in adults The recommended dosage of LINZESS is 145 mcg orally once daily. A dosage of 72 mcg once daily may be used based on individual presentation or tolerability
The recommended dosage of Linzess (linaclotide) for patients with Irritable Bowel Syndrome with Constipation (IBS-C) is 290 mcg orally once daily. For patients with Chronic Idiopathic Constipation (CIC), the recommended dosage is 145 mcg orally once daily, or 72 mcg once daily based on individual presentation or tolerability 2.
- Key points:
- Take Linzess on an empty stomach, at least 30 minutes prior to a meal, at approximately the same time each day.
- If a dose is missed, skip the missed dose and take the next dose at the regular time.
- Do not crush or chew Linzess capsule or capsule contents.
- Swallow Linzess capsule whole.
- For patients who are unable to swallow the capsule whole, Linzess capsules can be opened and administered orally in either applesauce or with water or administered with water via a nasogastric or gastrostomy tube 2.
- Dosage forms and strengths: Linzess capsules are available in 72 mcg, 145 mcg, and 290 mcg strengths 2.
From the Research
Recommended Dosage for Linzess
- The recommended dosage for Linzess (linaclotide) is 290 µg once daily for irritable bowel syndrome with constipation (IBS-C) and 145 µg or 72 µg once daily for chronic idiopathic constipation (CIC) 3.
Treatment Approach
- First-line treatment options usually include fiber and over-the-counter osmotic laxatives, but prescription secretagogues like linaclotide may be preferred when these options fail 4.
- Linaclotide has been shown to improve constipation, abdominal symptoms, and quality of life in patients with IBS-C and CIC, with a favorable safety profile 5.
- The treatment approach should be tailored by mutual decision-making between the patient and practitioner, with active monitoring and management to maximize clinical outcomes 4.
Safety and Efficacy
- Linaclotide has been demonstrated to be safe and effective in treating IBS-C and CIC, with the most common adverse event being diarrhea, which is usually mild or moderate 3.
- Linaclotide has been shown to increase fluid secretion and gastrointestinal transit, and to suppress visceral nociceptive responses in patients with colonic hyperalgesia 5.
- Emerging potential treatment options for IBS-C and CIC include prucalopride, plecanatide, elobixibat, and tenapanor, which may show promise in patients who have not responded to other therapies 6.