From the Guidelines
Linaclotide is the recommended medication for Irritable Bowel Syndrome with Constipation (IBS-C) due to its strong recommendation and high certainty in the evidence of effects, as stated by the AGA clinical practice guideline on the pharmacological management of IBS-C 1.
Key Points
- Linaclotide is a nonabsorbed 14-amino acid peptide that stimulates the GC-C receptor on enterocytes, resulting in intestinal chloride and bicarbonate secretion and inhibition of colonic nociceptors.
- The FDA-approved dosage of linaclotide for IBS-C is 290 mg once daily.
- A recent network meta-analysis ranked linaclotide first in efficacy among secretagogues for IBS-C, although head-to-head trials are lacking 1.
- Other prescription medications like plecanatide (Trulance) at 3 mg daily, or lubiprostone (Amitiza) at 8 mcg twice daily may be considered as alternative options, but linaclotide has the strongest recommendation and highest quality evidence supporting its use 1.
Treatment Approach
- Treatment should be started at lower doses and adjusted based on symptom response.
- Lifestyle modifications, including regular exercise, adequate hydration (at least 8 glasses of water daily), and a low-FODMAP diet to reduce fermentable carbohydrates that can trigger symptoms, are also important.
- Most patients require a combination approach and may need to try several options before finding what works best for their specific symptoms.
From the FDA Drug Label
LINZESS is a guanylate cyclase-C agonist indicated for treatment of: Irritable bowel syndrome with constipation (IBS-C) in adults. The recommended dosage in adults is: IBS-C: 290 mcg orally once daily.
Lubiprostone capsules are indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
The best medication for Irritable Bowel Syndrome with Constipation (IBS-C) is either linaclotide (LINZESS) at a dose of 290 mcg orally once daily for adults, or lubiprostone for women at least 18 years old. However, the dosage for lubiprostone is not specified in the provided text for IBS-C. Linaclotide has a more general approval for IBS-C in adults, while lubiprostone is specifically approved for women at least 18 years old 2, 3.
From the Research
Medication Options for IBS-C
- Linaclotide is a novel compound approved for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in the USA and EU 4, 5, 6.
- It acts on guanylate cyclase-C receptors to increase chloride and bicarbonate secretions into the intestine, inhibiting the absorption of sodium ions and increasing water secretion into the lumen 5, 6.
- Linaclotide has been shown to be effective in improving abdominal symptoms, bowel symptoms, and overall severity of IBS-C compared to placebo 4, 5, 6, 7, 8.
Efficacy and Safety of Linaclotide
- Clinical trials have demonstrated that linaclotide significantly increases weekly spontaneous bowel movements and complete spontaneous bowel movements, while reducing abdominal pain in patients with IBS-C 5, 7, 8.
- The most common adverse effect of linaclotide is diarrhea, which is generally mild and confined to the gastrointestinal tract 5, 6, 8.
- Linaclotide has a favorable safety profile, with minimal systemic bioavailability and low risk of relevant systemic adverse effects 4, 6.
Comparison to Other Medications
- Linaclotide is the only other medication approved for IBS-C, aside from lubiprostone 4.
- Osmotic or stimulant laxatives may be considered as first-line treatments for Chronic Idiopathic Constipation, due to their lower cost 4.
- Linaclotide is a first-in-class guanylate cyclase-C agonist, with a novel mechanism of action that relieves abdominal pain, bloating, and constipation associated with IBS-C 6.