Is abdominal pain a contraindication for Trulance (plecanatide)?

Abdominal Pain as a Contraindication for Trulance (Plecanatide)

Abdominal pain is not a contraindication for Trulance (plecanatide). According to the FDA label, the only contraindications for Trulance are patients less than 6 years of age and patients with known or suspected mechanical gastrointestinal obstruction 1.

Contraindications for Trulance (Plecanatide)

The FDA-approved contraindications for Trulance are specifically:

• Patients less than 6 years of age due to risk of serious dehydration
• Patients with known or suspected mechanical gastrointestinal obstruction 1

Abdominal Pain and Plecanatide Treatment

Rather than being a contraindication, abdominal pain is actually a target symptom that plecanatide can help treat, particularly in patients with irritable bowel syndrome with constipation (IBS-C). Clinical guidelines indicate that:

• Plecanatide is an efficacious second-line drug for IBS with constipation in secondary care 2
• Plecanatide treatment results in greater improvement in abdominal pain compared to placebo, with a risk difference of 10.1% 2
• In patients with severe constipation, plecanatide demonstrated significantly greater response rates for abdominal pain reduction compared to placebo 3

Side Effect Considerations

While abdominal pain is not a contraindication, it's important to note that:

• Diarrhea is the most common adverse event associated with plecanatide, reported in 4.3% of patients compared to 1% with placebo 2
• Diarrhea led to discontinuation in 1.2% of patients receiving plecanatide (3 mg) 2
• The incidence of serious adverse events was 0.8%, similar between plecanatide and placebo groups 2

Mechanism of Action

Plecanatide is a 16-amino acid peptide analog of uroguanylin that:

• Stimulates guanylate cyclase-C receptors to increase chloride and bicarbonate secretion into the intestine
• Prevents the absorption of sodium ions
• Increases secretion of water into the intestinal lumen
• Accelerates intestinal transit and softens stool 4

Clinical Application

When considering plecanatide for patients with constipation:

1. Rule out true contraindications:

   • Confirm patient is not less than 6 years of age
   • Ensure no mechanical gastrointestinal obstruction is present

2. Assess appropriateness:

   • Plecanatide is indicated for chronic idiopathic constipation and IBS-C
   • It can be used as a second-line treatment after over-the-counter agents 2
   • It may be particularly beneficial in patients with abdominal pain as a symptom

3. Monitor for adverse effects:

   • Counsel patients about the possibility of diarrhea
   • Follow up to assess efficacy and tolerability

In conclusion, not only is abdominal pain not a contraindication for plecanatide, but the medication is actually effective in treating this symptom in patients with IBS-C.