How to Take Linzess (Linaclotide)
Timing and Food Restrictions
Take Linzess on an empty stomach at least 30 minutes before your first meal of the day, at approximately the same time each day. 1 This timing is critical because taking Linzess with food significantly reduces its efficacy. 2
Dosing by Indication
The correct dose depends on your specific condition:
- For IBS-C (Irritable Bowel Syndrome with Constipation) in adults: 290 mcg once daily 1
- For CIC (Chronic Idiopathic Constipation) in adults: 145 mcg once daily is the standard dose, though 72 mcg once daily may be used based on individual presentation or tolerability 1
- For Functional Constipation in children ages 6-17: 72 mcg once daily 1
Capsule Administration
Swallow the capsule whole—do not crush or chew the capsule or its contents. 1
For Patients Who Cannot Swallow Capsules
If you cannot swallow the capsule whole, you have three options 1:
Option 1 - With Applesauce:
- Place one teaspoonful of room-temperature applesauce in a clean container
- Open the capsule and sprinkle the entire contents (beads) on the applesauce
- Consume the entire mixture immediately without chewing the beads
- Do not store for later use
Option 2 - With Water (Oral):
- Pour approximately 30 mL of room-temperature bottled water into a clean cup
- Open the capsule and sprinkle the entire contents into the water
- Gently swirl beads and water for at least 20 seconds
- Swallow the entire mixture immediately
- Add another 30 mL of water to any remaining beads, swirl for 20 seconds, and swallow immediately
- Note: The beads will remain visible and will not dissolve—this is normal
Option 3 - Via Nasogastric or Gastrostomy Tube:
- Open the capsule and empty beads into a clean container with 30 mL of room-temperature bottled water
- Mix by gently swirling for at least 20 seconds
- Draw up the mixture into a catheter-tipped syringe
- Apply rapid and steady pressure (10 mL per 10 seconds) to dispense into the tube
- Add another 30 mL of water to remaining beads and repeat
- Flush the tube with a minimum of 10 mL of water after administration
Missed Dose Instructions
If you miss a dose, skip it and take the next dose at your regular time—never take 2 doses at the same time. 1, 2 This is critical to minimize the risk of adverse effects, particularly severe diarrhea.
Critical Safety Warnings
Absolute Contraindications
- Do not use Linzess if you have known or suspected mechanical gastrointestinal obstruction 2, 1
- Never give Linzess to children under 2 years of age—it caused deaths due to dehydration in neonatal mice and carries a black box warning for this age group 1
Common Side Effects and Management
The most common side effect is diarrhea, which occurs in approximately 16-20% of patients 3:
- Most diarrhea is mild to moderate (90.5% of cases) 4
- Approximately 4-4.5% of patients discontinue treatment due to diarrhea 4, 5
- If you experience severe diarrhea, stop taking Linzess and rehydrate yourself 1
- Contact your healthcare provider if diarrhea is severe or persistent
Special Populations
- Patients taking diuretics or other medications affecting sodium balance: You may be at higher risk for hyponatremia (low sodium) when taking Linzess 6
- Patients over 65 years: Efficacy appears similar to younger adults, though study sample sizes were limited 6
Mechanism and Onset
Linzess works locally in your gastrointestinal tract without significant systemic absorption 7, 8:
- It acts as a guanylate cyclase-C agonist, increasing fluid secretion into the intestine and accelerating transit 6, 7
- The local mechanism allows for relatively rapid onset compared to systemic agents 7
- Clinical response at week 4 predicts sustained response at week 12 9
Duration of Treatment
Clinical trials evaluated treatment for 12-26 weeks, but the FDA label does not provide a limit on treatment duration, allowing for long-term use as needed 6, 4