Linzess Interactions, Taking Linzess at Night, & More FAQs

Linzess Interactions

Linzess Interactions with commonly prescribed drugs and food, especially coffee, and other FAQs (frequently asked questions about Linaclotide) are discussed here

Linzess (Linaclotide) is a drug that is used to treat patients with IBS and constipation. Most drugs that act on the GI tract directly affect the adsorption of food, medications, and probiotics.

Drug interactions also occur when the drug gets absorbed. However, Linzess does not get into your system.

How does Linzess affect the Absorption of Drugs and Food?

Linzess activates the GCC (guanylate cyclase receptors) in the intestinal lumen. It acts via three different mechanisms:

  • Increasing intestinal water, softening stools
  • Enhancing gut motility, and
  • Relieving abdominal visceral pain


Linzess Interactions with Drugs:

Linzess does not interact with medications once the drug is absorbed. Since Linzess (Linaclotide) acts only locally, it does not enter your bloodstream.

Most drugs that are metabolized by the liver’s P-450 enzymes (or other liver enzymes) have drug-drug interactions.

However, Linaclotide is locally metabolized into peptides and gets excreted without entering the bloodstream.

Therefore, Linzess does not affect the half-life of a drug once it is absorbed.

It does have some effect on the absorption of most medications. This is because Linzess increases gut motility and fluid content.



Here are some important Linzess drug interactions and FAQs:

Antacids are commonly used medications. Most patients are on concomitant antacids like omeprazole and pantoprazole.

Linzess Interactions with Omeprazole: Can I take Linzess and Omeprazole Together?

Linzess acts locally while Omeprazole blocks the stomach parietal cells after it gets absorbed. Omeprazole is sensitive to stomach acid.

Linzess enhances the secretion of bicarbonate-rich fluid into the intestine. So theoretically, Linzess protects omeprazole from getting degraded in the intestinal lumen.

It might enhance the absorption of omeprazole making it more effective. However, the manufacturer has not mentioned any Linzess-Omeprazole drug interactions.

People have noticed the following symptoms when they combined Linzess and Omeprazole together:

  • Kidney Injury
  • Diarrhea
  • Constipation
  • Irregular bowels
  • Fatigue and weakness
  • Headache
  • Breathing difficulty

To conclude:

YES! You can take Linzess and Omeprazole together but watch for any new side effects, especially kidney injury.



Linzess Interactions with Pantoprazole: Can I take Pantoprazole and Linzess Together?

Not all PPIs are the same. Omeprazole and Pantoprazole have some differences especially when they get metabolized.

However, since Linzess does not affect the metabolism of any of the PPIs, as Linzess does not get absorbed, it does not affect the efficacy of Pantoprazole.

On the other hand, it may slightly increase its effects because Linzess may enhance its absorption.

Patients who were using Linzess and Pantoprazole together commonly reported the following side effects:

  • Drowsiness and sleepy
  • Headache
  • Decreased Appetite
  • Joint pains, and
  • Changes in weight

None of the patients reported kidney injury while they were using Pantoprazole and Linzess together.

To Conclude:

Yes! You can take Pantoprazole and Linzess together. Compared to Omeprazole, Pantoprazole might be a safer alternative.



Linzess Interactions with Stool Softeners: Can I take a stool softener with Linzess?

Linzess (Linaclotide) is used to relieve constipation. Laxatives are also used to relieve constipation. It is generally advisable to stop all laxatives when starting Linzess treatment.

Combined Linzess and stool softeners might result in severe diarrhea and dehydration. Stimulant laxatives such as Bisacodyl and Sodium Picosulfate should be specifically avoided.

What if Linzess Doesn’t Work?

It is not uncommon that people complain of persistent constipation despite taking Linzess.

In clinical trials, Linzess was effective in relieving the symptoms of constipation and IBS in only about one-third of the participants [Ref].

In addition, dietary habits, exercise, and water intake have some effect on the efficacy of Linzess.

In such cases, to relieve the patient’s symptoms, one can follow these simple steps:

  • Take Linzess before the first meal of the day
  • Increase water intake when taking Linzess
  • Increase fiber intake in the diet or if at all required, take bulk-forming laxatives with it.

Fiber and bulk-forming laxatives are safer choices when combining a stool softener with Linzess.

It is important not to take a double dose of Linzess if the symptoms of constipation persist.



Linzess Interactions with Probiotics: Can You Take a Probiotic with Linzess?

Probiotics can be safely taken with Linzess. However, they should not be taken during the first few weeks of starting Linzess.

During the first few weeks, your gut and bowel movements will change. Some people may develop severe diarrhea, others may have little effect.

After two weeks, when your gut movements get in order, you can take a probiotic anytime after your mid-day meal or after dinner.

Avoid taking probiotics with Linzess at the same time as before breakfast.



Other Frequently Asked Questions:

How long does Linzess stay in your system?

Most people who ask this question want to know when their side effects are going to get better after stopping Linzess.

Linzess does not get into your system. It is not systemically absorbed, but its gastrointestinal effects may last up to two weeks.

This is not because Linzess’s effects last for weeks. Usually, its effects last for a day or so. However, sensitive patients such as children may have lots of GCC receptors in the intestinal lumen.

Once patients develop side effects such as diarrhea, the cells usually slough off and it may take time to recover.

It may take from 3 to 5 days, however, patients with comorbid conditions like diabetes, heart failure, and liver or kidney diseases and those of extreme ages may take two or more weeks to recover.

How to use Linzess for weight loss?

Linzess is not a weight loss medicine. It has neither been approved for any weight-related condition.

Patients may notice a change in weight because of either improvement in their well-being or may lose weight because of malabsorption and diarrhea.

Linzess Interactions with Food: Can You Take Linzess and Coffee Together?

Coffee has little effect on Linzess if the two are not combined. If you take Linzess on an empty stomach with water and drink coffee after 30 minutes or so, it could have little effect.

However, coffee intake and especially more than 4 cups of coffee per day, may cause heartburn, GERD (gastroesophageal reflux disease), dyspepsia, bloating, flatulence, and peptic ulcer disease.

Since most of the gastrointestinal side effects are already troubling patients with IBS, drinking excessive coffee may result in worsening symptoms.

Most experts do not recommend taking coffee while being treated for IBS with Linzess.



What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

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