Dr. Ahmed
Linzess pros and cons for the treatment of patients with IBS (irritable bowel syndrome) and patients with CIC (chronic idiopathic constipation) are discussed here.
Detailed FDA prescribing information regarding dosage and side effects are discussed in this article: Linaclotide (Linzess) Medication for IBS: Uses, Dosage, Cost, Side effects
What is Linzess (Linaclotide):
Linzess or Linaclotide is a new drug that is used to treat two very common medical conditions:
- IBS-C (irritable bowel syndrome with constipation), and
- CIC (chronic idiopathic constipation)
The one symptom common between these two conditions is constipation. So, basically, Linzess softens the stools by increasing the water content of the stools.
It does so by acting locally on the intraluminal gut epithelial cells activating the GCC receptors. This results in the secretion of chloride and bicarbonate-rich fluid into the intestinal lumen by the chloride channels.
Linzess also activates the smooth muscles of the intestine and increases the peristaltic movements of the gut, thereby increasing gut motility.
Another important function of Linzess that is especially helpful in patients with IBS is that it acts on the intraluminal visceral nerve endings and reduces the pain associated with IBS.
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Linzess Pros and Cons:
Linzess Pros and Cons are compared here with other laxatives and stool softeners. It is one of the newly approved medicines used to treat constipation and IBS [Ref]
Linzess Pros:
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Linzess is very safe to use:
Linzess (Linaclotide) acts locally and does not get absorbed. Since it does not get into systemic circulation, it is associated with minimal systemic side effects.
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Linzess is an effective medicine for chronic constipation and IBS-C:
Linzess (Linaclotide) relieves constipation by increasing gut motility as well as increasing the water content of the stools. Since it has a dual action, it is more potent than most drugs that are used to treat constipation.
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Linzess relieves abdominal pain:
Unlike most other laxatives, Linzess does not only relieve constipation, it also acts on the local nerve endings and relieves visceral pain associated with constipation and IBS.
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Linzess is taken once daily:
Most other laxative drugs are usually administered two to three times a day. However, Linzess is taken once daily before breakfast. The once-daily dosing is easy for most patients.
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Linzess Cons:
Linzess is associated with gastrointestinal side effects. In one study, 35% of the participants reported side effects and 13% had to discontinue Linaclotide because of the side effects [Ref].
It is especially not to be used in children because it can cause severe dehydration.
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Why is Linzess Dangerous in Children:
Linzess is considered a very safe medicine, however, in children, especially younger than 6 years of age, it can cause severe diarrhea and dehydration.
It is not recommended to be used in individuals who are younger than 18 years of age and is contraindicated in children 6 years of age or younger.
Younge children may develop severe diarrhea resulting in dehydration. These children may require hospitalization for intravenous fluid administration to prevent kidney injury and hypotension.
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Linzess and GI bleeding:
Also, the postmarketing data from Linzess shows that it may cause bleeding from the gut which can be very disturbing for patients [Ref].
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Linzess long-term side effects:
Linzess long-term side effects have not been studied beyond 26 weeks [Ref]. However, theoretically, it may result in kidney injury as a result of diarrhea and dehydration. Kidney damage can become permanent even after stopping Linzess.
Chronic use of Linzess can also result in dependence and the patient may develop severe constipation after stopping Linzess which may persist for a long time.
Chronic use, and especially misuse of Linzess, can result in chronic diarrhea, and electrolyte problems. Hypokalemia if persists for a long time as a result of chronic diarrhea can result in muscle weakness and proximal myopathy which may persist for a long time.
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Linzess is a Prescription Medicine:
Unlike most laxatives and stool softeners, Linzess is not available OTC (over the counter) and one has to get a prescription for Linzess to get it from a pharmacy. This is not the case with most other stool softeners and laxatives.
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Linzess is not approved for use in pregnancy:
Linzess has not been studied in pregnant and breastfeeding females. Although it acts locally, since data is not available to prove its safety in pregnancy and breastfeeding, it is not recommended.
Pregnant females and breastfeeding mothers however can use most other OTC stool softeners.
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Linzess is not available worldwide:
Linaclotide is available only in two generic brands: Linzess and Costella. It is not available everywhere. Other laxatives are available worldwide.
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Linzess is expensive:
Linzess is too costly. A monthly dose of Linzess costs about USD $500 or more. Other laxatives are more than 100 times cheaper than Linzess.
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Table Summarizing the Pros and Cons of Taking Linzess:
Linzess Pros |
Linzess Cons |
| It acts locally and has fewer side effects | It may cause severe diarrhea and dehydration in children |
| It has a dual-action | It may cause GI bleeding |
| It relieves intestinal pain | It is not recommended for pregnant and nursing mothers |
| It is administered once daily | It has only two available brands and is not available everywhere |
| It can be administered via an NG tube | It is very costly |
Lastly, I have a question for you:
Does Linzess cause belly fat?
I think it does not cause belly fat because:
- It acts locally on the intestines and has no direct effects on visceral or belly fat.
- It may cause belly fat to melt rather because of the increase in intestinal motility, it may cause diarrhea and malabsorption of nutrients resulting in some weight loss.
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