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 is discussed elsewhere and can be viewed here: Linaclotide (Linzess) Medication for IBS: Uses, Dosage, Cost, Side effects
A brief overview of Linzess:
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:
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.
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.
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.
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 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.
Also, the postmarketing data from Linzess shows that it may cause bleeding from the gut which can be very disturbing for patients.
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.
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.
Linaclotide is available only in two generic brands: Linzess and Costella. It is not available everywhere. Other laxatives are available worldwide.
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 Pros and Cons of Linaclotide:
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 |
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