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Tenapanor (Ibsrela) for IBS-C: Uses, Dosing, MOA, Side effects

Tenapanor (Ibsrela)

Drug Name: Tenapanor

Brand Name: IBSrela

Primary Indication: IBS-C

A new drug called Tenapanor was licensed in September 2019 to treat constipation-predominant irritable bowel syndrome (IBS-C) [Ref]

It was first synthesized in 2012 and works by inhibiting the sodium/hydrogen exchanger isoform 3 (NHE3) transporter.

Tenapanor is the only drug in its class at the moment and provides a new alternative in the treatment of IBS-C.

Tenapanor is prescribed by a doctor and comes in tablet form. It can be used to treat both IBS-C and constipation.

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How to use Tenapanor (IBSrela):

  • Read the Medication Guide and Patient Information Leaflet provided by your pharmacist before taking Tenapanor or after refilling it.
  • Ask your doctor or pharmacist if you have any questions.
  • Take Tenapanor by mouth, usually twice daily before breakfast and dinner, or as directed by your doctor.
  • Swallow the tablets whole, do not chew or crush them.
  • Take the drug regularly at the same times every day to get the best results and remember to take it.
  • If your condition does not improve or gets worse, inform your doctor.

IBSrela Dosing:

The usual recommended dose of IBSrela (Tenapanor) is 50 mg two times a day before each meal.

However, it is best to take it as your doctor prescribes it, and may also depend on the severity of your disease.

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Side effects of Tenapanor (IBSrela):

It’s possible to have diarrhea while taking this medication. If your diarrhea gets worse or doesn’t improve, talk to your doctor or pharmacist right away.

Your doctor prescribed this medication because they think it will help you more than it will harm you. Most people who take this medicine don’t have any big problems.

If you have any severe side effects, like really bad diarrhea, stop taking the medicine and contact your doctor right away.

Here is a summary of the side effects that you may notice while using Tenapanor (IBSrela):


Side Effects

GastrointestinalDiarrhea, abdominal pain, flatulence, nausea
Nervous systemHeadache
Respiratory SystemNasopharyngitis, upper respiratory tract infection

This medication rarely causes a very bad allergic reaction. But if you have a severe allergic reaction, like a rash, swelling, trouble breathing, or confusion, get medical help right away.

Symptoms of a Severe Allergic Reaction

Itchiness or swelling (especially of the face, tongue, or throat)
Extreme disorientation
Breathing difficulties


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Tenapanor: Warnings and precautions

  • Let your doctor or pharmacist know if you are allergic to Tenapanor or have any other allergies before taking it. The inactive ingredients in the medicine may cause allergic reactions or other problems. Ask your pharmacist if you have any questions.
  • Tell your doctor or pharmacist about all the medications you are currently taking, especially those that you have recently stopped taking.
  • Before any surgery or dental work, make sure to inform your surgeon or dentist about all the products you use, including prescription drugs, over-the-counter medications, and herbal products.
  • Tenapanor should only be used during pregnancy if it is absolutely necessary. Talk to your doctor about the benefits and risks before using it.
  • If you are breastfeeding, consult your doctor before taking Tenapanor, as it is unknown whether the medication passes into breast milk.
  • There is not enough research on the effects of Tenapanor in children under the age of six, so it should not be given to them.
  • Tenapanor should also not be given to young patients aged 6 to 17, as its safety and effectiveness have not been established in this age group.
  • So far, studies have not shown any specific issues that may limit the effectiveness of Tenapanor in elderly patients.
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Mechanism of action of Tenapanor:

Tenapanor is a medicine that blocks a specific molecule in the body called sodium-hydrogen exchanger isoform 3 (NHE3).

This molecule controls how sodium and fluids are balanced in the gut. By blocking it, Tenapanor helps to keep sodium in the intestine, which attracts water and softens the stool.

There is also some evidence that Tenapanor can stop the body from absorbing phosphorus from food, but we don’t know exactly how it does this.

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Tenapanor Dosing According to age group:

Tenapanor is a medication that comes in tablet form and is used to treat constipation and irritable bowel syndrome.


The dosage of Tenapanor depends on the patient’s age and medical condition, and you should always follow your doctor’s instructions or the label’s instructions. The typical dosages of this medication are:

  • For adults:
    • Take 50 mg of Tenapanor two times a day, just before breakfast and dinner.
  • For children aged 6 and older:
    • The doctor will determine whether the medication is appropriate and the amount to be used.
  • For children under six:
    • This medication should not be used.

It’s important to keep taking the medication as prescribed, even if you start to feel better.

If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

If your condition doesn’t improve or gets worse, tell your doctor right away.

Table: Dosage of Tenapanor for different age groups and medical conditions

Age group

Medical condition


AdultsConstipation, Irritable bowel syndrome50 mg twice a day
Children (6 years and older)As determined by the doctorAs determined by the doctor
Children (under 6 years)Not recommendedNot recommended


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Summary of different treatments for the treatment of IBS-C:

The following table compares the safety and efficacy of Tenapanor Vs other Novel therapies approved for the treatment of IBS-C.


Percentage improvement in symptoms

Common Side Effects

Tenapanor35-40%Diarrhea, bloating, abdominal pain
Linaclotide30-35%Diarrhea, abdominal pain
Prucalopride25-30%Nausea, diarrhea
Lubiprostone25-30%Nausea, diarrhea
Plecanatide20-25%Diarrhea, abdominal pain
Tegaserod20-25%Diarrhea, abdominal pain
Eluxadoline10-15%Nausea, abdominal pain


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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.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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