Dr. Ahmed
Drug Name: Plecanatide
Brand Name: Trulance
Primary Indications: IBS-C and Severe Idiopathic Constipation [Ref]
Plecanatide, which is sold under the trade name Trulance, is used to manage severe idiopathic constipation and irritable bowel syndrome with constipation.
It works by activating guanylate cyclase-C, which leads to an increase in cGMP. This, in turn, promotes the movement of fluids through the intestines, making it easier for stools to pass.
Essentially, Trulance helps to ease constipation by making it easier for waste to move through the digestive system.
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Trulance (Plecanatide) Indications:
Plecanatide (Trulance) is a medication used to treat certain gastrointestinal problems such as chronic idiopathic constipation and irritable bowel syndrome with constipation.
It works by increasing the amount of fluid in the intestines and helping food move through the digestive system more quickly.
By doing this, Plecanatide can improve symptoms like straining during bowel movements and the feeling that your bowel movements are incomplete.
It can also make your stool easier to pass. Essentially, plecanatide helps to relieve constipation and make bowel movements more comfortable.
Irritable bowel syndrome (IBS) is a long-term condition that can cause various symptoms. These may include:
- Stomach cramps and discomfort
- Bloating or a feeling of fullness in the abdomen
- Changes in bowel habits, such as diarrhea, constipation, or a mix of both
If you experience constipation, you may also notice:
- Hemorrhoids are swollen veins in the rectum or anus that can be painful and itchy
- Difficulty passing stools, or feeling like your bowel movements are incomplete
- Passing stools that are solid, dry, or lumpy
- Having fewer than three bowel movements per week
Here’s a table summarizing the symptoms:
| System | Symptoms of IBS |
| Digestive | Stomach cramps, bloating, changes in bowel habits |
| Rectal | Hemorrhoids, difficulty passing stools, incomplete bowel movements |
| Stool | Solid, dry, or lumpy stools, fewer than three bowel movements per week |
| Other | Anxiety, Palpitation, Fatigue, Numbness and tingling, and headaches |
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How to take plecanatide (Trulance)?
To use plecanatide, follow these steps:
- Read the medication guide that your pharmacist has provided each time you get a refill. If you have any questions, ask your doctor or pharmacist.
- Take the medication by mouth once per day, as directed by your doctor. You can take it with or without food.
- If you have trouble swallowing the pill whole, you can crush it and mix the powder with a teaspoon of room-temperature applesauce. Swallow the mixture immediately and do not store it for later use.
- Alternatively, you can dissolve the pill in one ounce (30 milliliters) of room-temperature water. Drink the mixture immediately after swirling it for at least 10 seconds. Then, add another ounce (30 milliliters) of water to the glass, swirl it for 10 seconds, and drink all the contents right away to make sure you get the full dose.
- If you need to use a nasogastric tube to administer the medication directly into your stomach (nasogastric or gastric tube), ask your doctor for specific instructions.
Here’s a table summarizing the directions:
Step |
Instructions |
| 1. | Read the medication guide each time you refill. Ask your doctor or pharmacist if you have any questions. |
| 2. | Take the medication once per day with or without food, as directed by your doctor. |
| 3. | Crush the pill and mix the powder with applesauce if you have trouble swallowing it whole. Do not store the mixture. |
| 4. | Dissolve the pill in one ounce of water, drink immediately, and then drink another ounce of water. |
| 5. | Ask your doctor for specific instructions if you need to use a tube to administer the medication directly into your stomach. |
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Side effects of Trulance (Plecanatide):
Trulance (Plecanatide) is a medication that can cause minor or major side effects. Some of the most common side effects of Trulance are listed below. However, there may be other side effects that are not included in this list.
Table of Trulance’s side effects:
System |
Side Effects |
| Gastrointestinal | Nausea, moderate diarrhea, abdominal bloating, or pain |
| Infections | Cold or flu, renal tract infections |
| Allergic Reaction |
|
Minor Side Effects of Trulance:
- Nausea
- Moderate diarrhea
- Abdominal bloating or soreness
- Infections such as cold or flu or renal tract infections
The minor side effects of Trulance may go away on their own in a few days or weeks. However, if they persist or worsen, consult your doctor.
Major Side Effects of Trulance:
- Severe allergic reaction
- Severe diarrhea
- Dehydration and electrolyte abnormalities
The major side effects of Trulance can be severe and require immediate medical attention.
Chronic diarrhea in children can lead to dehydration, causing lightheadedness, dizziness, tiredness, dry mouth, dry lips, and headaches.
An allergic reaction to Trulance can cause symptoms like itching, flushing, hives, eczema, or redness of the skin.
In rare cases, a severe allergic reaction can lead to swelling of the hands, face, feet, tongue, throat, or other parts of the body, or difficulty breathing.
If you experience any unwanted side effects, consult your doctor or pharmacist for advice on how to deal with them.
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Trulance Dosage:
Trulance (Plecanatide) is used for Chronic Idiopathic Constipation and Irritable Bowel Syndrome with constipation.
The recommended dose for both conditions is 3mg, taken orally once a day. Trulance is not recommended for children under the age of six, and it should not be used for patients between the ages of 6 and 18.
The safety and effectiveness of Trulance have not been studied in pediatric patients under the age of 18.
Here is a table summarizing the recommended doses:
| Condition | Recommended Dose |
| Chronic Idiopathic Constipation | 3mg, once daily |
| Irritable Bowel Syndrome with constipation | 3mg, once daily |
| Children under the age of 6 | Not recommended |
| Patients between the ages of 6 and 18 | Not recommended |
| Pediatric patients under 18 years old | Not studied for safety and effectiveness |
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Trulance MOA (Mechanism of action of Plecanatide):
Human uroguanylin and Trulance are similar in structure and both function as GC-C agonists.
Trulance and its active metabolite bind to GC-C, which has a local effect on the inside of the intestinal epithelium.
When GC-C is activated, the concentration of cGMP increases both inside and outside of cells.
An increase in intracellular cGMP primarily activates the cystic fibrosis transmembrane conduct regulator ion channel, which releases chloride and bicarbonate into the intestinal lumen, resulting in an increase in intestinal fluid and faster transit.
Trulance has been shown to speed up intestinal transit, increase fluid discharge into the GI tract, and affect stool consistency.
Pharmacokinetics of Trulance:
| Pharmacokinetic Parameter | Trulance |
| Bioavailability | Approximately 3% |
| Peak Plasma Concentration | 1-2 hours post-dose |
| Protein Binding | Greater than 99% |
| Metabolism | Metabolized by proteolytic degradation |
| Half-Life | 1-3 hours |
| Excretion | Feces: 75%,
Urine: 13% |
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Comparison of Trulance (Plecanatide) Vs other IBS Medications:
| Medication | Drug Name | Mechanism of Action | Indications in IBS |
| Trulance | Plecanatide | GC-C agonist | IBS-C in adults |
| Linzess | Linaclotide | GC-C agonist | IBS-C and IBS-D in adults |
| Motegrity | Prucalopride | 5-HT4 receptor agonist | IBS-C in adults |
| Xifaxin | Rifaximin | Bacterial antiseptic | IBS-D in adults |
| Ibsrela | Tenapanor | NHE3 inhibitor | IBS-C in adults |
| Miralax | Polyethylene glycol 3350 | Osmotic Laxative | May be used but not indicated in IBS |
| Amitiza | Lubiprostone | Prostaglandin E1 receptor agonist | IBS-C and IBS-D in adults |
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