Trulance®

Trulance (plecanatide), a new Rx for patients with irritable bowel syndrome with constipation (IBS-C).

Think of it as similar to Constella (linaclotide) or Ibsrela (tenapanor). All these meds increase sodium and water content in the gut to help speed up GI transit.

But keep in mind that about 1 in 10 patients on these meds see improvement in abdominal pain, bloating, etc.

Start with the basics…minimizing stress, increasing hydration and soluble fibre, and avoiding “FODMAPs.” These are fermentable oligo-, di-, and monosaccharides and polyols in some produce, milk, grains, etc.

If lifestyle changes aren’t enough, recommend the OTC osmotic laxative polyethylene glycol (Restoralax, etc). It helps constipation…but not other IBS symptoms (cramping, etc).

Suggest saving Trulance, Linzess, or Ibsrela for IBS-C in adults when other measures aren’t enough.

Expect patient and payer preference to guide the choice.

For example, Ibsrela is dosed twice daily before eating…Linzess is once daily before breakfast…and Trulance is once daily with or without food.

And Trulance tablets can be crushed if patients have trouble swallowing pills.

Point out that side effects (diarrhea, etc) with these meds are similar.

And explain that it’s okay to combine meds for IBS-C…but there’s no proof that combos work better.

If patients ask about supplements, tell them that some evidence suggests enteric-coated peppermint oil (IBgard, etc) or the probiotic B. infantis (Align) may reduce symptoms of IBS-C.