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Medically reviewed by, Russell Braun RPH
In this article we compare and contrast Amitiza (lubiprostone) and Linzess (lanaclotide). Constipation is the primary use for both drugs. Many people do not want to talk about constipation with there doctor but I will explain why you should.
#1 What are they used for?
Chronic Idiopathic Constipation (CIC) is a condition that can profoundly impact quality of life for those who suffer from it. The word idopathic means of an unknown cause. Today there are more options than ever for treating CIC. Deciding on which option is best for you is not always easy.
Amitiza and Linzess are also indicated for the treatment of constipation from irritable bowel syndrome (IBS-C). Amitiza is only indicated for IBS-C in women over 18 years of age. Linzess has that approval for all adults male and female.
Amitiza was recently also been approved for Opioid Induced Constipation (OIC) for those with pain not caused by cancer.
#2 Is Amitiza a laxative? What about Linzess?
A laxative is defined as something that promotes the emptying of the bowels. Normally, this is done to try and end constipation. Therefore, these drugs would be defined as laxatives.
Laxative drugs that have been on the market for years work in different ways than Amitiza or Linzess to empty the bowels. Many of these products are overused and abused, which can lead to diarrhea and dependence.
Amitiza activates chloride channels in the intestines. Leading to fluid being secreted into the bowel and making the stool easier to pass. It is a new drug class called chloride channel activators.
Linzess works on an enzyme in the intestines called guanylate cyclase-C. When activated it promotes fluid secretion into the intestines in response to a meal. It is also a new drug class called guanylate cyclase-C agonists.
#3 There might be other reasons for the constipation
Several medications prescription and over the counter can cause constipation. Here are a few examples:
- Calcium supplements
- Iron supplements
- Muscle relaxers
- Nausea medications
Don’t overlook medication effects even if you have been on a medication for years. Take a look at the top 5 reasons to bullet journal medication effects to see how you can track these things over time.
Disease states can also cause constipation. From diseases that damage neurons that control the gut to physical obstructions, the causes are numerous. Below are a few common diseases that can lead to constipation.
- Irritable bowel syndrome
- Diabetes mellitus
- Crohn’s disease
- Multiple sclerosis
- Colon cancer
Taking care of the underlying disease state can reduce the amount of constipation. This would be the preferred method over using another medication for constipation.
Constipation can be bad for your health. Keeping toxins that are in your stool in the intestines too long increases the likelihood of them being reabsorbed. Drugs can treat constipation. However, dietary changes should be tried first.
1. Stay hydrated by drinking plenty of water!
Experts recommend drinking 100 ounces of water per day. Many people would have constipation concerns resolved if they followed that simple recommendation
2. Avoid foods that can worsen constipation.
Milk and dairy products such as cheese are not the only foods that can cause constipation. Fried foods, excess red meat, processed grains and alcohol can all promote constipation as well.
A moderate level of activity is also going to help your digestive tract to continue to push the food through the system. Your intestines are a very long system for absorbing things we need from the food we eat. Moving around helps push food through that system so that you are not only relying on the walls of your intestines to do all the work.
#4 No generic available
Unfortunately, both of these drugs are still brand only products.
The FDA approved Linzess in 2012. A recent court victory by Allergen keeps the Linzess patent in effect until 2030. That means no generic until that patent expires.
The FDA approved Amitiza in 2006. A generic version is expected to be available in 2021. That is not too far out, however in the meantime the price tag for the brand product is very high.
#5 High price
Amitiza starting dose is 8 mcg capsules that are taken twice a day. The price for 60 capsules, which equals a one month supply is $288. Interestingly, the 24 mcg strength is the same price
Linzess starting dose is 72 mcg capsules taken once a day. The price of 30 capsules, which equals a one month supply is $430. The price of a 30 day supply of Linzess 145 mcg and 290 mcg are also the same.
If you were paying cash, Amitiza is the cheaper option. However, that may or may not make your insurance copay lower for Amitiza over Linzess.
Either drug taken for an extended period of time could be a significant drag on your budget. The first thing to do to save money if considering one of these drugs is to look for alternatives.
#6 Therapeutic alternatives
Both prescription and over the counter laxatives are available. I recommend checking the prices of the over the counter options with an app like GoodRx or looking at online retailers.
For prescription options you should look at the formulary for your insurance plan. More information on that option can be found below.
Three main types of laxatives besides Amitiza and Linzess:
Stimulant laxatives are powerful in the effect they have on bowel wall muscle. If used repeatedly the bowel can become dependent on them. Therefore, you should not use these types more than a few times per week.
Osmotic laxatives are good at getting fluid into the stool, but could cause electrolyte imbalances if overused.
Bulk forming laxatives are products that have fiber in them and they are safe for use on a regular basis.
- Stimulant laxatives include: bisacodyl, senna
- Osmotic laxatives include: polyethelene glycol, magnesium citrate
- Bulk forming laxatives include: psyllium, methylcellulose
Combining laxatives of different types can be effective as well. Even when taking two different laxatives you may save money over Amitiza or Linzess.
What medications are comparable to Amitiza and Linzess? PAA
Trulance is a guanylate cyclase-C agonist that works the same way as Linzess. It would not be any less expensive, but if neither Amitiza or Linzess works for you it may be work checking into.
- Trulance (Plecanatide)
Is Trulance better than Linzess or Amitiza?
There are no clinical trials that directly compare any of these drugs to each other. For more information check out a comparison of Trulance vs. Linzess.
Opioid antagonist drugs
While not necessarily cheaper, opioid antagonist options may be an effective therapeutic alternative to Amitiza or Linzess. Especially when constipation is caused by chronic opioid use.
- Movantik (naloxegol)
- Relistor (methylnaltrexone)
#7 Check for what is on formulary
Determining which drug is covered by your insurance would be a logical next step. If you know this before you talk to your doctor or pharmacist it can help you navigate the conversation.
A drug being preferred vs. non preferred can mean a big difference in cost for you in the long term. Especially, since both drugs have been shown to be effective in treating CIC.
Review your health plans website, most will list a drugs coverage status. If you are not internet savy, then calling the number on the back of your prescription drug card will put you in touch with someone who can assist.
Keep in mind formulary status can change anytime during the plan year. You should also look for the drug prior to enrollment in your health plan for the next year to ensure the status is not going to change.
#8 Request samples
Samples can be a valuable resource for drugs like Amitiza and Linzess. They allow you to try those medications for a trial period before you are actually on the hook to pay for them. Talk to your doctor, but typically a three to four week trial is long enough to know if they will work for you.
Check out top 5 reasons to bullet journal medication effects to see how you can determine if the drug works while you have samples.
#9 Patient assistance programs
Assistance is available through programs that both manufacturers have in place. The key to these programs is that you could receive the medication for free and what is better than free?
You will need to apply to see if you qualify, but these programs are not just for very low income patients. Many people are quite please to find out they qualify even with a moderate income.
Your doctor will have to fill out paperwork for you to get the assistance and in some cases they may request a fee for this. To see if you have a good chance at qualifying head to the Needymeds.org site and use their income calculator.
In addition to patient assistance Needymeds has money saving options for patients on many items such as medical supplies, medical transportation, etc.
Takeda patient assistance program is for those with no drug coverage and ineligible for federal and state programs. Income cutoff is at 500% of the federal poverty level.
The Allergan patient assistance program provides assistance for Medicare Part D if they have been denied or are ineligible for a low income subsidy. They also say that other insured patient should contact the program for details.
#10 Copay coupon card
Don’t go straight for the manufacturer copay coupon because it seems like a great deal and is easy. Try the other steps first because at some point the copay card will expire. That could leave you with a very large bill 9, 12 or 18 months down the road.
Medicare, Medicaid and other federal and state health plans are not eligible for these copay coupons!
Amitiza as noted above costs $288 cash for a 30 days supply. The Amitiza copay coupon can help lower that cost to $0. However, if your copay is over $75, the card will only pay up to $75. Example, if your copay was $100, then you would pay $25 out of pocket after the copay card pays $75.
Linzess costs around $442 cash price for a 30 day supply. The Linzess Savings program could get your copay down to $30. In fact, they also offer a 90 day supply for as little as $30 option also.
#11 Why should Linzess be taken only on an empty stomach?
It is true that Linzess should be taken on an empty stomach. This means taking the drug 30 minutes before your meal. It needs time to be released and start acting in the intestines. When taken this way, fluid will begin to be secreted into the intestines as the stool is being formed. This fluid will keep the contents of the stool moving down the GI tract.
The risk of side effects increases when you take Linzess with food. See #12 for a list of those side effects.
Conversely, it is recommended to take Amitiza with food and water.
#12 Side effects
The table below shows the most common side effects for both drugs. While is may seem like diarrhea is the desired effect, it is important to note that prolonged or explosive diarrhea is not normal.
|Abdominal pain||Abdominal pain|
|Abdominal distention||Abdominal distention|
Side effects should decrease over time as your body gets used to having more fluid in the intestines. Medical care is typically not required. If diarrhea persists that can lead to dehydration, which would be more serious. That is why it is important for you to document your symptoms so your doctor can give you the best advice.
#13 Drug interactions
Both drugs have a low risk of drug interactions. Key things to remember include:
- Both drugs can cause diarrhea, use caution when taking other drugs that also cause diarrhea.
- Other drugs that can cause nausea may have a greater risk of nausea when take with Amitiza or Linzess.
Talk to your doctor or pharmacist about the drugs you take and if they could interact.
Which is better
Both drugs have been proven to be more effective than placebo for treating constipation. Unfortunately, no clinical trials have been done directly comparing Amitiza vs Linzess.
The “better” option is the one that works for an individual patient with the fewest side effects and at a cost that allows them to continue treatment. Other less expensive options exist for treating constipation exist and those will save you the most money in the long run.
Using samples of Amitiza and Linzess to determine which works better for you is the next best practice. I would start by sampling the one that is on your formulary .
Check back to my blog for more step by step actionable advice on high cost medications. Teaching you how to use the best tools and resources available for keeping medication affordable.