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Medically reviewed by, Russell Braun RPH
Constipation can be a hard thing to bring up to your doctor. Many people will try to treat constipation on their own with home or over the counter remedies.
What do you do when those won’t cut it?
There are new options for patients who seek relief from chronic constipation. Since Trulance and Linzess both are prescription only, you will have to talk to your doctor. Which one should you ask for depends on a few key factors.
What are they used for?
Trulance and Linzess are used to treat two different types of constipation called chronic idiopathic constipation (CIC) and constipation from irritable bowel syndrome (IBS-C).
Chronic idiopathic constipation simply means they don’t know what causes you to have constipation, but it occurs frequently.
Constipation from irritable bowel syndrome (IBS-C) is caused by the immune disease IBS. Most people will have diarrhea from IBS, but for some constipation occurs too.
According to the American College of Gastroenterology, it is estimated that 10-15 percent of the U.S. adult population suffers from some form of IBS. However, the number of patients who have been diagnosed is far smaller at 5-7 percent.
Things to remember before you try either drug
#1 There might be other reasons for the constipation
CIC means chronic idiopathic constipation. The word idiopathic is medical jargan for don’t know the cause. Many people have idiopathic constipation, but many also have a known reason for the constipation.
Medications can cause constipation. Opiods or drugs used to treat pain are the primary culprit, but there are many other drugs that can cause to constipation. Tell your doctor if you take an opiod as they may want to use an entirely different drug than either Linzess or Trulance.
Any medication that can dehydrate you can also cause constipation. That would include diuretics often prescribed for high blood pressure. Many other drugs called anticholernergics can also lead to constipation and there are used to treat a wide array of health issues. Make sure you review your medication list with your doctor and pharmacist before starting any new drug treatment for constipation.
Disease states can also cause constipation. Neurologic diseases can damage the nerves in your digestive tract. Polyps and tumors can lead to blockages causing constipation. Make sure you rule out any of these types of causes before you decide to ask for a very expensive medication to treat constipation.
#2 Look at your diet and lifestyle
Constipation can be down right uncomfortable. If left go long enough it can become dangerous. If you are prone to bouts of constipation you need to look at your lifestyle.
There are two very important things to remember if chronic constipation is an issue for you.
- Drink 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. Stay active
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.
#3 Try more cost effective over the counter options
Over the counter laxatives can be an effective way to treat occasional constipation. This is especially true when you pair them with increased activity and more water consumption.
Laxatives work in three ways
- Stimulate the muscles in your bowel to move faster
- Increase the amount of fluid that enters the bowel
- Increase the bulk of the stool by absorbing water into the stool
Stimulant laxatives include: bisacodyl, senna
Osmotic laxatives include: polyethelene glycol, magnesium citrate
Bulk forming laxatives include: psyllium, methylcellulose
Bulk forming laxatives are products thathave fiber in them and they are safe for use on a regular basis.
Osmotic laxatives are good at getting fluid into the stool, but could cause electrolyte imbalances if used daily. 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.
#4 Both are expensive, which is better?
Trulance and Linzess both work in the same way in your body. They are called guanylate cyclase-C agonists. These drugs cause water to be pulled into your intestines which helps to relieve the constipation.
Both drugs can cause diarrhea to occur due to the nature of how the cure constipation, so it is important to know what your doctor wants you to do if that happens to you.
Trulance is the brand product that is available for sale today. The chemical name of Trulance is plecanatide. Trulance was approved by the FDA in 2017 and that means no generic is available at this time.
Trulance comes in one strengths as a 3mg tablet. The good news is you only have to take it once daily and it can be taken with or without food.
Improvements in the number of bowel movements per week are usually seen within the first week.
Linzess is also a brand only product. The chemical name of Linzess is linaclotide. It was approved by the FDA in 2012 and has no available generic. However, a generic manufacturer has applied for a patent to make a generic. After some court proceedings that action has been delayed until 2030! For more information on Linzess see 9 best tips on Linzess cost and generic availability.
Linzess comes in different strengths and is dosed based on the condition and severity. It comes as capsules that are available as 72mcg, 145mcg and 290mcg strengths.
Linzess must be take on an empty stomach 30 minutes before a meal.
Common side effects of both drugs:
- Abdominal pain
- Sinus or upper respiratory infection
Linzess has also been known to cause heartburn, vomiting and headache.
Trulance has been shown to increase some liver function tests.
How do I choose which one is right for me?
Both drugs have been proven to be effective.
In the clinical trials submitted to the FDA for Trulance, it was found to be effective. In those taking Trulance, 21% responded vs only 11% for the placebo. The numbers for the Linzess trials were almost identical. Both seem to increase the number of bowel movements by about 1.5 times each week.
Keep in mind that the over the counter laxatives are also effective and are likely to produce an similar increase in bowel movements per week. No direct studies between Trunlance or Linzess and the laxatives have been done at this point in time.
No single medication is effective for every patient. Even if you tried and failed one of the drugs it does not mean the other drug might not work for you.
It would be wonderful if a clinical trial was done comparing the two drugs head to head, but that isnt likely to happen due to the risk for the manufacturer who has the inferior product.
#5 Competition and misleading infromation
The pharmaceutical companies that make these drugs are in extreme competition for market share. There is a lot of advertising on television direct to patients about these drugs and they want to convince you their drug is better.
You may find things on the internet about these drugs that are misleading. If you see things stating there are clear advantages of one over the other, be wary of the source.
#6 Which drug is on formulary?
If you have health insurance that covers prescription drugs, then checking your formulary before you even talk to your doctor is a must. Since both drugs are in the same class and work the same, your insurer will have one that is on formulary and one that is not, or less preferred.
That can be a huge issue for you if you get the pharmacy to find the doctor wrote for the drug that is not on your formulary. You will quickly learn how expensive these medications are.
Formulary status of a drug can change at any point. Also, keep in mind that just because the drug might be covered by the formulary it might not be preferred. The more preferred the drug is the less you pay out of pocket.
It is definitely worth your time to look at the website for you health plan or call the number on your prescription drug card to determine what is the most preferred option for you. It can save you big time in the long run.
Once you decide you want to take the plunge and try either Trulance or Linzess, you will want to check on samples. Both drugs are brand name and therefore your doctor should have samples.
Try samples for a trial period to see if it works so you can avoid paying for a prescription if you don’t like that drug. Check out top 5 reasons to bullet journal medication effects to see how you can determine if the drug works while you have samples.
#6 Cash price
According to GoodRx, the cash price for these drugs are listed below.
Trulance 3mg 30 tablets
Linzess 72mcg, 145mcg and 290mcg 30 capsules of any strength
If you are not wanting to pay over $400 for a months supply then I recommend you check out the points below.
#7 Patient Assistance Programs (PAP’s)
Most people do not realize that assistance is available for free through many foundations for medication. Both Trulance and Linzess have a PAP program.
Your doctor will have to fill out paperwork for you to qualify for this assistance. If you are approved it could save you thousands of dollars as the medication is provided to you at no cost.
Trulance only offers the patient assistance for those who are uninsured. However, those on Medicare Part D are eligible.
Linzess 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.
Details on both programs can be found at Needymeds.org. Along with patient assistance programs they have money saving options for patients on many items such as medical supplies, medical transportation, etc.
#8 Copay coupon card
Both manufacturers offer copay coupons to help offset the cost of the drug. Keep in mind Medicare, Medicaid or other federal or state health plan patients are not allowed to use copay coupon cards!
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.
You have to register for a savings card like the one pictured above and if you are eligible you can get a new card right away.
The Trulance card provides up to a 90 day supply for no more than $25. If you enroll in the mobile savings to go program, the manufacturer will provide you the coupon on your mobile phone. In addition, they will send you texts to let you know when the prescription is ready at the pharmacy.
You can obtain a card via your mobile phone, email or print one out here.
#9 Check with insurance before using a copay coupon card
The coupon cards will not allow you to get the drug at this price forever! They will have maximum amount it will pay and then you will be stuck with the high copay after that point. This is why I recommend trying other steps before the manufacturer coupon card.
If you have a high deductible health plan (HDHP) you may have another problem. While this copay card is paying if your insurance has a copay accumulator program then the amount paid by the coupon will not count toward your deductible.
A copay accumulator is a fancy way to say they do not count the coupon toward your deductible, see the example below.
Your deductable is $1500, the card pays $200 per month while you pay $50 for six months.
$200 x 6 month = $1200 from copay coupon card
$50 x 6 months = $300 from you paying copay
$1200 + $300 = $1500
You might think your deductible has been met, however with a copay accumulator you would still owe $1200!
$1500 deductible minus $300 you actually paid, which is $1200.
What was your experience?
Please comment below if you have tired either Trulance or Linzess. The feedback helps other readers gain insight into how these drugs might work for them.
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Have you used Trulance or Linzess? How well did it they work for you? Please chime in below with your comments and thoughts below.