Linzess Review: IBS Relief in a Pill?

Linzess Review: IBS Relief in a Pill?


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Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Linzess is a medication that's FDA-approved to treat irritable bowel syndrome with constipation (IBS-C) and chronic constipation. The manufacturer claims that the drug can help patients have more frequent and complete bowel movements, and reduce uncomfortable IBS symptoms such as stomach pain and bloating.

The generic form of the drug is called linaclotide and we'll use these terms interchangably throughout this article as they refer to the same active drug ingredient.

But is Linzess proven in clinical trials to reduce IBS symptoms and constipation? Does the drug have any concerning side effects? How does it compare to other IBS medications like Trulance? And how do real users rate its effects?

In this article we'll answer all of these questions and more as we review medical studies on Linzess to determine if it's effective for IBS, compare its effectiveness with other leading medications, document its side effects and share real, unsponsored user reviews of the drug. 

Does Linzess Reduce IBS Symptoms?

Linzess has been studied in a number of clinical trials for both IBS and chronic constipation.

clinical trial published in the American Journal of Gastroenterology evaluated the efficacy of Linzess for treating IBS-C. Patients either took Linzess or a placebo pill daily for 26 weeks.

Linzess was found to be effective, reducing average scores for abdominal pain, abdominal bloating and bowel symptoms such as straining while passing stool. Gastrointestinal pain was reduced by 14.4% in the Linzess group compared to the placebo group.

A more recent clinical trial conducted in Germany tested the effects of Linzess on patients with "moderate to severe IBS-C." Rates of abdominal pain and bloating intensity reduced by around 50% for patients taking Linzess, and the researchers concluded that the drug is effective in improving major symptoms of IBS-C.

A medical review of Linzess, which analyzed results from 25 individual clinical trials, found the medication to be not only effective for managing IBS-C but also for managing chronic constipation. Patients with chronic constipation reported more frequent and normalized bowel movements while taking Linzess, and also reported reduced abdominal pain to a statistically significant degree.

We will conclude from the review of medical literature that Linzess is effective for treating both IBS-C and chronic constipation. 

Linzess Side Effects

Linzess black box warning

The FDA label for Linzess has a black box warning, shown above, that indicates that the drug can cause severe dehydration in pediatric patients, and that it should not be used in patients under 18 years of age.

Black box warnings are the most severe level of warning issued by the FDA, and indicate side effects with potentially life-threatening effects. This suggests that guardians of patients under 18 should speak with their doctor about alternative medications for IBS or chronic constipation.

Because Linzess increases intestinal motility and fluid secretion, the most common side effect is diarrhea. This is also why the drug is typically prescribed to IBS-C but not IBS-D patients.

One medical study found that upwards of 20% of patients on Linzess experienced regular diarrhea.

Another medical review examined the side effects experienced by Linzess patients, and noted increased rates of flatulence (gas). According to the linked study, 7.9% of Linzess patients had to discontinue medical trials due to uncomfortable side effects, compared with only 2.8% of patients taking placebo.

Clearly the more common side effects of the drug are milder, suggesting that the drug is only dangerous for children and not adults.

Real, Unsponsored Linzess User Review

One of the most popular YouTube videos on Linzess is a review published by a channel called "Heather B. Denture DiVa." The creator shares her experience of trying other medications for IBS and then compares them to Linzess:


Is the Generic Version of Linzess as Effective?

The generic form of Linzess is called linaclotide. Both drugs contain the exact same active chemical compound. 

A comprehensive meta-study published in the PLOS Medicine journal analyzed data from over 1 million patients and found that brand-name and generic drugs were equally safe and effective on average. This suggests that generic linaclotide should be just as effective as Linzess, but may be cheaper.

Unfortunately, at the time of updating this article, generic linaclotide does not appear to be available at least in the U.S. market according to GoodRx. Often drug manufacturers hold exclusive rights to sell a drug for a number of years, but once those rights expire, generic versions can be manufactured and sold for cheaper.

We would recommend that patients on Linzess ask their doctor about generic linaclotide every year until it becomes available.

For patients looking to save money on Linzess, we recommend checking out this resource on the drug manufacturer's Savings page. The coupon at the linked website, run by the drug's manufacturer, suggests that patients can fill in a form and pay as little as $30 for 90 days of Linzess.

Linzess Dosage

According to the manufacturer's website, Linzess is sold at three separate dosages: 72 micrograms (mcg), 145 mcg and 290 mcg.

All of the medical trials we’ve reviewed for IBS-C have used the dosage of 290 mcg, while the FDA approves Linzess for chronic constipation at a lower dose of 145 mcg.

A more recent medical trial conducted in Japan found that Linzess was effective for constipation at a dose of 0.5 milligrams (mg), which is around twice the highest dosage that’s currently approved in the U.S. 32.7% of patients on the 0.5 mg dosage reported relief from abdominal pain and discomfort, which was significantly higher than any of the other groups.

This study suggests that in the future, the FDA may approve Linzess at a dosage of 0.5 mg, but for now the strongest dose available is 290 mcg.

Linzess Vs. Trulance

Trulance is another commonly-prescribed medication for IBS, so patients are often curious about whether it's more or less effective than Linzess.

An extensive medical review published in the American Journal of Gastroenterology compared data on the two drugs, analyzing results from over 10,000 patients.

The study authors found that both drugs were similarly effective and had similar side effect profiles; there was no statistically significant difference between treatment with either drug.

This is unsurprising given that both drugs are guanylate cyclase-c agonists, meaning they are in the same drug class and have the same biological mechanism of action.

Given that the drugs are similarly effective, we would recommend that patients speak with their doctor about whether Linzess or Trulance may be cheaper for them.

Natural IBS Supplement

A 2018 clinical trial on patients with IBS compared the effects of Panax ginseng extract to a leading IBS medication. The researchers found that at a daily dose of 300 mg, ginseng was equally effective in reducing abdominal pain.

Illuminate Labs manufactures a Panax ginseng extract supplement that's potent (standardized to minimum 8% ginsenosides) and third-party tested to ensure purity and label accuracy.

Interested consumers can check out Illuminate Labs Panax Ginseng Extract at this link to the product page on our website.

We are not suggesting that Panax ginseng is as effective as Linzess for IBS, just that it's a natural, herbal supplement that patients may wish to speak with their doctor about based on this promising (but early) research. It may be possible to take both a prescription IBS treatment and ginseng.

Linzess Vs. Amitiza

An older-generation IBS medication called Amitiza has also been studied in comparison with Linzess. 

A medical review compared the two medications (amongst other IBS drugs), and found that Linzess was more effective overall in terms of reduced abdominal pain and complete bowel movements.

It’s common for newer drugs to be more effective due to improved research and development, so this result is unsurprising.

The review did note that Amitiza caused significantly fewer events of diarrhea, which means it may be a more effective option for IBS-D than Linzess.

How Does Linzess Work?

Linzess is a peptide composed of 14 individual amino acids. It’s minimally-absorbed by the body, and increases intestinal fluid secretion which causes improved intestinal transit.

The term “bloating” typically refers to a feeling of fullness in the stomach and is often caused by delayed gastric emptying and delayed intestinal motility, so Linzess can resolve this in some patients.

Put simply, many patients with IBS-C or chronic constipation don’t move food from their stomach through their intestines at a normal rate, and Linzess can speed up the rate of food breakdown and digestion which reduces symptoms.

One of the medical reviews cited earlier in this article documented how Linzess was not found to impact metabolism, and that neither the drug nor its active metabolite were found in blood samples, which suggests that Linzess functions entirely in the intestinal tract and then is excreted.

Linzess Patient Reviews

Linzess has been reviewed over 800 times on Drugs.com, which is a website that allows prescription medication users to publish reviews rating and sharing their personal experience on a medication.

The average user rating of Linzess for chronic constipation is 6.6/10 and the average rating for IBS-C is 6.5/10.

The top positive review of Linzess for IBS is written by a user named "Toya" who claims that the drug has managed their symptoms:

"I been on 72mg for about a month in a half. I love it. I do drink a lot of water with it, I get a good cleaning out daily. I take 1 capsule first thing in the morning around 4am. It makes me use the bathroom about a hour later."

The top negative review of Linzess for IBS comes from a user named "Hyper" who gave the drug a 1/10 rating and claims the drug caused severe side effects:

"I have to force myself to eat, because I have so much trapped air, and it’s very difficult to even belch and pass gas...When I belch now it’s more so like the air reverses and go into my stomach, and causes me to spit up my food. :("

How Long Does It Take For Linzess To Work?

The Linzess website claims that the medication is likely to work within the first week, and that does appear to be accurate based on medical research.

One of the previously-linked trials we covered in the efficacy section includes a graph (which we can’t post here for copyright reasons) detailing symptom relief over time. Linzess patients experienced around a 10% decrease in pain in the first week, and the pain scores continued to drop throughout the trial.

This means it might only take a few days for Linzess to have some beneficial effect, but its most significant effect will be experienced after months of continued use.

Stay up-to-date on our research reviews

Conclusion

Linzess is proven to be effective for treating IBS-C and chronic constipation, and appears to work within its first week of use.

The drug has relatively concerning side effects in children, and is not recommended for use in anyone under the age of 18. The potential side effects for adults are milder, including diarrhea. 

We consider Linzess to be more effective than Amitiza, and similarly effective to Trulance (both IBS medications) based on a review of clinical research.

The generic form of Linzess is not currently available in the U.S., but we recommend that patients on Linzess check with their doctor annually about its availability, given that generic forms of medications are equally effective but can be significantly cheaper.




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