Plecanatide

TRULANCE

Open Plecanatide in the interactive console ↗

Pronunciation: ple-KAN-a-tide (TROO-lanz)

Plecanatide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Plecanatide ballicule

What it isUroguanylin-analog guanylate cyclase-C agonist; chronic idiopathic constipation and IBS with constipation.

Why this oneIts pH-sensitive activity is concentrated proximally, unlike the pH-independent action of linaclotide.

What limits itOnly modestly effective; diarrhea is the main adverse effect. Contraindicated in mechanical bowel obstruction.

Pearls

IBS-C: second-line after fiber and polyethylene glycol fail.
With or without food; tablet can be crushed into applesauce or water.

Plecanatide molecular structure (skeletal formula) — Molecular structure: Plecanatide

Plecanatide prescription history

Animated chart of estimated U.S. prescriptions per year, Constipation meds (1900–2026). Plecanatide enters in 2017 (estimated).

FDA-approved for

chronic idiopathic constipation (2017)
IBS with constipation (2018)

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk0 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Contraindicated in patients <6 yr (fatal dehydration in juvenile mice); avoid in patients 6 to <18 yr

FDA dosing	Population	Start	Target	Max
Chronic idiopathic constipation (CIC)	Adults	3 mg QD	3 mg QD	3 mg QD
Irritable bowel syndrome with constipation (IBS-C)	Adults	3 mg QD	3 mg QD	3 mg QD

Renal Undefined

Hepatic Undefined

Instructions

Take with or without food; swallow tablet whole
For swallowing difficulty or NG/G-tube: may crush and mix with applesauce or water

Available strengths

tab 3 mg

Contraindications

Patients <6 years of age (risk of serious dehydration)
Known or suspected mechanical GI obstruction

Cautions

Diarrhea, may be severe — suspend dosing and rehydrate
Risk of serious dehydration in pediatric patients

Adverse reactions

Diarrhea

Pregnancy Negligibly absorbed; fetal exposure not expected; data insufficient

Lactation Not measurable in breast milk; clinically relevant infant exposure not expected

Cost

Plecanatide (TRULANCE)

Strength		#/mo	generic $/mo	CostPlus
3 mg	tab	30 qd		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Plecanatide is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2034 est.

Open Plecanatide in the interactive console ↗

Self-check

Plecanatide: How does its pH dependence differ from linaclotide?
It is pH-sensitive; linaclotide is pH-independent.
Plecanatide: Why avoid young children?
Secretory diarrhea can cause fatal dehydration.