Plecanatide
TRULANCE
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 itAvoid in young children because profound secretory diarrhea can cause fatal dehydration.
FDA-approved for
- chronic idiopathic constipation (2017)
- IBS with constipation (2018)
FDA label
Read the full label on DailyMed ↗
| 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
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
⚠ BOXED WARNING
- Contraindicated in patients under 6 years
Cost, est. cash$300–$2,500/month
Generic entry2034 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.
Mechanism of action: Plecanatide ballicule
