Lubiprostone

About Lubiprostone

Lubiprostone acts locally in the intestine, where it activates a chloride channel (ClC-2) in the lining; the chloride-rich fluid this releases into the bowel increases its motility and eases the passage of stool. The label covers chronic idiopathic constipation in adults; opioid-induced constipation in adults with chronic non-cancer pain, including pain related to a past cancer or its treatment, who do not need frequent (for example, weekly) increases in their opioid dose; and IBS-C in women at least 18 years old. Its effectiveness for opioid-induced constipation in people taking methadone or other diphenylheptane opioids has not been established. The dose is 24 mcg twice a day for either kind of constipation and 8 mcg twice a day for IBS-C, with lower doses for liver impairment depending on its severity, and the label asks prescriber and patient to reassess from time to time whether it is still needed. Safety and effectiveness in children have not been established, and a 12-week trial in children 6 to 17 with functional constipation did not show a benefit.

There is no boxed warning. Lubiprostone must not be taken with a known or suspected mechanical bowel obstruction, and anyone with symptoms that suggest one is examined first. Nausea is common, and taking it with food may reduce it; it is avoided in severe diarrhea and stopped if severe diarrhea develops. Fainting and low blood pressure have been reported in use after approval, mostly at 24 mcg twice a day and sometimes within an hour of a dose, and a few people needed a hospital stay; diarrhea, vomiting and medicines that lower blood pressure may add to the risk. Shortness of breath, usually described as chest tightness and difficulty taking in a breath, has generally begun 30 to 60 minutes after the first dose and eased within a few hours, but it often returns with later doses. The most common side effects are nausea and diarrhea, plus abdominal pain in IBS-C, and headache, abdominal pain, bloating and gas in chronic idiopathic constipation.

Data in pregnancy are too limited to show whether there is a risk, and the label advises watching a breastfed infant for diarrhea. The capsules are swallowed whole, not broken apart or chewed, and MedlinePlus adds that they should not be opened or crushed, and that anyone who cannot swallow them whole should tell the doctor. Amitiza was first approved in 2006 and comes in bottles of 60, a month’s supply at twice a day; generic capsules, first approved in 2021, now come from several makers.

Taking Lubiprostone

How to take it

Twice a day, in the morning and evening, with food and water, at around the same times each day. Swallow each capsule whole; do not open, break apart, crush or chew it.

If you miss a dose

MedlinePlus says to skip the missed dose and continue the regular schedule. Do not take a double dose to make up for a missed one.

Storage

At room temperature in the container it came in, tightly closed, away from light, heat and moisture (not in the bathroom), and out of reach of children. Do not flush unused capsules; use a medicine take-back program.

Interactions to know about

Methadone and other diphenylheptane opioids may weaken its effect, more so at higher opioid doses. Medicines that lower blood pressure may add to the risk of fainting or low blood pressure, as can diarrhea or vomiting.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Lubiprostone differs from pharmacy to pharmacy

Several companies make generic lubiprostone, each rated equivalent to Amitiza, so a pharmacy can fill either strength with whichever generic it stocks, and quotes differ mainly by what the pharmacy paid and its markup; whether it appears on a pharmacy’s flat-price generic list varies. A prescription that names Amitiza and blocks substitution is filled with the brand and priced as one.

At two capsules a day, a month is 60 capsules, so the price per capsule, not just the dispensing fee, shapes the quote. The 8 mcg and 24 mcg capsules are separate products, and a pharmacy that keeps only one strength on hand may need to order the other.

Ways to pay less for Lubiprostone without insurance

• Ask for generic lubiprostone, and make sure the prescription does not block substitution.
• Ask whether it is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once you know it helps and the dose is settled, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Lubiprostone

1. 1.Should I take my doses with breakfast and dinner to help with nausea?
2. 2.What should I do if I feel faint, dizzy or short of breath after a dose?
3. 3.Will my methadone or other opioid make it work less well?
4. 4.Do my blood pressure medicines raise my risk of fainting on it?

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