Linaclotide

About Linaclotide

Linaclotide is structurally related to the human peptides guanylin and uroguanylin. It and its active metabolite act on guanylate cyclase-C on the inner surface of the intestine, increasing the secretion of chloride and bicarbonate, which draws fluid into the bowel and speeds transit; in animal studies it also reduced intestinal pain. Very little is absorbed into the body. The dose depends on the use: for IBS-C, 290 mcg once a day in adults and 145 mcg in children 7 and older; for chronic idiopathic constipation in adults, 145 mcg once a day, or 72 mcg depending on the person or how well it is tolerated; and for functional constipation in children 2 and older, 72 mcg once a day. The uses in children are recent: functional constipation was approved for ages 6 to 17 in 2023 and extended down to age 2 in May 2026, and IBS-C in children 7 and older was approved in November 2025.

The boxed warning is about serious dehydration in young children: in newborn mice, a single dose comparable to an adult dose caused deaths from dehydration, so linaclotide is contraindicated under age 2, and its safety and effectiveness have not been established below age 2 for functional constipation or below age 7 for IBS-C. It must also not be taken with a known or suspected mechanical bowel obstruction. Diarrhea is the most common side effect in adults and children. Since approval, severe diarrhea with dizziness, fainting, low blood pressure and low potassium or sodium, needing a hospital stay or intravenous fluids, has been reported, and the label says to stop doses and rehydrate if severe diarrhea occurs. Abdominal pain, gas and bloating are the other common side effects in adults.

It is taken on an empty stomach, at least 30 minutes before a meal, at about the same time each day; taken right after a high-fat breakfast it caused looser, more frequent stools. Someone who cannot swallow the capsule can open it and take the beads on a teaspoon of room-temperature applesauce or in about 30 mL of room-temperature bottled water, without chewing them, or give them through a nasogastric or gastrostomy tube; other foods and liquids have not been tested. A young child who swallows it by accident can develop severe diarrhea, so it is stored securely. Use during pregnancy is not expected to expose the baby, and the drug was not detected in breast milk.

Taking Linaclotide

How to take it

Once a day on an empty stomach, at least 30 minutes before a meal, at about the same time each day. Swallow the capsule whole; do not crush or chew it or the beads inside. If you cannot swallow it, open it and sprinkle all the beads on a teaspoon of room-temperature applesauce, or swirl them for at least 20 seconds in about 30 mL of room-temperature bottled water, and swallow the whole mixture at once without chewing.

If you miss a dose

Skip the missed dose and take the next dose at the regular time. Do not take two doses at the same time.

Storage

At room temperature in the original bottle, tightly closed and protected from moisture, with the desiccant left in. Keep it secure and out of reach of children. Do not flush it; use a medicine take-back program.

Interactions to know about

Linaclotide is minimally absorbed, no drug interaction studies have been done, and laboratory tests suggest it does not affect the common drug-processing enzymes. Tell the doctor and pharmacist about every other medicine, vitamin and supplement you take.

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 Linaclotide differs from pharmacy to pharmacy

With no generic on the market, every quote is for the Linzess brand, so quotes differ by what each pharmacy paid and its markup, and a pharmacy has nothing it can substitute. A bottle of 30 is a month’s supply at one capsule a day, so a ninety-day supply is three bottles.

The three strengths are separate products. A pharmacy that keeps only the strengths it fills most often may need to order yours, which can affect how quickly it is ready and what it quotes.

Ways to pay less for Linaclotide without insurance

• Ask the maker whether its savings program applies to someone paying cash; many copay cards require commercial insurance, so ask rather than assume.
• For chronic idiopathic constipation, or IBS-C in a woman 18 or older, ask the prescriber whether generic lubiprostone would suit you.
• For constipation, ask the prescriber whether a generic such as lactulose would be an option.
• Once the dose is settled, ask for a ninety-day supply, and compare more than one pharmacy.
• 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 Linaclotide

1. 1.How long before a meal should I take my capsule, and what should I do if I forget until after eating?
2. 2.Can I open my capsule onto applesauce or into water if I cannot swallow it?
3. 3.What should I do if I get severe diarrhea, or feel dizzy or faint?
4. 4.How should I store it so that young children in my home cannot get to it?

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