Plecanatide

About Plecanatide

Plecanatide is a structural analog of human uroguanylin and works the same way: it and its active metabolite act on guanylate cyclase-C on the inner surface of the intestine, and the cyclic GMP this produces drives chloride and bicarbonate into the bowel, mainly through the CFTR channel, increasing intestinal fluid and speeding transit. It is minimally absorbed. It was approved in January 2017 for chronic idiopathic constipation and in January 2018 for IBS-C, both in adults, and for either use the dose is one 3 mg tablet once a day, with or without food. The label lists only this one strength.

The boxed warning concerns serious dehydration in children. In young juvenile mice a single oral dose caused deaths from dehydration, so it is contraindicated under age 6; there were no deaths in older juvenile mice, but given the deaths in younger ones and the lack of data in children, the label says to avoid it from 6 to under 18, and its safety and effectiveness below 18 have not been established. It must not be taken with a known or suspected mechanical bowel obstruction. Diarrhea is the most common side effect and is sometimes severe; the label says to stop doses and rehydrate if severe diarrhea occurs, and the Medication Guide tells patients to stop it and call their doctor.

A tablet that is hard to swallow can be crushed to a powder and mixed with a teaspoon of room-temperature applesauce, or placed in about 30 mL of room-temperature water and swirled until it falls apart; either mixture is swallowed right away, and the applesauce mixture is not saved for later. It can also be given in water through a nasogastric or gastric feeding tube. Because so little is absorbed, use in pregnancy is not expected to expose the baby, and it was not measurable in breast milk. A child who swallows it by accident, especially one under 6, can develop severe diarrhea and dehydration, so the label asks patients to store it securely and dispose of unused tablets. Trulance comes only in bottles of 30 tablets, with a desiccant that stays in the bottle.

Taking Plecanatide

How to take it

One tablet once a day, with or without food, swallowed whole. If you cannot swallow it, crush it and mix the powder with a teaspoon of room-temperature applesauce, or place it in a cup with about 30 mL of room-temperature water and swirl for at least 10 seconds until it falls apart; swallow the mixture right away, and if any is left, add another 30 mL of water, swirl and swallow.

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, with the desiccant left in. Store it securely, out of reach of children, and dispose of tablets you no longer need.

Interactions to know about

Plecanatide is negligibly absorbed, and its label lists no drug interactions. Still, tell the prescriber about every medicine, vitamin and herbal product you use.

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 Plecanatide differs from pharmacy to pharmacy

Trulance is sold only as the brand and in one strength, so a quote reflects the brand price plus each pharmacy’s markup, and there is no generic to substitute. A bottle of 30 is a month’s supply, so a ninety-day supply is three bottles.

A pharmacy that rarely fills it may not keep it on the shelf and may need to order it, which can affect both how soon it is ready and the quote.

Ways to pay less for Plecanatide 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.
• Ask the prescriber whether generic lubiprostone would suit you; it is labeled for chronic idiopathic constipation in adults and for IBS-C in women 18 and older.
• For constipation, ask the prescriber whether a generic such as lactulose would be an option.
• Once you know it works for you, 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 Plecanatide

1. 1.Can I crush my tablet into applesauce, or let it fall apart in water, if I cannot swallow it?
2. 2.What should I do if I get severe diarrhea?
3. 3.How should I store it so children in my home cannot get to it, and how do I dispose of unused tablets?
4. 4.Is it safe for me while I am pregnant or breastfeeding?

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