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Linzess (linaclotide) is an interesting medication used to treat constipation and the pain that often accompanies it in irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). It's a relatively new treatment, approved in the US and EU in 2012, and is the first of its type widely available on the market.

The medication works entirely in the intestine; it is not absorbed into the body. It increases fluid secretion into the intestine while decreasing the sensitivity of pain-detecting nerves. It is technically not a laxative, and does not contain NSAIDs, opioids, or any other painkiller.

Linzess can produce diarrhea, sometimes severely so. In most (but not all) cases diarrhea will start in the first two weeks of treatment; if severe, treatment should end until speaking with a doctor. In studies, young animals given Linzess often died of dehydration. For this reason the medication is contraindicated in patients under age 6, and for those age 7 to 17 use is not recommended as effects are unclear. Effects on unborn or nursing infants are also unknown and use is discouraged while pregnant or breastfeeding.

How to Take Linzess

Linzess comes in capsules, which must be swallowed whole and not crushed, chewed, or otherwise damaged. Capsules are taken once per day, usually every day, in the morning about 30 minutes prior to breakfast. Those who have difficulty swallowing may open capsules and sprinkle contents onto soft foods, such as applesauce, as long as it is swallowed without chewing. Likewise capsules may be opened and administered with water via gastrostomy tube.

Dosage depends on what's being treated.

For irritable bowel syndrome with constipation:

• The standard dose is 290 mcg once per day.

And for chronic idiopathic constipation:

• The standard dose is 145 mcg once per day.

In both conditions dosage may be lowered if side effects are disruptive. Patients should not exceed 290 mcg per day; do not take a double-dose if a dose is missed.

It will take about a week of regular use to see improvements, and may take six weeks for full benefit. Patients taking the medication for CIC generally have faster results than those taking it for IBS-C, though there are exceptions.

Treatment may continue indefinitely as long as it is providing benefit and no serious adverse effects develop. Many patients take Linzess for years, though most patients do like to occasionally stop treatment to see if it's still needed. Unlike most laxatives, there are no known long-term gut motility issues.

Warnings & Side Effects

Some patients will experience side effects Linzess; fortunately these are usually mild and not cause for concern. Most common are:

• Diarrhea
• Gas
• Stomach distention
• Stomach discomfort

Mild, infrequent diarrhea is not cause for concern. If it becomes severe, stop taking Linzess until a doctor can be consulted. Rarely some individuals pass blood in stools. If this happens, treatment should also end until a doctor can be consulted.

Linzess should not be used in individuals who have a bowel blockage. As mentioned above, it should also not be used in children age 6 or younger, and use in children age 7 to 17 is not recommended.