Trulance (Plecanatide) - Oral

Warning:

The Food and Drug Administration (FDA) has warned against using this medication in children, especially those under age 6, due to the risk of serious dehydration.

What Is Trulance?

Trulance (plecanatide) is used to treat chronic constipation and irritable bowel syndrome with constipation (IBS-C) in adults. It is a prescription drug only available in tablet form. Trulance is part of a class of drugs called guanylate cyclase-C agonists.

Too much fluid in the gut leads to diarrhea, whereas too little fluid causes constipation. Specific substances, such as a small peptide called uroguanylin, help to control the amount of fluid your bowel makes. Trulance works like uroguanylin. It increases fluid secretion in the gut leading to softer stools and more bowel movements. It also increases food movement through the gastrointestinal (GI) tract.

The Food and Drug Administration (FDA) has warned against using this medication in children, especially those under age 6, due to the risk of serious dehydration.

Drug Facts

Generic Name: Plecanatide

Brand Name(s): Trulance

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Gastrointestinal agent

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Plecanatide

Dosage Form(s): Tablet

What Is Trulance Used For?

Trulance is a prescription medication. The FDA approved Trulance to treat adults with chronic constipation and irritable bowel syndrome with constipation (IBS-C) in adults.

This medication is not approved for use in individuals under 18. In addition, the FDA issued a boxed warning, the agency’s most stringent warning, against its use in children, especially those younger than 6. Nonhuman animal studies have shown severe dehydration leading to death associated with plecanatide use in young mice.

Trulance (Plecanatide) Drug Information - Showing areas affected in the organs of a body

Verywell / Zoe Hansen

How to Take Trulance

Take once a day with or without food as directed by your healthcare provider. Swallow the tablet whole with water. If you cannot swallow pills, you can crush the tablet and mix it with either water or applesauce. Mixing Trulance in other liquids or other soft foods has not been tested.

You can also give this medicine mixed with water through a feeding tube.

Mixing in Water

Add the tablet to a cup. Pour 1 ounce (30 milliliters [ml]) of room temperature water into the cup and swirl the cup for about 10 seconds until you see the tablet dissolve. Drink the whole mixture immediately.

If you see any residue of your pill left in the cup, add another 1 ounce of room temperature water. Swirl for 10 seconds and drink instantly. Do not save any mixture for later.

Mixing in Applesauce

Crush the pill into a powder. Add one teaspoonful (5 milliliters) of room temperature applesauce. Mix and swallow immediately. Do not keep any mixture for later.

Taking Via Feeding Tube (Nasogastric or Gastric)

Flush the feeding tube with 1 ounce (30 milliliters) of water using a proper syringe.

Mix the tablet with 30 milliliters of room temperature water in a cup. Swirl gently for at least 15 seconds. The tablet will break apart in the water. Draw up the mixture with a syringe and immediately give it through the feeding tube.

If some tablet particles are left in the cup, add another 30 milliliters of room temperature water. Swirl gently for 15 seconds, draw it up with the same syringe, and immediately give it through the feeding tube. Do not save any mixture for later.

Flush the feeding tube after giving the drug. Flush with 10 milliliters of water using a fresh syringe or the same syringe you used.

Storage

Store your medicine at room temperature (68 to 77 degrees F). During travel, you can store it between cool and mildly hot temperatures (between 59 F and 86 F).

When storing Trulance, remember to keep the pills:

  • In a dry place, away from moisture (e.g., do not store it in the bathroom and do not take the anti-moisture packet out of your pill bottle)
  • In their original containers (do not repackage or split up your medication into pill trays or pillboxes)
  • Out of reach of children and pets

Toss any unused and expired drugs. Do not toss your pills down the drain or toilet. Contact your healthcare provider or pharmacist if you do not know the best way to get rid of your medications. Check out drug take-back programs in your area.

How Long Does Trulance Take to Work?

It takes between 12 hours and 24 hours for Trulance to begin to work.

What Are the Side Effects of Trulance?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

A common side effect of Trulance is diarrhea. You may see this within the first month of starting this medicine.

Severe Side Effects

Call your healthcare provider as soon as possible if you have serious side effects. Follow your healthcare provider’s instructions. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.

Most people rarely have severe reactions while on Trulance. Serious side effects can include the following:

Severe or persistent diarrhea may happen within the first three days of use. Tell your healthcare provider immediately if this happens. If this occurs, your healthcare provider may advise you to stop taking the medication and drink more water to rehydrate.

Report Side Effects

Trulance may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Trulance Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For chronic idiopathic constipation and irritable bowel syndrome with constipation:
      • Adults—3 milligrams (mg) once a day.
      • Children 6 years of age and older—Use and dose must be determined by your doctor.
      • Children younger than 6 years of age—Use is not recommended.

Modifications

For people who cannot swallow pills, plecanatide tablets can be crushed and mixed in either water or applesauce. After crushing and mixing the pill in water or applesauce, take the mixture right away. You can also take Trulance mixed with water through a feeding tube.

Trulance is not expected to cause drug-associated risks to a fetus or infant when taken during pregnancy or while breastfeeding.

Missed Dose

If you miss your Trulance dose, skip the missed dose and return to your regular schedule. Do not double up on your dose or take extra pills.

Overdose: What Happens If I Take Too Much Trulance?

Overdose symptoms may include:

  • Nausea
  • Vomiting
  • Severe diarrhea
  • Dehydration

What Happens If I Overdose on Trulance?

If you think you or someone else may have overdosed on Trulance, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Trulance, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects.

Call your doctor right away if you have severe diarrhea.

What Are Reasons I Shouldn't Take Trulance?

Trulance cannot be used in children younger than 6. It may cause bowel obstruction in this group. Its safety and effectiveness in children 6 to 17 are unknown. Avoid this drug in children under 18. It may cause death due to severe dehydration.

Do not use this drug if you are allergic to it or any parts of its formulation.

What Other Medications Interact With Trulance?

There are no known significant interactions between Trulance and other drugs. Do not start, adjust or stop any medicine without talking to your healthcare provider.

What Medications Are Similar?

There are drugs similar to Trulance that also treat chronic constipation or irritable bowel syndrome (IBS).

These drugs include:

Amitiza takes twice as long as Trulance to begin working. It also has more common side effects than Trulance.

Linzess treats constipation caused by taking opioids. It has the same onset of action but more side effects than Trulance.

Zelnorm is used to treat IBS with constipation. Unlike Trulance, people older than 65 cannot use Zelnorm. Zelnorm has more side effects than Trulance.

Frequently Asked Questions

  • What is Trulance used for?

    Trulance is used to treat chronic constipation and irritable bowel syndrome.

  • What should I do if I miss a dose of Trulance?

    If you miss your dose, skip the missed dose. Go back to your regular time. Do not double up on doses or take extra doses.

  • How does Trulance work?

    Trulance works by acting like a molecule in your body called uroguanylin, which regulates the amount of fluid your bowel makes. Plecanatide causes your gut to secrete more fluid, leading to softer stools and more bowel movements.

  • What are some side effects of Trulance?

    The main side effect of this medicine is diarrhea.

How Can I Stay Healthy While Taking Trulance?

Taking Trulance daily as directed by your healthcare provider will help control your symptoms by softening your stools and regulating your bowel movements. 

Lifestyle modifications, such as diet changes, can also help manage your symptoms. Pay attention to the food that you eat. Some foods can trigger or worsen your symptoms. Keep track of this by starting a food diary. It may help to eat fiber-rich foods and avoid lactose or gas-producing foods.

If this drug causes you to have diarrhea, watch for weight loss. Drink lots of fluids and talk to your healthcare provider.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lammers E, Srivastava SB. Constipation treatment: a review. Orthopaedic Nursing. 2020;39(3):194-198. doi:10.1097/NOR.0000000000000657

  2. MedlinePlus. Plecanatide.

  3. Food and Drug Administration. Trulance label.

  4. Kamuda JK, Mazzola N. Plecanatide (Trulance) for chronic idiopathic constipation and irritable bowel syndrome with constipation. P T. 2018; 43(4): 207-209, 232.

By Queen Buyalos, PharmD
Queen Buyalos is a pharmacist and freelance medical writer. She takes pride in advocating for cancer prevention, overall health, and mental health education. Queen enjoys counseling and educating patients about drug therapy and translating complex ideas into simple language.