Motegrity vs Linzess

Guidelines on the management of constipation advise increased fiber intake and osmotic laxatives. Stimulant laxatives are used as needed or as “rescue agents”. Motegrity and Linzess can be used when symptoms of constipation do not respond to laxatives.

Motegrity and Linzess are brand names for prescription drugs used for the treatment of a range of gastrointestinal disorders such as constipation, chronic constipation, chronic idiopathic constipation (CIC), and irritable bowel syndrome (IBS) with constipation and irritable bowel syndrome with constipation (IBS-C).

Linzess and Motegrity have different mechanisms of action and belong to different drug classes. Linzess is a guanylate cyclase-C agonist and Motegrity is a serotonin-4 (5-HT4) receptor agonist. Here we explain how they work, their similarities and differences and their side effects, and more. This should provide you with the basics to better understand your options.

What is Motegrity?

Motegrity is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Takeda Pharmaceuticals, originally developed by Shire. It is a prescription medicine given to adults for the treatment of chronic idiopathic constipation (CIC) and for the treatment of irritable bowel syndrome with constipation (IBS-C). Chronic idiopathic constipation can be treated by making lifestyle changes, like eating more dietary fiber, increasing your water intake, and taking regular physical exercise. But often this may prove insufficient, particularly with stubborn cases. If you have chronic idiopathic constipation, your doctor may have prescribed Motegrity to you.

The active ingredient in Motegrity is called prucalopride. It’s a type of drug called a serotonin receptor agonist that can speed up how quickly food moves through your digestive system, also known as motility. Muscles in your bowels rhythmically contract (tighten) and relax, to move food through your bowels. This process is called peristalsis, and if it happens too slowly, it can cause constipation as the food in your bowels hardens over time. Motegrity can help to stop this from happening. Motegrity stimulates colonic peristalsis and bowel motility by causing acetylcholine release in gastrointestinal neurons.

When you take Motegrity, the active ingredient prucalopride is released into your bowels. It attaches to areas on the outside of the cells in your bowels called 5-HT4 serotonin receptors. This stimulates the receptors, making them produce a natural substance called acetylcholine. The acetylcholine makes your bowel muscle contract faster, speeding up peristalsis and motility.

Motegrity dosage

Motegrity is available in 1mg or 2 mg tablets of prucalopride. Take Motegrity with or without food once daily to increase the speed at which food moves through your bowels, helping you have more frequent and regular bowel movements. The recommended adult dose is 2 mg once daily. Patients with severe renal impairment (creatinine clearance (CrCL) less than 30 mL/min) are recommended to take 1 mg once daily.

What is Linzess?

Linzess is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Allergan. It is a medication used to treat constipation. Most often it’s prescribed for chronic constipation and irritable bowel syndrome (IBS) with constipation and irritable bowel syndrome with constipation (IBS-C). Linzess may sometimes be used off-label in the treatment of opioid-induced constipation (OIC) caused by drugs like morphine.

Linzess helps with constipation by reducing any pain in the bowels and by causing more liquid to enter your bowels from your body. This softens your stools and makes it easier to pass them. The medication is swallowed as a capsule when you have an empty stomach. It’s usually taken once a day, before your first meal.

If someone is constipated, they find it difficult to pass a stool. Their stools may be hard and dry, and they may feel bloated and in pain. It can lead to the development of hemorrhoids, anal fissures, and fecal impaction. Chronic constipation is constipation that lasts several weeks or longer. Irritable bowel syndrome (IBS) is a group of conditions that can cause abdominal pain and bowel problems, including constipation.

The active ingredient in Linzess is called linaclotide. Linaclotide isn’t easily absorbed by your body, but this is a good thing. It means the drug reaches your bowels where it can do its work, rather than being absorbed and dispersed around your body.

When linaclotide reaches your bowels, it binds to the cells in the walls of your gut. Once there, it increases the amount of water and other fluids that pass from your body into your bowels, softening your stools. It also decreases the activity of sensory cells in your bowels, reducing any pain felt.

Linzess dosage

Linzess is available in 72 mcg, 145 mcg, and 290 mcg capsules. The recommended dosage in adults will depend on the condition being treated. Take this medication on an empty stomach at least 30 minutes before your first meal of the day. Do not crush or chew the capsule or the contents of the capsule. If you have difficulty swallowing capsules whole or have a nasogastric or gastrostomy tube, see the full prescribing information for how to open the capsule to take with applesauce or water.

Common side effects of Motegrity and Linzess

The most common side effects of Motegrity in clinical trials compared to placebo include:

• Headaches
• Fatigue
• Dizziness
• Gastrointestinal disorders – flatulence (gas), feeling bloated, stomach pain, diarrhea
• Nausea (feeling sick)
• Vomiting (being sick)

More serious side effects of Motegrity include:

• Severe allergic reactions – swelling of your tongue, mouth, or throat, which can make it difficult to breathe
• Changes in your mental state, including depression and suicidal thoughts and actions

The most common side effects of Linzess in clinical trials compared to placebo include:

• Diarrhea
• Bloating
• Stomach pain
• Flatulence
• Dizziness

More serious side effects of Linzess include

• Severe diarrhea – Although diarrhea is a common side effect of Linzess, it should pass. If it lasts for more than seven days, and you feel lightheaded, dizzy, or faint (signs of dehydration), or if your diarrhea is severe, stop taking the medication and contact your physician. Diarrhea caused by Linzess can stop other medications from working properly, especially medicines with exact doses. Prolonged diarrhea could stop birth control from working, so you should use other methods of contraception when taking Linzess

These aren’t all of the side effects Motegrity or Linzess can cause. You can find more details in the patient leaflet that comes with your medication. If you have any concerns about side effects, talk to your physician or a pharmacist.

Motegrity and Linzess drug interactions

Motegrity can interact with other medications. These include:

• Anticholinergics – atropine, cyclizine, procyclidine
• Antimuscarinics – oxybutynin
• ACE inhibitors – captopril
• Antifungals – itraconazole, ketoconazole
• Calcium channel blockers – nifedipine, verapamil
• Other medications you’re taking to treat your constipation

Linzess can interact with other medications. These include:

• Progestins – etonogestrel, levonorgestrel, norgestrel
• NSAIDs – bromfenac, diclofenac, ibuprofen, naproxen
• Proton pump inhibitors – esomeprazole, lansoprazole, omeprazole
• Levothyroxine
• Bisacodyl
• Magnesium hydroxide

Motegrity and Linzess can interact with other medications. This can change how Motegrity and Linzess and other medications work and can make side effects more likely. Tell your prescribing physician about all drugs you’re taking, including vitamins and dietary supplements. In particular, tell them if you’re taking medicines that increase the risk of diarrhea, like laxatives, medicines for stomach ulcers, and NSAIDs.

Motegrity and Linzess contraindications

You should not use Motegrity if you:

• Are allergic to the active ingredient prucalopride, or any of the other ingredients in Motegrity
• Have a blockage in your stomach or bowels (intestinal obstruction)
• Have a tear in your stomach or bowels (bowel perforation)
• Have a serious bowel disease, such as Crohn’s disease or ulcerative colitis
• Are under 18 years of age

Talk to your doctor before using Motegrity if you:

• Have or have ever had depression
• Have or have ever had suicidal thoughts or tried to commit suicide
• Have any kidney problems
• Are pregnant or are planning to become pregnant
• Are breastfeeding or are planning to breastfeed – The ingredients in Motegrity may pass through breast milk

You should not use Linzess if you:

• Are allergic to the active ingredient linaclotide
• Are allergic to any of the other ingredients found in Linzess (listed in the leaflet which comes with the medication)
• If you have a blockage in your stomach or bowels
• Are pregnant or breastfeeding
• Are under the age of 18

Talk to your doctor before using Linzess if you:

• Have severe or prolonged diarrhea caused by another condition
• Have heart disease or a disease of the blood vessels
• Have a disease of the bowels that causes inflammation, like Crohn’s disease
• Are over 65 years of age

Other drugs for chronic idiopathic constipation

• Trulance (plecanatide)
• Amitiza (lubiprostone)
• Lotronex (alosetron)
• Zelnorm (tegaserod)

If you have any concerns about Motegrity or Linzess’s side effects, talk to your physician, cardiologist, or pharmacist for medical advice. Also inform your healthcare provider about any medical conditions, supplements, and over-the-counter meds you are taking. You are also encouraged to report side effects to the FDA: visit http://www.fda.gov/medwatch or call 1-800-FDA-1088.