Trulance (Plecanatide)

Medically Reviewed By Heather Bruce, PharmD

This drug has a boxed warning, the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Trulance has a boxed warning for the risk of serious dehydration in children.

In animal studies, Trulance caused serious dehydration in young animals given the drug. Animal studies don’t always predict what will happen in people. However, due to the way the drug works, Trulance could cause severe diarrhea in children younger than 6 years of age. This could lead to serious dehydration in this age group.

Because of this possible risk, Trulance should not be given to children younger than 6 years of age. In fact, doctors typically will not prescribe Trulance for people younger than 18 years of age. This drug is not approved for use in this age group. Instead, Trulance is only approved for use in adults.

To learn more, see the “ Trulance: Side effects” section below.

About Trulance

Trulance is a brand-name prescription medication. It’s approved by the Food and Drug Administration (FDA) to treat certain types of constipation in adults.

Specifically, it’s approved for:

For details about these conditions and how the drug treats them, see the “Trulance: Uses” section below.

Key points

The following table provides key facts about Trulance.

Active drug plecanatide
Drug class guanylate cyclase-C agonist
Form oral tablet

Finding a healthcare professional

If you’re interested in taking this drug, search here to find a doctor who might prescribe it.

Trulance: Generic

Trulance contains the active drug plecanatide. It only comes as a brand-name medication. And it isn’t currently available as a generic drug.

A generic is an identical copy of the active drug found in a brand-name medication. Generics typically cost less than brand-name drugs.

Trulance: Side effects

As with most drugs, it’s possible to have side effects with Trulance. These can include some mild side effects, but also some serious ones.

To learn more about Trulance’s side effects, talk with your doctor or pharmacist. They may also provide information about managing certain side effects of this drug.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Trulance, you can do so through MedWatch.

Mild and serious side effects

Mild and serious side effects of Trulance are listed in the table below. This table does not include all of Trulance’s possible side effects.

Mild side effects* Serious side effects
flatulence (gas) • severe diarrhea†
• abdominal tenderness • risk of dehydration in children‡
• dizziness allergic reaction
• infections, such as urinary tract infection (UTI) and upper respiratory infection, including sinusitis or the common cold  
• altered results of liver function tests  
• mild diarrhea†  
• nausea and bloating†  

* This is not a complete list of Trulance’s mild side effects. To learn about other mild side effects of this drug, ask your doctor or pharmacist. Or you can view the drug’s prescribing information.
† For more information about this side effect, see “Trulance’s side effects explained” below.
Trulance has a boxed warning for this side effect. A boxed warning alerts doctors and patients about drug effects that may be dangerous. For more information about this side effect, see “Trulance’s side effects explained” below.

Most times, mild side effects of a drug go away within a few days or a couple of weeks. Talk with your doctor or pharmacist if any side effects become severe or don’t go away.

Serious side effects from Trulance aren’t common, but they are possible. If you have serious side effects, call your doctor right away. However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Trulance’s side effects explained

Below, you can find detailed information about some of Trulance’s side effects. To learn more about other side effects of this medication, talk with your doctor.  

Risk of dehydration in children

Trulance has a boxed warning for the risk of serious dehydration in children. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

In animal studies, Trulance caused serious dehydration in young animals given the drug. Dehydration occurs when large amounts of fluid and electrolytes are lost from the body. (Electrolytes are minerals such as sodium and potassium.)

Animal studies don’t always predict what will happen in people. However, due to the way the drug works, Trulance could cause severe diarrhea in children younger than 6 years of age. This could lead to serious dehydration in this age group. Serious dehydration can lead to dangerous problems such as seizures and kidney failure.

Trulance hasn’t been studied in people younger than 18 years of age. And it’s not approved for use in this age group. Instead, Trulance is approved only for use in adults.

What to do

Due to the risk of serious dehydration, Trulance should not be given to children younger than 6 years of age. In fact, doctors typically will not prescribe Trulance for people younger than 18 years of age.

Talk with your doctor about other treatment options for your child’s condition.

Diarrhea

You may have diarrhea while taking Trulance. In clinical studies, diarrhea was the most common side effect reported with the drug.

In most cases, diarrhea is mild with Trulance. It may cause symptoms such as loose stools, frequent stools, and abdominal cramps. In clinical studies, most cases of diarrhea occurred in the first 4 weeks of Trulance treatment.

In rare cases, Trulance may cause severe diarrhea. With severe diarrhea, you may need treatment in a hospital. In clinical studies, most cases of severe diarrhea occurred in the first 3 days of Trulance treatment.

With both mild and severe diarrhea, your body can lose large amounts of fluid and electrolytes (minerals such as sodium and potassium). And this can lead to dehydration.*

Symptoms of dehydration can include:

  • reduced urination or dark-colored urine
  • thirst
  • dry mouth and lips
  • dizziness
  • lethargy
  • confusion

If it’s not treated, dehydration can quickly lead to serious problems such as seizures and kidney failure.

* Trulance has a boxed warning for the risk of serious dehydration in children. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see “Risk of dehydration in children” just above.

What to do

If you have diarrhea with Trulance, it’s important to drink plenty of fluids to help avoid dehydration. It’s useful to drink rehydration solutions, such as Pedialyte, or sports drinks, such as Gatorade. These drinks can help replace electrolytes that are lost with diarrhea.

If you have diarrhea that’s bothersome or severe, talk with your doctor. They may advise stopping Trulance until your diarrhea lessens. In severe cases, your doctor may advise going to a hospital. You may need to be rehydrated with IV fluids.

Bloating

You may feel bloated while taking Trulance. However, in clinical studies bloating was rarely reported.

Bloating can also be a symptom of irritable bowel syndrome and constipation, which are both conditions Trulance treats. So, you may have this symptom due to your condition rather than the drug.

What to do

If you have new or worsening bloating with Trulance and it’s bothersome to you, talk with your doctor. They may recommend switching to a different treatment.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Trulance. A more severe allergic reaction is rare but possible.

Possible symptoms of mild and serious allergic reactions are listed in the table below.

Mild allergic reaction symptoms Serious allergic reaction symptoms
flushing • swelling under your skin, possibly in your hands, feet, lips, or eyelids
rash • swelling in your throat or mouth
• itching trouble breathing

If you have an allergic reaction to Trulance, call your doctor right away. This is important to do because the reaction could become severe.

However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Trulance: Alternatives

Doctors may prescribe drugs other than Trulance for your condition. Certain drugs may work better for you than others.

Trulance is used to treat certain types of constipation. Here’s a summary of other drugs that doctors sometimes prescribe for digestive health conditions such as constipation.

Trulance vs. Linzess and other alternatives

To learn more about one alternative of Trulance, view the following article:

Your doctor can tell you about other similar drugs, such as:

For information about other alternatives to Trulance, ask your doctor. They can tell you about medications that could be prescribed for your condition.

Trulance: Dosage

Below, you’ll find dosages that are commonly recommended for Trulance. However, you should take the dosage your doctor prescribes for you. They’ll recommend the dosage that’s best for your needs.

Trulance’s forms and strengths

Trulance is available as follows.

  • Form: oral tablet
  • Strength: 3 milligrams (mg)

Trulance’s recommended dosages

Recommended dosages for Trulance to treat certain types of constipation are described below. To read about the conditions Trulance treats, see the “Trulance: Uses” section.

Adult dosage

The recommended dosage for Trulance in adults is as follows.

  • Starting dosage: 3 mg once per day
  • Maintenance dosage: 3 mg once per day
  • Maximum dosage: 3 mg once per day

Dosage considerations

Below are some things to consider about Trulance’s dosage.

  • Missing a dose. If you miss a dose of Trulance, skip the missed dose and take your next dose as scheduled. Do not take a double dose or extra doses to make up for a missed dose. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.
  • Length of treatment. Doctors may prescribe Trulance as a long-term treatment. You may take it long term if you and your doctor feel it’s safe and effective for your condition.

Trulance: Cost

As with other medications, prices for Trulance may vary. The drug’s price will depend on factors such as:

Cost considerations for Trulance

Here’s a list of things to consider when looking into the cost of Trulance.

  • Option for a 90-day supply. For some drugs, it’s possible to get a 90-day supply. If this option is approved by your insurance company, it can help lower the cost of the drug. It can also help you avoid frequent trips to your pharmacy. If you’d like to learn more about this option, ask your doctor, pharmacist, or insurance company.
  • Need for prior authorization. Before insurance coverage for Trulance is approved, your insurance company may require prior authorization. In this case, your doctor and insurance company will communicate about your prescription for Trulance. Then, the insurance company will decide if the drug will be covered. To find out if you need prior authorization for Trulance, contact your insurance company.
  • Possible cost assistance options. Financial assistance to help lower the cost of Trulance is available. A savings card for Trulance may help reduce its cost. To learn more and see if you’re eligible for support, visit the manufacturer’s website. Also, check out this article to learn about ways to save on prescription drugs.
  • Use of a mail-order pharmacy. Trulance may be dispensed through mail-order pharmacies. Getting your prescription through a mail-order pharmacy could lower its cost. It can also allow you to get the drug without leaving home. To find out more about this option, check with your doctor, pharmacist, or insurance company.
  • Availability of a generic form. Trulance doesn’t come in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Typically, generics cost less than brand-name drugs.

Trulance: Uses

Prescription drugs, such as Trulance, are approved by the Food and Drug Administration (FDA) to treat certain conditions. Doctors sometimes prescribe drugs off-label for other conditions. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for.

Using Trulance for irritable bowel syndrome with constipation (IBS-C)

Trulance is FDA-approved for use in adults to treat irritable bowel syndrome with constipation (IBS-C).

Irritable bowel syndrome (IBS) is a long-term condition that causes symptoms such as:

  • abdominal pain and cramps
  • bloating
  • changes in bowel movements such as constipation, diarrhea, or both

With IBS-C, the main change in your bowel movements is constipation. It typically causes constipation along with other IBS symptoms.

Doctors prescribe Trulance to relieve constipation related to IBS-C. The drug helps soften your stools and speed up their passage through your bowel. It makes bowel movements easier to pass and increases the number of bowel movements you have each week. It also helps reduce abdominal pain due to IBS-C.

Using Trulance for chronic idiopathic constipation

Trulance is FDA-approved for use in adults to treat chronic idiopathic constipation. This condition causes long-term, ongoing constipation with no known cause.

With constipation, you may have symptoms such as:

  • developing hemorrhoids
  • passing hard, dry, lumpy stools
  • needing to strain during bowel movements
  • feeling that your bowel is not fully emptied
  • having bowel movements fewer than three times per week

Doctors consider constipation to be chronic if you’ve had symptoms for 3 months or longer.

Doctors prescribe Trulance to relieve chronic idiopathic constipation. The drug helps soften your stools and speed up their passage through your bowel. This makes bowel movements easier to pass and increases the number of bowel movements you have each week.

Using Trulance in children

Trulance is not FDA-approved for use in children. In fact, the drug has a boxed warning* about the risk of serious dehydration if Trulance is used in children.

Due to this risk, Trulance should not be given to children younger than 6 years of age. In fact, doctors typically will not prescribe Trulance for people younger than 18 years of age.

* A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients to drug effects that may be dangerous. To read more about the boxed warning for Trulance, see “Trulance: Side effects” above.

Finding a healthcare professional for Trulance

If you’re interested in taking Trulance, you can find a doctor who may prescribe it by searching here. To prepare for your appointment, you may find it helpful to visit our appointment guide for irritable bowel syndrome with constipation (IBS-C).

Trulance: Questions you may have

Here are some common questions about Trulance and brief answers to them. If you’d like to know more about these topics, ask your doctor.

What should I do if Trulance is not working or stops working?

If Trulance doesn’t work to relieve your constipation, talk with your doctor. They may recommend switching to a different treatment.

Is Trulance a controlled substance?

No, Trulance isn’t a controlled substance.

Controlled substances are drugs that are regulated by the federal government because they have a high risk for misuse. (With misuse, a drug is taken in a way that’s not prescribed, usually to produce a pleasurable effect.) However, Trulance doesn’t carry a risk for misuse.

Does Trulance come in 6-mg tablets? Is it prescribed in 6-mg doses?

No, Trulance doesn’t come in 6-milligram (mg) tablets. And it’s not prescribed in 6-mg doses.

Clinical studies of Trulance found that 6-mg doses weren’t more effective than the recommended dose. Additionally, in the studies, 6-mg doses caused more side effects than the recommended dose. For this reason, doctors typically only prescribe Trulance in 3-mg doses.

To learn more about typical recommended doses of Trulance, see the “Trulance: Dosage” section above.

Will Trulance cause weight loss?

Weight loss wasn’t reported in clinical studies of Trulance.

However, the types of constipation that Trulance treats can sometimes cause bloating. If you’re bloated, you may have a small amount of weight gain. Taking Trulance to relieve constipation may also reduce bloating, which may lead to a small amount of weight loss.

If you’re concerned about weight loss with Trulance, talk with your doctor.

Is Trulance a laxative?

No, Trulance isn’t a laxative. Instead, it’s a type of drug called a guanylate cyclase-C agonist.

Both Trulance and laxatives are used to treat constipation. However, Trulance works in a different way than laxatives.

Laxatives work quickly to help you have a bowel movement. There are several different types that work in different ways.

Trulance is similar to a protein that helps control the amount of fluid and electrolytes in your intestine. (Electrolytes are minerals such as sodium and potassium.) Trulance attaches to the same sites in your intestine as this protein does, and it has the same effect as the protein. It increases the amount of fluid in your intestine, making stools softer and easier to pass.

To learn more about how Trulance works, see “Trulance: How it works” below.

Can Trulance be used to treat gastroparesis?

It’s not likely.

Gastroparesis is a condition that’s sometimes called stomach paralysis. It causes your stomach to empty more slowly than usual, and it affects how food moves from your stomach into your intestine.

Trulance doesn’t help your stomach empty, so doctors are unlikely to prescribe it for gastroparesis. Additionally, Trulance is not approved to treat this condition.

If you’re interested in finding treatment for gastroparesis, talk with your doctor.

Trulance: Consuming alcohol during treatment

Trulance doesn’t interact with alcohol. However, consuming alcohol during Trulance treatment may raise your risk for certain side effects. These include diarrhea, nausea, and dizziness.

If you drink alcohol, talk with your doctor about how much is safe to consume during treatment with Trulance.

Trulance: How to take

Your doctor will recommend how to take Trulance. It’s important that you take the drug according to their directions.

Trulance comes as oral tablets. You’ll take the drug by swallowing it.

Questions about taking Trulance

Here’s a list of common questions related to taking Trulance.

  • When should I take Trulance? You should take Trulance once per day. View these medication reminder options to help avoid missing doses of Trulance. You could also set an alarm, use a timer, or download a reminder app on your phone.
  • Do I need to take Trulance with or without food? It doesn’t matter. You can take Trulance with or without food.
  • Can Trulance be chewed, split, or crushed? Trulance should usually be swallowed whole. You should not chew or split Trulance tablets. However, if you have trouble swallowing Trulance whole, you can crush a tablet and mix it with water or applesauce to take it. Instructions for taking the drug this way are available in Trulance’s prescribing information and on the drug manufacturer’s website. Talk with your doctor or pharmacist about the best way for you to take Trulance.
  • Is there a best time of day to take Trulance? No, there’s not. You can take Trulance at any time of day, but try to stick to the same time each day. Taking Trulance around the same time of day helps keep a steady level of it in your body. This helps the medication work effectively.

Trulance: How it works

Trulance is used to treat certain types of constipation. To read about the conditions Trulance is used to treat, see the “Trulance: Uses” section.

What happens with constipation

With constipation, you have dry, hard, lumpy stools that are difficult to pass. You may also have fewer than three bowel movements per week.

What Trulance does

Trulance is a type of drug called a guanylate cyclase-C agonist. It works by attaching to specific sites called guanylate cyclase-C receptors. These sites are found on the cells lining your intestine.

When Trulance attaches to these sites, it makes the cells release fluid into your intestine. This is the drug’s mechanism of action.

Trulance increases the amount of fluid in your intestine. This helps soften your stools and speed up their passage through your bowel. This makes bowel movements easier to pass and increases the number of bowel movements you have per week.

How long does Trulance take to start working?

It usually takes about 1 week for Trulance to start working to relieve constipation.

How long will Trulance stay in my body? What’s its half-life?

Trulance isn’t absorbed into your body. Instead, the drug works locally in your intestine. It’s also broken down in your intestine.

It’s not known how long Trulance remains active in your intestine or the length of its half-life. (A drug’s half-life describes the length of time needed for your body to clear half a dose of the drug. Generally, it takes about five half-lives for a drug to clear fully from your body.)

Trulance: Overdose

For some drugs, taking more than the recommended dosage may lead to unwanted side effects or overdose. Do not use more Trulance than your doctor advises.

What to do if you take too much Trulance

Call your doctor if you think you’ve taken too much of this drug. Also, you can call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. However, if your symptoms are severe, call 911 or your local emergency number. Or go to the nearest emergency room right away.

Trulance: Taking while pregnant

Trulance isn’t absorbed into your bloodstream, so a developing fetus is unlikely to be exposed to it if it’s taken during pregnancy. However, there haven’t been enough pregnant people who took Trulance for doctors to determine whether the drug is safe during pregnancy.

In animal studies, Trulance didn’t cause problems with fetal development. However, animal studies don’t always predict what will happen in humans.

If you’re pregnant or planning to become pregnant, talk with your doctor before taking Trulance.

Trulance and birth control needs

Doctors aren’t sure whether it’s safe to take Trulance during pregnancy. Talk with your doctor about your birth control needs with Trulance if you’re sexually active and you or your partner can become pregnant. Your doctor can recommend if you should use birth control with this medication.

Trulance: Taking while breastfeeding

It may be safe to take Trulance while breastfeeding. The drug isn’t absorbed into your bloodstream, so it’s unlikely to pass into breast milk. In clinical studies, Trulance wasn’t found in breast milk.

If you’re breastfeeding or planning to breastfeed, talk with your doctor about healthy ways to feed your child.

Trulance: Interactions

Trulance isn’t known to interact with other medications, supplements, or foods. However, this doesn’t mean interactions aren’t possible.

Interactions with drugs can cause different effects. Some interactions can interfere with a drug’s effectiveness. Others can increase a drug’s side effects or cause them to be severe.

Before starting Trulance, tell your doctor about any prescribed or over-the-counter medications, herbs, vitamins, or supplements that you take. They can check for any possible interactions between these products and Trulance.

Trulance: Precautions

This drug comes with several precautions.

FDA warning: Risk of dehydration in children

This drug has a boxed warning, the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Trulance has a boxed warning for the risk of serious dehydration in children.

In animal studies, Trulance caused serious dehydration in young animals given the drug. Animal studies don’t always predict what will happen in people. However, due to the way the drug works, Trulance could cause severe diarrhea in children younger than 6 years of age. And this could lead to serious dehydration in this age group.

Because of this possible risk, Trulance should not be given to children younger than 6 years of age. In fact, doctors typically will not prescribe Trulance for people younger than 18 years of age. This drug is not approved for use in this age group. Instead, Trulance is only approved for use in adults.

To learn more, see the “Trulance: Side effects” section above.

Other precautions

Tell your doctor about your health history before starting treatment with Trulance. Your doctor may not recommend this medication if you have certain factors affecting your health or specific medical conditions.

These factors and conditions include those listed below.

  • Allergic reaction. Your doctor will likely not prescribe Trulance if you’ve had an allergic reaction to it or any of its ingredients. To find out about other treatment options, talk with your doctor.
  • Bowel obstruction. Doctors typically won’t prescribe Trulance if you havea blockage in your small or large intestine. Talk with your doctor about alternative treatment options.
  • Pregnancy. Doctors aren’t sure if Trulance is safe to take during pregnancy. If you’d like to learn more about taking Trulance while pregnant, view the “Trulance: Taking while pregnant” section above.
  • Breastfeeding. It may be safe to take Trulance while breastfeeding. If you’d like to learn more about taking Trulance while breastfeeding, view the “Trulance: Taking while breastfeeding” section above.

To learn more about side effects of Trulance that could be harmful, see the “Trulance: Side effects” section above.

Trulance: Expiration, storage, and disposal

Here’s some information about Trulance’s expiration date, as well as how to store and dispose of the drug.

  • Expiration. Your pharmacist will add an expiration date to the label on Trulance’s packaging. This date is usually 1 year from the date the medication was dispensed to you. Expiration dates help ensure that a medication is effective during a period of time. The Food and Drug Administration (FDA) advises that you avoid using expired drugs. If you have an unused medication and it’s past the drug’s expiration date, talk with your pharmacist. They can let you know whether you might still be able to use the medication.
  • Storage. Many factors determine how long a medication remains good to use. These factors include how and where you store the drug. Trulance tablets should be stored at a room temperature of 68°F to 77°F (20°C to 25°C). For short periods, it can be stored at a temperature of 59°F to 86°F (15°C to 30°C). Avoid storing it in areas where it could get damp or wet, such as bathrooms. The medication should be kept in its original packaging.
  • Disposal. It’s important to safely dispose of Trulance if you no longer need to take it and have unused medication. Doing so helps prevent others, including children and pets, from accidentally taking the drug. It also helps avoid causing harm to the environment. Ask your pharmacist for information about disposing of Trulance. Also, check out this page for several tips on safe medication disposal.

Trulance: Questions for your doctor

If you have questions about Trulance, talk with your doctor. They can advise whether Trulance could be a good treatment option for you.

Here’s a list of questions you may want to ask your doctor:

  • How long will I need to take Trulance?
  • Will I need to take laxatives during Trulance treatment?
  • Can I take Trulance with my other medications?
  • Does Trulance have any long-term effects?

Your doctor may also tell you about other treatment options for your condition. You may find this article helpful in learning about alternative drugs for digestive health conditions.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical Reviewer: Heather Bruce, PharmD
Last Review Date: 2022 Apr 29
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.