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Clinician’s Corner: Fiber supplements and stimulant laxatives

Fiber supplements and stimulant laxatives have been around for a very long time.  Many of us “seasoned” pharmacists remember “if not nature—Metamucil” and “Doxidan in the PM for a BM and the AM.”  There have always been a lot of advertising for laxatives in the media, but you are better off trusting your Thompson Pharmacist.  Since 2006, we have had three new laxatives on the prescription shelves that are indeed effective and very expensive. Let’s look at the prescription options for treatment of chronic idiopathic constipation (CIC) and Irritable bowel syndrome constipation predominant (IBS-C) 


AMITIZA®  (Lubiprostone) : 8mcg and 24mcg (wholesale cost=$445.32)

First approved 2006

HOW IT WORKS: Lubiprostone enhances a chloride-rich intestinal fluid secretion without altering sodium and potassium concentrations in the bloodstream. By increasing intestinal fluid secretion, lubiprostone increases movements in the intestine, thereby increasing the passage of stool and alleviating symptoms associated with chronic idiopathic constipation.


  • Treatment of chronic idiopathic constipation (CIC) in adults.
  • Treatment of irritable bowel syndrome with constipation (IBS-C) in women over 18 years old
  • Also indicated for opioid induced constipation.


Potential to cause miscarriage (have negative pregnancy test, use contraceptive measures)

May cause nausea, diarrhea, abdominal distention, loose stools, flatulence and vomiting

May also cause headache, dizziness and swelling

LINZESS® (linaclotide)    72mcg, 145mcg and 290mcg caps (wholesale cost = $464.47)

First approved:2012

HOW IT WORKS: Linaclotide leads to secretion of chloride and bicarbonate into the intestinal lumen which causes an increase in fluid and speeds up the bowel movements.

WHAT IT IS USED FOR: irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC).

HOW TO TAKE: one capsule each day on an empty stomach, at least 30 minutes before your first meal of the day. Swallow LINZESS capsules whole, do not break or chew the capsules

TRULANCE®  (plecanatide)    3mg tablets   ($466.16)

First approved-2017

Trulance (plecanatide) 3 mg tablets is indicated in adults for the treatment of

  • Chronic Idiopathic Constipation (CIC) and
  • Irritable Bowel Syndrome with Constipation (IBS-C).

HOW IT WORKS: Like the others TRULANCE increases fluid secretion in the intestines and decreases pain sensation.

Dose: 3mg once a day, taken with or without food.

When the over the counter laxatives are not effective, trust your Thompson Pharmacist to work with your family physician to get you the best treatment option for your constipation, especially if pain is associated with your condition.