Oral peptide that acts inside the intestine to increase fluid secretion and ease bowel movements. Used in chronic idiopathic constipation and in irritable bowel syndrome with constipation.
Regulatory status
Approved (FDA / EMA)
Family
Guanylate cyclase C receptor agonist (uroguanylin analog)
Scientific evidence
High
Number of findings
1
Where it acts
Digestion and weight
Also known as
plecanatide, Trulance, SP-304
Regulatory status
FDA (US): Approved (2017, Trulance) for chronic idiopathic constipation in adults; expanded in 2018 to irritable bowel syndrome with constipation
EMA (EU): Not approved (no authorization in the EU)
Dose
3 mg orally once a day, with or without food (FDA label Trulance).
Safety
The most frequent adverse effect is diarrhea (about 5–6% vs 1% with placebo); stop if it is severe. Contraindicated in children under 6 years because of the risk of severe dehydration (seen in young animals) and in intestinal obstruction. Avoid under 18 years.
Effect by goal · level of evidence
Chronic idiopathic constipation
improvesHighRCT (AA)in people
21% vs 10% responders
Phase 3 trial with 1,394 adults over 12 weeks. A sustained response occurred in 21.0% with 3 mg and 19.5% with 6 mg vs 10.2% with placebo. Diarrhea in about 6% vs 1.3% with placebo.
It mimics uroguanylin, a natural gut peptide. It activates the guanylate cyclase-C receptor in the intestinal wall, which increases cGMP and the flow of chloride and bicarbonate into the intestinal lumen. More water enters the intestine, stools soften, and transit speeds up. It is barely absorbed into the blood.
What the evidence says
In people
Chronic idiopathic constipation. Phase 3 trial with 1,394 adults over 12 weeks. A sustained response occurred in 21.0% with 3 mg and 19.5% with 6 mg versus 10.2% with placebo. Diarrhea occurred in about 6% versus 1.3% with placebo. PubMed 28169285