Plecanatide (Trulance) is a guanylate cyclase C agonist drug approved by the FDA. It softens the stools by increasing the water content of the stools and relieves constipation by increasing the intestinal transit.

Plecanatide (Trulance) Uses:

• Chronic idiopathic constipation:
  • It is used to treat chronic idiopathic constipation (CIC) in adults
• Irritable bowel syndrome with constipation:
  • It is used to treat patients with irritable bowel syndrome with constipation (IBS-C) in adults.

other drugs from the same class include prucalopride and linaclotide.

Plecanatide dose in Adults

Plecanatide dosage in the treatment of chronic idiopathic constipation (CIC):

• 3 mg orally once a day.

Plecanatide dose in the treatment of Irritable bowel syndrome with constipation (IBS-C):

• 3 mg orally once a day.

Use in Children:

The safety and efficacy of the drug in children have not been established.   

Pregnancy Risk Category: N (Not assigned)

• The drug is not absorbed into systemic circulation so maternal exposure to it does not increase fetal exposure.

Plecanatide use during breastfeeding:

• It is unknown if the drug will be excreted into breastmilk.
• The drug is not absorbed in the maternal circulation at recommended doses so drug exposure to the infant while breastfeeding is unlikely.
• Manufacturers recommend that you weigh the benefits and risks.

Plecanatide Dose in Kidney Disease:

• The manufacturer has not recommended any adjustment in the dose is patients with kidney disease.
• However, since systemic absorption is minimal, dose adjustment is not required.   

Plecanatide Dose in Liver disease:

• The manufacturer has not recommended any adjustment in the dose in patients with liver disease.
• However, since systemic absorption is minimal, dose adjustment is not required.   

Side Effects of Plecanatide (Trulance):

• Central Nervous System:
  • Dizziness
• Gastrointestinal:
  • Diarrhea
  • Abdominal Distension
  • Abdominal Tenderness
  • Flatulence
  • Nausea
  • Severe Diarrhea
• Genitourinary:
  • Urinary Tract Infection
• Hepatic:
  • Increased Serum ALT
  • Increased Serum AST
• Respiratory:
  • Sinusitis
  • Upper Respiratory Tract Infection
  • Nasopharyngitis

Contraindications to Plecanatide (Trulance):

• Children younger than 6 years old
• Patients who have a known or suspected gastrointestinal obstruction.

Warnings and precautions

• Diarrhea:
  • It can cause severe diarrhea, especially in the first three days.
  • If severe diarrhea is experienced, treatment may be stopped.

Monitoring parameters:

• Monitor the frequency of straining and the quality and frequency of spontaneous bowel movements.

How to administer Plecanatide (Trulance) Tablets?

• You can take it with or without food. 
• It is best to swallow the whole tablet without chewing, crushing, or breaking it.
• For those who are unable to swallow the tablets, they may crush them and then mix it with water or applesauce. 
• It has not been tested to mix it with other liquids or food.

Administration in applesauce

• Mix the crushed tablet with 5 ml applesauce at room temp. The entire mixture should be taken immediately. It should not be kept for later use.

Water administration:

• Place the tablet in a cup with 30 ml water at room temperature. Stir it gently for 10 seconds. The water will cause the tablet to break apart.
• After mixing the contents, swallow the entire contents of the cup. Add 30 ml more water to the cup to make sure that the tablet is completely dissolved. The mixture should not be stored for future use.

Administration via a gastric feeding tube or nasogastric tube

• Place the tablet in a cup with 30 ml water at room temperature. Stir the contents gently for 15 seconds.
• The tablets will break apart. Flush the tube, nasogastric, or gastric with 30 ml water.
• Mix the mixture using the syringe. Then, administer the mixture via the gastric feeding tube or the nasogastric.
• You can add 30 ml more water to the cup if any tablet is not completely dissolved. Stir it for 15 seconds, then immediately give it the same syringe.
• Use the same syringe to flush the tube with 10ml water.
• The mixture should not be stored for future use.

Mechanism of action of Plecanatide (Trulance):

• Plecanatide and its activemetabolite are guanylate-cyclase C agonists that can be found on the luminal surfaces of intestinal epithelial cell cells.
• This causes an increase in the concentrations of cyclic Guanosine Monophosphate both within and outside the cells.
• This causes an increase in the secretion of bicarbonate and chloride into the intestinal lumen, accelerating intestinal transit times and increasing GI fluid.

Absorption:

• It is very low in systemic absorption when taken at the recommended doses.

Distribution:

• It is not easily absorbed so it does not spread to the tissues at recommended doses.

Metabolism:

• It is metabolized in the GI tract to small peptides or amino acids through the process of proteolytic degrading.

International Brands of Plecanatide:

• Trulance

Plecanatide Brand Names in Pakistan:

No Brands Available in Pakistan.