# How long has Linzess worked for you?



## sjw596 (Feb 19, 2014)

I started Linzess 145s a little over a year ago, and it provided fantastic relief after suffering CIC for 40+ years! I'm a 67 y/o male in excellent health and physical condition. I did have a right hemi-colectomy two years ago, and a recent colonoscopy was perfect. However, over the past couple of weeks, Linzess stopped working as effectively. It strikes me as odd that the change came on suddenly. I will say that this sudden lack of success with Linzess came on once before, and I had narrowed it down to what likely was a bad batch of pills, which Allergan replaced. For the past week, I've been using a 1/2 dose of Miralax every other day, which the GI's PA said was fine to do indefinitely. That has helped. Basically, using the Linzess always produced a complete BM almost every day (often quite loose) , but now seems to be effective every other day instead. My stools also are better formed, which may be good.

Linzess has been around for only 4-5 years, and I know of no long term studies dealing with effectiveness over time. When I first started, the PA said that I always could go to the 290 mcg pills if I wanted. I'll probably experiment by trying two 145s for a few days. I take my Linzess about 15 minutes afrer I get up and have breakfast 40 +- minutes later. Thanks!


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## annie7 (Aug 16, 2002)

sorry the 145 mcg linzess stopped working for you.

yes, do try taking 290 mcg. that dose might be a lot more effective for you.

another thing you could try is eating breakfast sooner after taking it. one of my gastro docs has done research and has run clinical trials on linzess. he told me that linzess works on the same receptors that food does. so generally, the closer you take it to eating a meal, the more diarrhea you get and the quicker it works. and conversely, the more time that elapses between taking linzess and eating, the less D you get. eating a warm breakfast with some healthy fat in it also can also make it work better.

so you might want to experiment with taking linzess 30-15 minutes or even less before eating instead of 45 minutes before like you're doing now.. that might make it work better for you. it made a difference for me.

good luck. hope you can get it to work for you again.


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## Guineagirl (Dec 1, 2016)

Hi! Yes, what Annie7 said--eating it closer to breakfast seems to make it work more for me--especially if I include some fat in the meal--like peanut butter on my waffles. Of course the 297 might be just what you need too. Linzess seems to affect people differently. I've settled into taking it every other or even every couple of days, depending on how things are going. Hope it works for you.


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## Thisisaproblem (Sep 5, 2014)

Get rid of the miralax, the linzess, all of it. Magnesium. You will never be constipated again. I would say start with 400 mg and work your way up. I take it at bedtime. Usually 800. Haven't had any problems in a LONG time. I was also taking Linzess and while it worked for me, it's expensive.


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## sjw596 (Feb 19, 2014)

Thanks, but I had tried Mg before, and it was of no help. 800 mg. is way over what's considered toxic. Anyway, Linzess is cheap for me - $30 for 90 days.


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## Stevect06 (Jun 20, 2014)

I also believe more fat is good for C. I can afford to have some since my weight is on the low side, and ironically this time of year what little weight I gain I tend to work it off preparing firewood! For years I avoided fat due to a stoke in 2002. Bought low fat this, no fat that. Still need to be sensible though, eat healthy and keep fat in moderation. I do believe, cutting way back on it was a detriment in my case. Also, I learned on this forum fiber can have the opposite effect on us than thought. Cutting back on fiber helped me.

I'm on Miralax every day. I wish I could reduce that to every other. Maybe I can - but don't know if I want to risk trying. Interesting how Linzess just stopped working. I've heard about similar situations with that and Miralax. If Linzess worked for me (did not) I'd probably prefer it over Miralax - just seems more convenient to take a pill. That $30 price sounds good too - Miralax is close to $30 for the best value which is 45 doses.


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## sjw596 (Feb 19, 2014)

Thanks, Stevect06. I began taking the 290 mcg dose on Friday and noticed improvement beginning on Saturday. I started the 145s in 12/2014, so it a worked well for > a year. Prior to that, I took Miralax daily, until it stopped working after about a year. I could stay with the 145 Linzess if I added a reduced dose of Miralax. When the Linzess 145s were working, I took nothing else, except for one Fibercon tablet a day. I'll give the 290 dose a while and see how it goes. I will say that my stools have started out quite loose, but that's how the 145s worked much of the time.

I'm going to heed the wisdom of others in this thread and increase my breakfast fat a little. I've been on a high-fiber/low fat diet forever. I'm 67, 140#, and very active (run, lift, or hike every day) and in good health, except for mild osteoporosis and a right hemi-colectomy two years ago (twisted gut). I certainly could add some fat and gain a few pounds. I have to watch my cholesterol, which is about 205. My breakfast includes about 5 gr. fiber from whole grain cereal/oatmeal, plus perhaps 2 gr. from whole wheat toast with jam. I get about 4-6 gr. fat from 2% milk or yogurt and the toast. So, I have about 7 gr. fiber plus 6 gr. fat, on average, for breakfast. Otherwise, I eat very little red meat and lots of veggies (a couple pints of good beer/day probably doesn't help my C, but makes me happy!). I already eat nuts every day, and could add a tablespoon of almonds or walnuts to my cereal, and maybe switch to whole milk. I really don't like the lower-fiber cereals, which also are loaded with sugar. Many of the cereals already contain nuts, so I'll have to see what else I can do to add a little fat (can't handle meat for breakfast).


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## annie7 (Aug 16, 2002)

sjw--good to hear that the 290 mcg is working for you. sounds like you have a good plan going.

my healthy fat go-to is olive oil. and peanut butter.


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## flossy (Dec 8, 2012)

I have had a bottle of Linzess sitting in my cupboard for over a year now, still never tried it. I've read one too many "I don't like it" stories about it here. I'll stick to what I'm using, haven't tried anything better as of yet:










*sjw596, have you tried Intestinal Formula yet or no?*

More info:

http://www.ibsgroup.org/forums/topic/239065-finally-a-product-i-can-recommend/

All right, I just drank a Coke and am a bit amped up. Time for the Super Bowl!







Hopefully the game won't suck, like a lot of the post-season games.


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## sjw596 (Feb 19, 2014)

Thanks, Flossy. I'll definitely check out the Intestinal Formula. FWIW, I would try the Linzess if I were you and suffered from C in any chronic form. I did a lot of research before I went along with my GI's suggestion to try Linzess. True, it doesn't work for everyone and may cause distress for some. Even if there are some "horror" stories, I'd struggle with Linzess for a few days, as it doesn't take very long to work, if it will at all. Symptoms like diarrhea usually diminish after a week or two. In my case, Linzess changed my life immeasurably after 40 years of C. I just hope that the 290s hold the same promise for me. Good luck!


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## sjw596 (Feb 19, 2014)

annie7 said:


> sjw--good to hear that the 290 mcg is working for you. sounds like you have a good plan going.
> 
> my healthy fat go-to is olive oil. and peanut butter.


Thanks again, annie7. Yes, the 290s are working noticeably better than the 145s, though I wouldn't say that the improvement is dramatic thus far. I envisioned that I'd get a healthy urge to go within an hour after breakfast, as I did when I first started the 145s. Not so, as it's more like 1.5 hours (I really shouldn't complain), and the urge is minimal. I have upped my breakfast fat somewhat, and that might have added to the improvement.

It is a little challenging for me to find healthy fats, other then nuts, and I've added a almost a tablespoon of nuts to my cereal/granola/oatmeal. While I switched to whole milk from 2%, I wouldn't call milk a healthy fat (notwithstanding the calcium, etc.), and I use regular yogurt (2 gr. fat). I agree about olive oil, but there's nothing I can add that to, given my breakfast menu. Anyway, I'll stick with the program for a while.


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## annie7 (Aug 16, 2002)

have you tried taking the 290 mcg closer to your breakfast time---like 5-10-15 minutes closer than what you're doing now? reducing the time between taking linzess and eating usually makes the urge come on stronger and sooner.


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## annie7 (Aug 16, 2002)

oh--and about the olive oil. i used to drink(eat) a scant teaspoonful of extra virgin olive oil straight at breakfast time. it is definitely an acquired taste lol... now i mix it in with my eggs.


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## sjw596 (Feb 19, 2014)

Thanks...in the morning? Maybe walnut oil







I just noted that the Linzess official instructions include thist:

Pharmacodynamics -Food Effect

taking LINZESS immediately after the high fat breakfast resulted in looser stools and a higher
stool frequency compared with taking it in the fasted state
In clinical trials, LINZESS was administered on an empty stomach, at least 30
minutes before breakfast.

I wonder whether many folks who've poor success with the official instructions have tried taking Linzess after breakfast? I think if all else failed, I don't know that it would be harmful.



> have you tried taking the 290 mcg closer to your breakfast time---like 5-10-15 minutes closer than what you're doing now? reducing the time between taking linzess and eating usually makes the urge come on stronger and sooner.


No, I haven't tried eating sooner, but that's next on my list.


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## annie7 (Aug 16, 2002)

yes--right--i've read that too in the linzess official instructions. that's the same thing my gastro doc told me, like i mentioned earlier here in this thread

i've taken it both with breakfast as well as afterwards. both ways it gave me a much stronger urge and yes, more frequent stools, just like they--and my gastro doc-- said.


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## sjw596 (Feb 19, 2014)

annie7 said:


> have you tried taking the 290 mcg closer to your breakfast time---like 5-10-15 minutes closer than what you're doing now? reducing the time between taking linzess and eating usually makes the urge come on stronger and sooner.


Annie, you just might have given me hope! Let me give you a rundown on what I've tried. On Day 1, I took a 290, 25 minutes before breakfast, which was about 15 minutes sooner that usual. That made no difference. On Days 2 & 3, I took a 290 15 minutes before breakfast. The results were great, but with a little too much D. So, on Days 4, 5, and 6 I went back to the 145s, taken 15 minutes before breakfast, with excellent results and without excessive D! I'm not sure that three days of success predicts permanent improvement, but I'm off to a great start. I also took your suggestion and added a little more fat to breakfast. I toss a rounded Tbsp. of chopped nuts to my cereal, so that adds 6-8 gr. of healthy fat. I've been using whole milk (1/2 C.), but may return to 2% and see whether it matters.

So, thank you so much for the suggestions! I really doubt that most GIs have any idea about the timing of Linzess-to-food, when it comes to efficacy in different individuals. I'll report back.


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## sjw596 (Feb 19, 2014)

I thought I'd bump this thread instead of starting a new, related one. As suggested by others, I had been having success by taking Linzess 145s about 15 minutes before breakfast. However, the results waned, and my GI suggested trying 217 mcg or 290 as the need required. That worked over a couple months, but I had a abrupt decrease in results even with 290s. For the first time in a couple of years, it failed to produce a BM a few days ago. Later that day I had modest results with a Fleet enema. However, the next day Linzess again failed to provide relief, so I used a Dulcolax suppository and has adequate results. This seems a little odd, but I have seemed to be following a path of diminishing results.

I wonder whether, at this point, I need to "jump start" my system with a laxative like magnesium citrate or something else? However, I haven't seen medical research suggesting that Linzess be preceded (before its first use) with a "cleanout", unlike other drugs. A more palatable idea may be to move my dose even closer to breakfast, say five minutes.


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## annie7 (Aug 16, 2002)

sorry your results with linzess have been waning.

yes, do try taking it five minutes before breakfast or even with breakfast--it's always worth a try.

no, i haven't seen any medical research that says that it's best to do a cleanout before trying linzess but i have read that advice on another board that i read. several people said that this was what their gastro docs advised them to do.

other people take linzess with miralax or even a stimulant laxative and get good results with that combo although ideally it would work by itself.

good luck. keep us posted.


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## Pete11 (Jul 6, 2017)

I feel so blessed to have found this Website. I am a 67 year-old male in relatively good health with the exception of chronic idiopathic constipation. After years of dealing with this condition and facing possible surgery, my doctor recommended Linzess. It changed my life! For the last 6 or 7 months it worked perfectly, and made a unbelievable positive difference in my life. I was eleated to say the least. However, about 3 weeks ago, it abruptly stopped working. I am not able to identify any changes in eating habits or life style. Per directions, I don't eat breakfast until at least 30 minutes after taking a 290 Linzess capsule. However, since reading the posts on this site, I will definitely experiment with altering the time before the meal.

Since my problem reoccurred, I have been supplementing the 290 Linzess with Miralax, but with unsatisfactory results. I am also taking lots of vitamin C. The only thing that seems to work, and then only partially, is a mini-Fleet's mineral oil enema. However, I don't want to get hooked on those long term, especially with the inconsistent results. I am also trying to eat more fats at breakfast per the recommendations I've read on this site.

Again, thank you all for sharing your experience and let's pray that someone will come up with some common solutions to reestablish Linzess effectiveness in cases like ours.


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## annie7 (Aug 16, 2002)

Hi Pete

yes, do try experimenting with the timing of linzess and your breakfast. i was amazed at what a difference this can make.

also--another thing about linzess is that it is a very unstable med and is very susceptible to heat and humidity. it's important that your pharmacy sells it to you in the original bottle with the dessicant packs in it instead of decanting it into one of the pharmacy bottles. it says that right on the bottle--to keep it in the original container.

there is a new med out now for chronic constipation called trulance (plecanatide). it is somewhat like linzess but some people find it more effective. it got good reviews on drugs.com. you might want to give that a try if you can't get linzess to work again for you.

good luck!


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## sjw596 (Feb 19, 2014)

Pete11 said:


> I am a 67 year-old male in relatively good health with the exception of chronic idiopathic constipation... After years of dealing with this condition and facing possible surgery, my doctor recommended Linzess. It changed my life! For the last 6 or 7 months it worked perfectly, and made a unbelievable positive difference in my life. I was eleated to say the least. However, about 3 weeks ago, it abruptly stopped working. I am not able to identify any changes in eating habits or life style. Per directions, I don't eat breakfast until at least 30 minutes after taking a 290 Linzess capsule. However, since reading the posts on this site, I will definitely experiment with altering the time before the meal.
> 
> Since my problem reoccurred, I have been supplementing the 290 Linzess with Miralax, but with unsatisfactory results. I am also taking lots of vitamin C. The only thing that seems to work, and then only partially, is a mini-Fleet's mineral oil enema. However, I don't want to get hooked on those long term, especially with the inconsistent results. I am also trying to eat more fats at breakfast per the recommendations I've read on this site.





annie7 said:


> Hi Pete
> 
> yes, do try experimenting with the timing of linzess and your breakfast. i was amazed at what a difference this can make.
> 
> ...


Thank you both for updates. Pete, I'm much like you: 68 y/o male in excellent health. I did have an right hemicolecomy a couple of years ago as a result of a twisted gut, but recovered very well. Linzess 145s worked well for over two years. It changed my life, too. The success diminished, and I found Annie's advice quite worthwhile. I started 15 minutes before breakfast. That didn't work so well after a while, so my GI suggested 217 mcg or 290 as the need required. As I mentioned just above, that failed abruptly, out of the blue. Like you, I used a Fleet enema and suppositories, and started Miralax yesterday. This morning, I took a 290 five minutes before breakfast, and had modestly good results, perhaps helped by the Miralax. I suggest you try Annie's suggestion.

Annie, I researched Trulance, and will speak about it with my GI in two weeks, Have you seen any threads that discuss how folks like it? It is very $$$, so I'll have to apply for a waiver from the insurance company. Same for Amitiza, which is slightly cheaper.


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## annie7 (Aug 16, 2002)

the reviews on drugs.com are the only reviews i've seen.

https://www.drugs.com/comments/plecanatide/trulance.html

we've had a few posts on here about it. in the first one, she said it gave her D. in the second one, the poster said that they had gotten samples for it but never came back to say how it worked.

http://www.ibsgroup.org/forums/topic/330226-trulance/?hl=trulance

http://www.ibsgroup.org/forums/topic/330489-trulance/?hl=trulance

in the other couple posts, people were just asking if anyone has tried it and did it work for them but there were no replies.

hopefully you can get samples from your doc like the other people did so you can see if it works for you without having to get a script for it right away.


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## sjw596 (Feb 19, 2014)

I've been trying my Linzess (290) five minutes before breakfast and it has improved my results. I've been off Miralax supplementation for three days, just to be sure that it's hasn't been involved in the improvement. It's way too soon to make a judgment. I'm still researching Trulance and Amitiza. As noted, there is very little info on the former.

One thing good about Linzess, for me, is that it has been predictable over the years, while it was working well. In other words, I took it in the morning and had a BM within 30-90 minutes. I'm a morning person anyway, so the timing was great. Trulance is taken any time of the day, and Amitiza is taken 2x/day. Aside from the obvious issue of efficacy, I wonder whether Trulance or Amitiza may be just as predicable? Everyone's different, so there may be little more than anecdotal evidence. The official web sites make no mention of what to expect, other than a daily BM if things work as intended.


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## Mowokie (Jul 19, 2017)

I tried mirilax and benefiber and that made it worse for me. Tried linzess for a couple of weeks and nothing. Tried trulance. It doesn't give a time to take it. Took it in the morning and had cramps all day, but it eventually worked. Wow, did it work! I then took it right after dinner and had complete emptying within 2 hours every time. It's been a month now and it's not as predictable but still going each and every day so it's a winner! No more cramping either, that lasted about 3 days total. It is pricey but if insurance doesn't cover it, they give you a card, you text the number, show the code to pharmacist and only pay $25 out of pocket. Everyone gets this card.


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## annie7 (Aug 16, 2002)

thanks, Mowokie, for posting this ! so glad trulance is working for you! and it's good to know that there is a savings card for it, too.


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## sjw596 (Feb 19, 2014)

Yes, thanks for the info. I see my GI next week so that I can check on Trulance and Amitiza. On a good note, I am having better results with Linzess since taking it 5 miuntes before breakfast, as Annie mentioned. We'll see how long this lasts. I have been cutting down the fasting time from 30 minutes, with improving results after each reduction. However, the improvement hasn't been long-lasting with each step downward. For the most part, I take 217 mcg, with an occasional 290. What concerns me about Trulance and Amitiza is that I haven't found much discussion about the time between taking the drug and getting results. Trulance can be taken, with/without food at any time. Amitiza is 2x daily, with food, which presumes breakfast and dinner. But, I really don't want to have "results" at 2:00 AM! I'm hopeful that I can get my Linzess regulated again, as it has been very predictable over the years.


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## sjw596 (Feb 19, 2014)

I saw my GI's PA. For now, she is not recommending Trulance for her patients. She does not think that the trials or general usage has demonstrated how well Trulance works. It's kind of like I said; I'd like to take a pill and have some idea of when/how it should produce results. Of course, every new drug has to start somewhere, and my PA is very open to trying anything that may help, should Linzess just stop working entirely. First, she would try Amitiza, which has been around longer that Linzess.

For now, I'll go back to taking a 290 daily and supplement with varying doses of Miralax. I'm not crazy about Miralax, but the PA said that the dosage is up to me, we can try anything from a tablespoon to 2-3 full doses a day (I'll go back to try Amitiza before I go that far). What's tough is reaching a point where I have the Linzess and Miralax working in harmony. I've been taking a different sleeping pill (Lunesta) lately, and I'll stop and see if that caused an issue.


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## Mowokie (Jul 19, 2017)

We are now into September. I take my trulance each night at 6 after dinner. In 2 hours, I'm in the bathroom. There are maybe 4 times a month it doesn't work that night but it does the following morning. My insurance approved it with no problems given my history. My co-pay is $23 a month.


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## sjw596 (Feb 19, 2014)

Thanks for the info. I've been taking Amitiza since mid-August, after my Linzess quit. The results are okay, but not great. Coincidentally, my GI prescribed Trulance today for a month to see how it works. My co-pay will be $25 for a month's supply, but I can save more if it works and I go to a 90-day supply. What I'm anxious about is the timing, which you described in regard to how Trulance works for you. Over the past two years, I've had a BM within about 1 to 1.5 hours after breakfast, thanks to Linzess or now Amitiza. I've found no information on suggested times to take Trulance, with respect to timing. They just say to take it once a day. I'll probably start with taking a pill as soon as I get up in the morning. If it works within 2 hours, that will be fine with me. I just don't want to get the urge when I'm out for a jog or in the car. You can see more of my Amitiza history at http://www.ibsgroup.org/forums/topic/339737-started-amitiza/.


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## jza (Oct 4, 2016)

I've been taking Trulance for about 3 weeks and posted about my experience in another thread. It has been very effective and I had horrible constipation from SIBO for nearly 3 years. The minor downside is that it's unpredictable. It will empty you out, but sometimes it take 30 mins and sometimes it takes a few hours. My GI said the best time to take it is when you wake up, but I take it when I get to work so that I don't have the urge to go while I'm mid-commute. The consistency of the bowel movements is also unpredictable. For me, I never have a "normal" bowel movement.. it's usually somewhere from mild diarrhea to watery diarrhea. I was at a point where I was having on average 1 complete evacuation a month, so having diarrhea once per day and not walking around backed up with several lbs of stool on a daily basis is much preferred. I have no other side effects from it (my GI mentioned the major advantage over similar medications is that it doesn't cause cramping).


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## sjw596 (Feb 19, 2014)

Thanks. My plan is start in the morning when I get up. Even the manufacturer doesn't have a good answer or any suggestions. They'll only stick with the company line of "it usually works within 24 hours of your very first dose." I may start taking it on a day when I don't want to go for a jog for 2-3 hours.







I never had any discomfort with Linzess or Amitiza. Linzess had been a sure thing and produced mild diarrhea most days, while Amitiza produces "normal" stools that require a little effort to evacuate. After Trulance, I will have tried them all, as far as drugs go. If it doesn't work, I'll go back to Amitiza. I agree with your thoughts on diarrhea being of little consequence if you can achieve a CSBM every day!


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## mpfiorv (Jul 4, 2017)

can someone help....but...did Linzess help with the IBS tension/pain in the abdomen area??? please let me know folks....

I have tons of tension/pain in the lower abdomen and into my lower back....its all day..non stop...debilitating......


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## sjw596 (Feb 19, 2014)

I'm sorry that I can't speak to your issues, as I have CIC and not IBS-C. Linzess, however, is indicated for both, and only the suggested starting dose differs for each ailment.


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## flossy (Dec 8, 2012)

mpfiorv said:


> can someone help....but...did Linzess help with the IBS tension/pain in the abdomen area??? please let me know folks....
> 
> I have tons of tension/pain in the lower abdomen and into my lower back....its all day..non stop...debilitating......


I don't take Linzess, but I do take aloe vera pills every day, a couple with each meal (4 total daily). They help the intestines feel better. Recommended.


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