# Trulance



## Shalom (Apr 25, 2017)

Hi everyone!

I have severe constipation that requires ALOT of miralax plus MILk of MAG daily.

Been through all the treatments and diets etc over the years. Im like Annie- I take what I need to go.

just saw gastro and asked for Trulance samples.

Have it!

now , the big question: When to take and how soon does it work?

If I take it at night is it strong enough without MOM or a little miralax?

should I take first thing in am?

the doctor said take it whenever you want , just always take at same time everyday.

thoughts????

amitiza and liness made stomach hurt and feel ill. zelnorm was good  propulsid was great. too bad everything that works gets yanked off market.


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## annie7 (Aug 16, 2002)

congrats on getting trulance to try! hope it helps you.

hopefully someone here can answer your questions

here are some reviews on drugs.com:

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

good luck. fingers crossed it helps!


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## jza (Oct 4, 2016)

I was just prescribed Trulance. I'll post my experience once I start. Miralax quickly lost its effectiveness for me, and milk of magnesia is only somewhat effective. I have SIBO-C.


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## annie7 (Aug 16, 2002)

good luck---hope it helps you!


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## jza (Oct 4, 2016)

I took my first dose yesterday. I was able to go to the bathroom within 30 minutes. It completely emptied me out over a period of a few hours (watery stool). I weighed myself in the morning and before bed, and there was a 7lb difference. I took my second dose this morning and so far haven't had the urge to go but am also not bloated or constipated. Major relief so far, and I'm hoping the severe diarrhea isn't an every day issue. Will post more updates once I've been on it a little longer.


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## annie7 (Aug 16, 2002)

thanks for the update.

glad you had some relief and yes, hope severe D isn't a daily issue. good luck.


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## jza (Oct 4, 2016)

Had severe diarrhea on day one. Day 2 had bloating and felt backed up but had a complete bowel movement at the end of the day. It took me about 40 minutes to pass though. Day 3 had a couple of partial bowel movements and some bloating. Day 4 and I have diarrhea again (although nowhere near as severe as the first day). My reaction to it seems to be impacted by whether I eat with it and how much I eat when I take it. If I take it without food, no diarrhea. If I take it with food, it seems the more I eat with it, the more likely the diarrhea is. My reaction to it so far is not ideal since I haven't been "regular" one day yet, but it's still an improvement over what I was previously dealing with (2-3 partial bowel movements per week and an average of one complete evacuation per month).


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## jza (Oct 4, 2016)

One week on Trulance and my constipation is definitely gone. The downside is my stool is consistently between a 5-7 on the Bristol scale. I'll happily take that over the moderate to severe constipation I've dealt with for the past few years though. While it causes diarrhea, I haven't had an intense urgency to go so no issues making it to the bathroom or anything in time. The diarrhea usually hits within in an hour of taking it, so I take it when I get to work instead of in the morning before my commute. While there's not an intense urgency, I don't want to risk it. I could see this possibly being an issue if I were on vacation or something where I may be away from the bathroom for a long time, but I'd much rather deal with this than deal with walking around with several lbs of stool in me at all times (and all the other symptoms associated with that.. negative mood, skin problems, pain, etc).


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## annie7 (Aug 16, 2002)

thanks for the update.

that's terrific that your C is definitely gone! and yes, mushy, loose or watery stool is definitely better than being miserably constipated. that's what i always thought.

and that's good that so far urgency hasn't been a problem. that was a good idea--taking it after you get to work. hope it continues to work for you.


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## dorkal (Sep 17, 2017)

Anyone have any more feedback on their Trulance experience? I see this thread is a few months old ... I've been on it for three days and nothing. I was on Amitiza for three weeks prior with no relief, in which I switched to Trulance hoping it would work.


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## kikiveronica (Sep 17, 2017)

I tried Trulance twice for a week and ended up with very unpredictable diarrhea and decided not to take it anymore.


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## jza (Oct 4, 2016)

kikiveronica said:


> I tried Trulance twice for a week and ended up with very unpredictable diarrhea and decided not to take it anymore.


It is definitely unpredictable. I'm trying to determine why it causes a Bristol scale 7 some days, and other days I'm closer to the middle of the scale. I think it's a mix of fluid intake, the amount of time I take it after waking, and how close I take it to consuming food.

I also don't think it agrees with alcohol. Even if I only have 1-2 glasses of wine late evening, I notice when I take the Trulance the next morning, I'm much more likely to have #7 than if I consume no alcohol. The only days I ever drink alcohol are Fridays or Saturdays, so it's become very apparent that I don't have the #7 all week and then will have it on a Saturday or Sunday morning after consuming alcohol the evening before.


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## kikiveronica (Sep 17, 2017)

The unpredictability of Trulance made me stop it. Maybe I have exercised "control" for too long via enemas, but I didn't like not feeling any awareness of when it might work, and when it did it was watery, similar to Linzess. I have given up both meds.


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## jza (Oct 4, 2016)

I just found out my insurance carrier is no longer covering Trulance!







It's way too expensive to buy at the retail price ($2000+/mo).

They suggested I switch to Amitiza or Linzess. I'm very frustrated because I feel like I took control of my life back since started on Trulance last year.


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## annie7 (Aug 16, 2002)

oh no--that's terrible! i hate insurance companies.

back in the day, my insurance company suddenly decided that they no longer would cover zelnorm. i called them to protest and they told me i could "just take laxatives" instead.

my doctor sent them a letter (something like a prior authorization) saying that i needed it and that i had tried everything and nothing else would work for me and that i could not "just take laxatives" and then they finally agreed to cover it again. do you think a prior auth from your doc would help at all?

i know that on their website trulance has a savings card but i think that's just for copays and scripts...

you (or your doctor) should be able to file an appeal with your insurance company.

https://www.consumerreports.org/health/4-ways-to-get-insurance-to-cover-your-prescription-drugs/


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## jza (Oct 4, 2016)

annie7 said:


> oh no--that's terrible! i hate insurance companies.
> 
> back in the day, my insurance company suddenly decided that they no longer would cover zelnorm. i called them to protest and they told me i could "just take laxatives" instead.
> 
> ...


My insurance carrier was a pain about approving it even before they announced they wouldn't be covering it at all anymore. They kept pushing back, and my doctor had to keep sending them letters of medical necessity every time I needed to refill it. I'm still going to reach out to my doctor to see if they can get the insurance carrier to cover it out of medical necessity regardless. Regular laxatives don't work for me either. I haven't tried Amitiza or Linzess, but I've heard (from here and my own doctor) that they have more side effects than Trulance.


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## annie7 (Aug 16, 2002)

yes, that's a good idea to reach out to your doctor anyway. did your insurance company send you a letter about their denial with an appeal form included? that's what mine is starting to do now.

good luck and fingers crossed! keep us updated.


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## jza (Oct 4, 2016)

annie7 said:


> yes, that's a good idea to reach out to your doctor anyway. did your insurance company send you a letter about their denial with an appeal form included? that's what mine is starting to do now.
> 
> good luck and fingers crossed! keep us updated.


Thank you. Not yet. They just told me starting in July it's a non-covered medication and that I should explore Amitiza and Linzess as alternatives.


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## annie7 (Aug 16, 2002)

oh really, that's terrible. amitiza and linzess are not acceptable alternatives at all. i personally found amitiza to be useless and have bad side effects (huge bloating--even my ankles!) and linzess too tricky--either too much D or not working at all.

they should at least have you try step therapy (i've had to do this several times for certain meds) and then if amitiza and linzess don't work, they should agree to pay for trulance.

it's just not right that they suddenly just pulled the rug out from under you and refused to cover it at all after everything you had to go through to get them to cover it before. and it is a medical necessity!! what part about that don't they get! obviously none of these people making this decision has had to suffer with chronic constipation.


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## sjw596 (Feb 19, 2014)

I've used Trulance since last September. It had been working extremely well, but its effectiveness has diminished somewhat over the past month. I take it first thing in the morning, and it usually produces results within two hours. I now supplement it with Miralax once daily. I had taken Linzess for 1.5 years with good results, but then it quit entirely rather suddenly. I went to Amitiza, which did not work at all. As others have mentioned, it seems that none of these new drugs work indefinitely, or at least none has been around long enough to determine long-term efficacy. I got an exception for Trulance from the insurance company and pay $100 for a 3-month supply. To get an exception, which I must renew annually, I have to set forth that the similar meds were not effective. The only "similar" med is Linzess.


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## wgbutler (Mar 15, 2018)

I visited my GI last week and got some samples of Trulance. From what I can tell its basically the same drug as Linzess. I don't see any real difference. Both drugs give me runaway diarrhea for 2-3 hours.

Trulance does have a few slight differences. Each pill is in its own blister pack, which is better than Linzess because I've read that after you open up a bottle of LInzess the moisture in the air starts degrading the pills in the bottle.

Also, Trulance is in pill form and LInzess is in capsule form. So the Trulance takes effect sooner (yesterday it took effect after about an hour and 15 minutes vs the 2 hours that Linzess usually takes to take effect).

It would also make it easier to split the pill with a pill splitter. I'm going to try this next. I'm going to take HALF of a Trulance to see if that can give me some relief without the accompanying 3 hours of diarrhea.


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## dac122 (Feb 13, 2012)

wgbutler said:


> It would also make it easier to split the pill with a pill splitter. I'm going to try this next. I'm going to take HALF of a Trulance to see if that can give me some relief without the accompanying 3 hours of diarrhea.


How did you make out with the pill splitter?


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## wgbutler (Mar 15, 2018)

OK I've tried the pill splitting twice and this is what happened.

Last week I used my pill splitter to try to split the pill in half. Unfortunately, it ended up creating a pill that was about 2/3 the normal size and 1/3 the normal size. I took the 2/3 pill first and it gave me runaway diarrhea for about 2 hours. (Not quite as bad as the first time I took a whole pill which gave me runaway diarrhea for about 3 hours.)

I put the 1/3 pill in a plastic bag and the next day I took the 1/3 pill to see what would happen. Basically nothing happened. A few hours after I ingested it I kind of felt like I had to go to the bathroom but not really, and nothing came out. So it just wasn't enough.

Today I tried it again and I did a pretty good job of splitting the pill 50/50. Magic! About an hour and a half later I had a very relieving bowel movement (it was like mud but who cares). I felt so much better. I had to go another 3 or 4 times over the next 45 minutes (diarrhea) but that was it. So basically everything ran its course in less than an hour.

Unfortunately the other half of the pill split into two fragments but I will try to take those fragments soon to see if they still work after being out of the blister pack for a day or two.

The pill is very small and hard to split 50/50. It crumbles very easily. And I'm not sure how quickly it degrades after taking it out of the blister pack. I've read that Linzess degrades after you open up the bottle because the moisture in the air starts contaminating the pills and makes them less effective.


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## jza (Oct 4, 2016)

jza said:


> Thank you. Not yet. They just told me starting in July it's a non-covered medication and that I should explore Amitiza and Linzess as alternatives.


They already stopped covering it! I'm meeting with my doctor in a few weeks to switch medications.

I started splitting the Trulance I have left, and it seems to still work even if I take half a pill. The downside is, as the previous poster said, the pill crumbles (it's a tiny pill to begin with) when you split it so you have to scoop up a bunch of fragments and take them.


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## annie7 (Aug 16, 2002)

oh i'm really sorry that they stopped covering it! that's terrible! does your doc have any samples he/she can give you?

good luck with switching medications--sounds like you'll be trying linzess and amitiza? i hope they help. keep us posted and good luck.


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## jza (Oct 4, 2016)

annie7 said:


> oh i'm really sorry that they stopped covering it! that's terrible! does your doc have any samples he/she can give you?
> 
> good luck with switching medications--sounds like you'll be trying linzess and amitiza? i hope they help. keep us posted and good luck.


Yes, thankfully they gave me samples to get me through until my appointment.

I'm thinking of switching to Linzess since it seems to be the most similar medication available at the moment.

I'll post updates on my experience with it.


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## annie7 (Aug 16, 2002)

oh that's good that you have some samples.

good luck with linzess. and thanks for keeping us updated on how it goes. there are a lot of posts on here about linzess and how to tweak it if need be.


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## slv1200 (Jun 11, 2018)

sjw596 said:


> I've used Trulance since last September. It had been working extremely well, but its effectiveness has diminished somewhat over the past month. I take it first thing in the morning, and it usually produces results within two hours. I now supplement it with Miralax once daily. I had taken Linzess for 1.5 years with good results, but then it quit entirely rather suddenly. I went to Amitiza, which did not work at all. As others have mentioned, it seems that none of these new drugs work indefinitely, or at least none has been around long enough to determine long-term efficacy. I got an exception for Trulance from the insurance company and pay $100 for a 3-month supply. To get an exception, which I must renew annually, I have to set forth that the similar meds were not effective. The only "similar" med is Linzess.


I have to take Miralax with Trulance, too. Do you take a full dose of both? I feel like I am over medicating.


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## sjw596 (Feb 19, 2014)

I had been taking a full dose, and the GI's PA said that I could take two doses if it became necessary. I stopped the Miralax entirely as it, plus the Trulance, gave me diarrhea or caused pencil-thin stools. The Trulance works, but less effectively than at the beginning, and it seems that I have to jump start it occasionally. Now, I do so with a half-dose of MoM before bed. I take Trulance with at least 8 oz. water when I arise, and usually have a BM within 1.5 hours. It helps if I sit and relax for a while after I do a bunch of morning chores. I used to be on my feet just waiting for the "urge."


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## dac122 (Feb 13, 2012)

wgbutler said:


> OK I've tried the pill splitting twice and this is what happened.
> 
> Last week I used my pill splitter to try to split the pill in half. Unfortunately, it ended up creating a pill that was about 2/3 the normal size and 1/3 the normal size. I took the 2/3 pill first and it gave me runaway diarrhea for about 2 hours. (Not quite as bad as the first time I took a whole pill which gave me runaway diarrhea for about 3 hours.)
> 
> ...


wgbutler, I too am taking Trulance and splitting. It seems to work well this way but I am having the same problem as you with an uneven split and crumbling.

Any luck splitting it evenly and not crumbling?

Thanks


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## jza (Oct 4, 2016)

When I was taking Linzess, it was nearly impossible to split the pills. They crumble into dust since they're so small and not scored. So far, I prefer Linzess because I'm on the lowest dose and it usually makes me go without hours and hours of diarrhea like the Trulance dose caused.


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## Countrycuz (Jul 12, 2018)

I have been taking Trulance for about two months now. I am like a person that does not have IBS-C anymore!

I take trulance in the morning before I eat breakfast. I usually now have abut two bowel movements a day with no stress and no drama. I can not live without this drug!

I have more energy now and no linger get fatigued and and sleepy after eating lunch like I use to. I consider this drug a miracle drug for all that it has done for me. I sleep better at nifht, my aching lower abdominal pain is gone. and when I feel the urge to go to the bathroom, I know that as soon as I sit down,I just need to relax and enjoy the ride! no straining,no pain, no hassle. Every trip to the toilet is like a day in paradise. I am lucky that I get mine from the VA and have to pay 15 dollars a Month.

I would not ever consider not taking this medicine because nothing solves the constipation like this drug does.


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## Countrycuz (Jul 12, 2018)

jza said:


> When I was taking Linzess, it was nearly impossible to split the pills. They crumble into dust since they're so small and not scored. So far, I prefer Linzess because I'm on the lowest dose and it usually makes me go without hours and hours of diarrhea like the Trulance dose caused.
> 
> I have heard people say that LInzess caused them to never leave the toilet for hours. We also need to make sure that we do not also have a small intestinal bowel infection. I took some antibiotics for this and I could tell that there was a difference in my bowel symptoms.


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## Countrycuz (Jul 12, 2018)

slv1200 said:


> I have to take Miralax with Trulance, too. Do you take a full dose of both? I feel like I am over medicating. try taking orange flavored Metamucil each night in a glass of water instead of MOM. I might have had small intestinal bacteria because after I took flagyl and another antibiotic they gave me, My bowell movements became more healthy looking with Trulance and not long and thin like before.


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## Countrycuz (Jul 12, 2018)

dac122 said:


> How did you make out with the pill splitter? If splitting a pill is a problem, crush the pill into powder and measure out equal amounts and put into some orange juice and drink it.


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## dac122 (Feb 13, 2012)

Countrycuz said:


> dac122 said:
> 
> 
> > How did you make out with the pill splitter? If splitting a pill is a problem, crush the pill into powder and measure out equal amounts and put into some orange juice and drink it.


Unfortunately, not much luck. It seems if I split slowly I can get one half in tact but not always. It is simply too soft and crumbly. If I have at least one half left in tact I can take that part later.


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## jza (Oct 4, 2016)

Countrycuz said:


> I have heard people say that LInzess caused them to never leave the toilet for hours. We also need to make sure that we do not also have a small intestinal bowel infection. I took some antibiotics for this and I could tell that there was a difference in my bowel symptoms.


That might depend on the dosage and how close they take it to eating.


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