Linaclotide prescribing

Linaclotide prescribing guidance in primary care

Criteria	Linaclotide Guidance
Indication	Adults with moderate to severe irritable bowel syndrome with constipation (IBS-C) and no response to optimal or maximum tolerated doses of previous laxatives from different classes for at least 12 months
Dosing	290 micrograms once daily, at least 30 minutes before meals
Review	After 4 weeks of no response
Contraindications	Gastro-intestinal obstruction, Inflammatory bowel disease, Pregnancy or breastfeeding
Cautions	Predisposition to fluid and electrolyte disturbance, Increased risk of diarrhoea with co-prescribing NSAIDs or proton pump inhibitors, Concurrent use of medications absorbed in the intestinal tract with a narrow therapeutic index (e.g. levothyroxine)
Adverse Effects	Abdominal distention, abdominal pain, diarrhoea, dizziness, flatulence. In severe or prolonged diarrhoea, consider stopping treatment and using additional contraceptive methods. Severe cases may involve intestinal perforation, absorption of other oral medicinal products may be affected, and the use of an additional contraceptive method is recommended. Other adverse effects include decreased appetite, dehydration, haemorrhage, faecal incontinence, hypokalaemia, orthostatic hypotension, skin reactions, and vomiting.

Linaclotide is a synthetic peptide and agonist of intestinal guanylate cyclase type C (GC-C), related to the guanylin peptide family, with secretagogue, analgesic, and laxative properties. When orally administered, it binds to and activates...

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