Linaclotide

How it works

It activates guanylate cyclase-C on the intestinal epithelium, raising intracellular cyclic GMP, which increases secretion of chloride and bicarbonate into the lumen, accelerates transit and reduces visceral pain signalling.

Prescribing in practice

• Diarrhoea is the most common adverse effect and can be severe; advise patients to stop and seek advice if it becomes severe or prolonged, particularly with dehydration risk.
• It is contraindicated in known or suspected mechanical gastrointestinal obstruction.
• Take on an empty stomach before the first meal of the day, and review treatment if there is no improvement after several weeks.

Monitoring

Routine laboratory monitoring is not required; monitor the clinical response and the severity of diarrhoea, reassessing if it is severe or persistent.

Counselling the patient

• Take the capsule on an empty stomach, before your first meal of the day.
• Diarrhoea can occur, especially early in treatment; stop and seek advice if it is severe or persistent.

Evidence & guidelines

Linaclotide is recommended by NICE as an option for moderate to severe irritable bowel syndrome with constipation in adults who meet specified criteria.