Gastrointestinal Peptide Medicines

What this page covers

Three prescription medicines used for gut conditions are built on natural gut peptides: linaclotide (sold in the US as Linzess), plecanatide (Trulance) and teduglutide (Gattex). They treat very different problems and are not alternatives to each other. This page gives no amounts, no injection instructions and no advice to start, stop or switch a medicine. It also says nothing about over-the-counter or supplement products. For everyday constipation information see constipation and gut and digestive health.

Evidence labels: approved medicine means the named regulator has approved the product for the stated use; established means more than one randomized trial agrees. Label statements come from US FDA labels on DailyMed and, for teduglutide, the European Medicines Agency (EMA), read 2026-10-22. Other countries were not checked. Labels change.

Summary table

Linaclotide and plecanatide

What they are. Linaclotide is structurally related to the natural gut peptides guanylin and uroguanylin. Plecanatide is a structural analogue of human uroguanylin. [1][2] Both bind GC-C on the lining of the intestine and act locally, which increases fluid in the bowel and speeds movement; in animal models, they also reduced signals from pain-sensing nerves. [1][2]

Evidence. Two randomized phase 3 trials of linaclotide in IBS-C, each of about 800 people, ran for 12 and 26 weeks. More people on linaclotide than on placebo had a meaningful drop in abdominal pain or discomfort (54.8% vs 41.8% in one trial, 54.1% vs 38.5% in the other) and reported their symptoms as considerably or completely relieved (37.0% vs 18.5% and 39.4% vs 16.6%). [4] Funding was not stated in the abstract. Evidence label: established for symptom response in adults with IBS-C in these trials, with a substantial placebo response. The trials measured symptom scores over weeks to months, not long-term outcomes. Plecanatide's label reports responder rates from two placebo-controlled IBS-C studies, which were not summarized here. [2]

Safety.

• Boxed warning. Both drugs carry a boxed warning about serious dehydration in young children. Linzess is contraindicated under age 2 (deaths from dehydration in infant mice), and Trulance is contraindicated under age 6 and its label says to avoid use between 6 and under 18. [1][2]


• Diarrhea. Diarrhea was the most common adverse reaction with linaclotide in adult trials, with severe diarrhea in 2% of adults at the two higher studied strengths. [1] For plecanatide, severe diarrhea was reported in 0.6% in each pooled group of trials. [2]


• Obstruction. Both are contraindicated with known or suspected mechanical gastrointestinal obstruction. [1][2]

Teduglutide

What it is. GLP-2 is a natural hormone that helps the gut lining; the Gattex label says GLP-2 is known to increase intestinal blood flow and inhibit gastric acid secretion, and teduglutide activates GLP-2 receptors, causing local release of messengers including IGF-1. [3] In the EU it is sold as Revestive for short bowel syndrome in adults and children from 4 months, and has orphan-medicine status. [5]

Short bowel syndrome is a condition in which a large part of the intestine has been removed and nutrients and fluids are not absorbed properly. [5]

Evidence. In a 24-week trial of 86 adults with short bowel syndrome with intestinal failure, 63% (27 of 43) of those given teduglutide were responders, meaning they cut their need for intravenous nutrition by more than 20%, versus 30% (13 of 43) on placebo. [6] Evidence label: promising but limited (one 24-week trial of 86 people in a rare condition). The abstract also reported a higher blood level of citrulline, a marker of gut lining; that is a biomarker, not a health outcome. [6]

Safety. The Gattex label lists possible growth of tumors and polyps in the gut (colonoscopy and upper endoscopy with polyp removal are called for before and during treatment), intestinal obstruction, gallbladder and pancreas disease, fluid overload and heart failure, and increased absorption of other oral medicines. [3] It lists no contraindications. [3]

Professional-care context

All three are prescription medicines. Constipation and gut symptoms can have causes that need examination, so new or changing symptoms are worth a visit; see digestive symptoms: when to get help. Teduglutide is managed in specialist care because of the monitoring the label describes. Research interest in other peptides for gut conditions is in peptides and gastrointestinal conditions; individual guides are linaclotide and plecanatide and teduglutide.