When You Can't Get Ibsrela, What Are Your Options?

Living with irritable bowel syndrome with constipation (IBS-C) is uncomfortable enough without the added stress of not being able to fill your prescription. Whether your pharmacy doesn't stock Ibsrela, your insurance won't cover it, or the cost is simply too high, you deserve to know what other treatment options are available.

In this article, we'll cover what Ibsrela is, how it works, and walk through several FDA-approved alternatives that your doctor may consider if you can't get your Ibsrela prescription filled.

What Is Ibsrela?

Ibsrela (tenapanor) is a prescription medication FDA-approved for the treatment of IBS-C in adults. It was first approved in September 2019 and is manufactured by Ardelyx, Inc. Ibsrela is available only as a brand-name medication — there is no generic version, and none is expected until at least 2033.

Ibsrela is taken as a 50 mg tablet twice daily, immediately before breakfast and dinner. The cash price without insurance runs approximately $2,000 to $2,500 for a 30-day supply, though the Ardelyx copay program can reduce costs significantly for commercially insured patients.

How Does Ibsrela Work?

Ibsrela works differently from other IBS-C medications. It belongs to a class called sodium/hydrogen exchanger 3 (NHE3) inhibitors. By blocking the NHE3 transporter in the intestinal lining, Ibsrela reduces sodium absorption in the gut. This draws more water into the intestines, resulting in softer stools and more regular bowel movements while also reducing abdominal pain.

For a deeper dive, see our article on how Ibsrela works.

Because Ibsrela has a unique mechanism of action, the alternatives below work through different pathways — but they target the same core symptoms of IBS-C.

Alternative 1: Linzess (Linaclotide)

Linzess is one of the most commonly prescribed IBS-C medications and is often the first treatment doctors try before considering Ibsrela.

• Drug class: Guanylate cyclase-C (GC-C) agonist
• How it works: Linzess activates GC-C receptors on the intestinal lining, increasing fluid secretion and accelerating bowel movements. It also reduces pain signaling in the gut.
• Dosage: Available in 72 mcg, 145 mcg, and 290 mcg capsules, taken once daily on an empty stomach at least 30 minutes before the first meal
• Approved for: IBS-C and chronic idiopathic constipation (CIC) in adults
• Common side effects: Diarrhea (most common), abdominal pain, bloating, gas
• Cost: Approximately $500 to $600 per month without insurance; generic linaclotide is now available and may be significantly cheaper

Linzess is widely stocked at pharmacies and has better insurance coverage than Ibsrela, making it the most accessible alternative for many patients.

Alternative 2: Trulance (Plecanatide)

Trulance is another GC-C agonist similar to Linzess but with a slightly different molecular structure.

• Drug class: Guanylate cyclase-C (GC-C) agonist
• How it works: Like Linzess, Trulance activates GC-C receptors to increase intestinal fluid secretion and promote bowel movements
• Dosage: 3 mg tablet taken once daily with or without food
• Approved for: IBS-C and chronic idiopathic constipation in adults
• Common side effects: Diarrhea, though it may cause less diarrhea than Linzess in some patients
• Cost: Approximately $500 to $600 per month; no generic available as of 2026

Some patients who experience significant diarrhea with Linzess find Trulance to be better tolerated. It also has the advantage of being taken with or without food.

Alternative 3: Amitiza (Lubiprostone)

Amitiza has been available since 2006 and is one of the longest-established IBS-C treatments.

• Drug class: Chloride channel activator
• How it works: Amitiza activates chloride channels in the intestinal lining, increasing fluid secretion and promoting bowel movements
• Dosage: 8 mcg capsule taken twice daily with food and water for IBS-C
• Approved for: IBS-C in women 18 and older, chronic idiopathic constipation in adults, and opioid-induced constipation
• Common side effects: Nausea (most common), diarrhea, headache, abdominal pain
• Cost: Generic lubiprostone is available and may cost $50 to $200 per month, making it significantly cheaper than Ibsrela

Amitiza's biggest downside is nausea, which some patients find difficult to tolerate. However, its generic availability makes it a much more affordable option.

Alternative 4: Motegrity (Prucalopride)

Motegrity takes a completely different approach to treating constipation.

• Drug class: Selective 5-HT4 receptor agonist
• How it works: Motegrity stimulates serotonin receptors in the gut, which increases intestinal motility (the movement of food through the digestive tract)
• Dosage: 1 mg or 2 mg tablet taken once daily
• Approved for: Chronic idiopathic constipation in adults (not specifically for IBS-C, but sometimes used off-label)
• Common side effects: Headache, abdominal pain, nausea, diarrhea
• Cost: Approximately $500 to $600 per month without insurance

While Motegrity is not specifically FDA-approved for IBS-C, some gastroenterologists prescribe it off-label when other treatments haven't worked or when a patient's primary symptom is slow motility rather than abdominal pain.

How to Choose the Right Alternative

The best alternative to Ibsrela depends on your specific situation:

• If you need the most affordable option: Generic lubiprostone (Amitiza) or generic linaclotide (Linzess) may offer significant savings
• If diarrhea is a concern: Trulance may cause less diarrhea than Linzess in some patients
• If slow motility is your primary issue: Motegrity targets gut movement specifically
• If you've tried everything else: Talk to your doctor about other strategies, including combination therapy or dietary modifications

Always discuss medication changes with your doctor before switching. Each of these medications has its own drug interaction profile and side effect considerations.

Final Thoughts

Not being able to fill your Ibsrela prescription is frustrating, but you have options. Several FDA-approved alternatives treat the same symptoms of IBS-C, and some are more affordable and easier to find than Ibsrela.

If you'd prefer to stick with Ibsrela, tools like Medfinder can help you find a pharmacy that has it in stock. And if cost is the barrier, explore the savings options available for Ibsrela — you may pay less than you think.