Alternatives to Trulance If You Can't Fill Your Prescription

Trulance (plecanatide) is an effective prescription treatment for irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). But it's not always accessible. Whether your pharmacy is out of stock, your insurance won't cover it, or the cost is prohibitive without a manufacturer savings card, you deserve to know your options. Here's a thorough look at the best FDA-approved alternatives to Trulance — and how they compare.

Why Patients Look for Trulance Alternatives

The most common reasons patients need a Trulance alternative include:

• Cost. Trulance's retail price of $749–$830 per month makes it one of the more expensive GI medications on the market. Without insurance or manufacturer assistance, many patients simply can't afford it.
• Prior authorization denial. Some insurance plans require patients to try and fail other drugs before they'll approve Trulance.
• Local pharmacy unavailability. Some pharmacies simply don't stock it, especially smaller independent locations.
• Side effects. Though diarrhea from Trulance is less common than with Linzess, some patients still don't tolerate it.

1. Linzess (Linaclotide) — Closest Drug Class Alternative

Linzess is the most direct alternative to Trulance. Like Trulance, it's a guanylate cyclase-C (GC-C) agonist — meaning they work through essentially the same mechanism: activating GC-C receptors in the intestine to increase fluid secretion and speed up bowel transit. It's FDA-approved for both IBS-C and CIC in adults, and additionally approved for functional constipation in children ages 6–17.

Key difference: Linzess must be taken on an empty stomach at least 30 minutes before eating. Trulance can be taken with or without food at any time. Linzess also has a higher reported rate of diarrhea than Trulance.

Cost: Linzess has a similar retail price (~$700/month), though a generic version (linaclotide) became available in 2025, which may bring the cost down significantly.

ACG recommendation: The American College of Gastroenterology gives a strong recommendation to both Trulance and Linzess for IBS-C.

2. Amitiza (Lubiprostone) — Generic Available

Amitiza (lubiprostone) works differently from Trulance — it activates chloride channels in the intestinal lining to increase fluid secretion rather than going through the GC-C pathway. It's been on the market since 2006 and is FDA-approved for CIC in adults and IBS-C in adult women (not men for IBS-C). A generic version, lubiprostone, is available, making it one of the most affordable prescription options for constipation.

Key difference: Unlike Trulance's once-daily dosing, Amitiza is typically taken twice daily with food and water. Nausea is the most common side effect (vs. diarrhea with Trulance).

Cost: Generic lubiprostone can cost as little as $35–$200/month, a dramatic savings over Trulance.

3. Motegrity (Prucalopride) — Different Mechanism, CIC Only

Motegrity (prucalopride) works through a completely different mechanism: it's a 5-HT4 serotonin receptor agonist that stimulates gut motility. Rather than increasing fluid in the intestines, it tells the bowel muscles to move stool along faster. It's FDA-approved for CIC in adults only — not IBS-C.

Key difference: Motegrity has an important safety warning about worsening depression and suicidal thoughts. Patients with mental health conditions should discuss this with their doctor carefully before starting.

Cost: Motegrity is similarly priced to Trulance without insurance, though discount programs may reduce costs.

4. Ibsrela (Tenapanor) — IBS-C Only

Ibsrela (tenapanor) targets a completely different pathway from Trulance. It's an NHE3 (sodium/hydrogen exchanger 3) inhibitor that reduces sodium absorption in the intestines, drawing more water into the gut. It's FDA-approved only for IBS-C in adults, not CIC. Like Trulance, it's a brand-name-only drug with no generic available.

5. Over-the-Counter Options

For patients who can't access or afford prescription alternatives, over-the-counter options may help bridge the gap. These include:

• MiraLax (polyethylene glycol 3350) — an osmotic laxative that pulls water into the bowel; very affordable at ~$20–$30/month
• Fiber supplements (psyllium/Metamucil) — first-line for mild constipation, very affordable
• Senna or bisacodyl — stimulant laxatives, effective short-term but not recommended for daily long-term use

How to Choose the Right Alternative

Your best alternative depends on several factors:

• If your priority is cost: Generic lubiprostone (Amitiza) is the most affordable prescription option
• If you have IBS-C and want the closest substitute: Linzess is your best bet
• If slow gut motility is your primary problem: Ask your doctor about Motegrity

Never switch constipation medications without talking to your doctor first. Each drug has unique side effects and interactions.

The Bottom Line

If you can't find or afford Trulance, you're not without options. Linzess is the closest prescription substitute, Amitiza offers a more affordable generic route, and Motegrity and Ibsrela offer different mechanisms that may work for your specific type of constipation. Before giving up on Trulance entirely, try medfinder to check whether any pharmacy near you has it in stock today.