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Linaclotide for irritable bowel syndrome with constipation: a review

Michael Arriaga & Eamonn MM Quigley

Irritable bowel syndrome (IBS) is a common disorder that poses a management challenge. IBS with constipation as the dominant bowel habit is a common phenotype and features abdominal pain, infrequent bowel movements or difficult defecation, bloating and distention, as major symptoms. While laxatives increase stool frequency, they have little impact on other symptoms; prior, more specifically targeted, therapies have been withdrawn because of adverse events. Prosecretory agents represent a new drug class that act locally and have minimal systemic absorption; linaclotide is the latest to obtain regulatory approval and provides significant relief of the cardinal symptoms of IBS-constipation. Linaclotide also accelerates colonic transit and animal data suggest a visceral analgesic effect. The main side effect has been diarrhea.