Linzess Side Effects: A Comprehensive Guide

Linzess Side Effects: A Comprehensive Guide

Authored by Oto Idah, / Medically Reviewed by Dr. Conor Sheehy, PharmD, BCPS
Last Updated: October 9, 2023


Linzess (generic name linaclotide) is a once-daily prescription medication used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in adults. Linzess is also used to treat functional constipation (FC) in children and adolescents aged 6 to 17 years. Though generally effective in managing these conditions, like any medication, Linzess is associated with side effects. In this comprehensive guide, we’ll explore the intricacies of Linzess—its common uses, mechanism of action, and therapeutic benefits. We will also provide a detailed overview of Linzess side effects and arm you with the knowledge to make informed decisions about your health.

IBS-C is a common gastrointestinal disorder characterized by abdominal pain/discomfort and changes in bowel habits, with constipation being a predominant symptom. “Idiopathic” means the cause of the constipation is unknown. Thus, CIC is chronic constipation of unknown cause. IBS-C and CIC are the most commonly diagnosed gastrointestinal disorders in North America. They are more common in females, the elderly, and lower socioeconomic groups. Linzess alleviates symptoms, relieves constipation, improves bowel function, and promotes regular bowel movements in adults with IBS-C and CIC. Treatment options for IBS-C and CIC are limited. Linzess is one of only three FDA-approved options.

Understanding Linzess mechanism of action

Linzess, also known by its generic name linaclotide, belongs to the class of drugs called guanylate cyclase-C agonists. It works by increasing chloride and water secretion in the intestines. Linzess operates through a complex mechanism of action involving the selective activation of guanylate cyclase-C receptors in the intestinal epithelium. This activation increases cyclic guanosine monophosphate (cGMP), leading to increased chloride and bicarbonate secretion into the intestinal lumen, which augments bowel movements, alleviates constipation, and improves symptoms associated with IBS-C and CIC.

Understanding how Linzess works is fundamental to appreciating how it interacts with the gastrointestinal system and its potential side effects. It is important to use Linzess under the guidance of a healthcare professional who can can assess your specific condition and determine whether it is an appropriate treatment for you. Always follow your healthcare provider’s instructions and inform them of any side effects you experience or other concerns you develop.

Understanding Linzess side effects

Linzess is an efficacious and well-tolerated treatment option for IBS-C and CIC. However, understanding its potential side effects is crucial for several reasons.

Informed decision-making

Knowing the possible side effects allows you to make an informed decision about whether to take the medication. This is particularly important if you have other health conditions, are taking other medications, or have concerns about the potential impact of side effects on your daily life.

Early recognition of potential concerns

Being aware of potential side effects helps you recognize and report any unusual symptoms or reactions promptly. Early detection of issues allows for timely intervention by your healthcare provider.

Adherence to treatment

When aware of the possible side effects, you are more likely to adhere to the prescribed treatment plan. If unexpected side effects occur, discussing them with your healthcare provider can help you find a solution, such as adjusting the dosage or trying an alternative treatment.

Safety considerations

Understanding potential interactions with other medications, substances, or medical conditions is crucial for your safety. Certain side effects are more concerning for specific populations or for those taking other specific drugs.

Communication with healthcare providers

Open communication with your healthcare provider is essential. When you understand the potential side effects, you can have more productive discussions with your healthcare team about your concerns, preferences, and any adjustments needed in your treatment plan. Always take medications as prescribed and do not hesitate to reach out to your healthcare provider if you have questions or concerns about the side effects of Linzess or any other medication.

Side effects of Linzess

Common questions about Linzess include the following: Is it a high-risk medication? What are the common side effects of Linzess? What are its long-term effects? If you are already taking Linzess or planning to start, here is what you need to know about this medication’s side effects. Some are common and mild, while others are rare, unique, and sometimes severe.

Common side effects of Linzess

Common side effects of Linzess include diarrhea, abdominal pain, passing gas, body aches or pain, chills, ear congestion, excess air or gas in the stomach or intestines, fever, a full or bloated feeling, headache, loss of voice, sneezing, sore throat, and stuffy or runny nose. It’s important to note that not everyone will experience these side effects, and some may have different reactions. If you experience severe or persistent side effects, it’s crucial that you contact your healthcare provider promptly.

Linzess and diarrhea

Diarrhea is the most frequently reported Linzess side effect in both adults and children, and it occurs in a substantial number of users. This is not surprising because of the medication’s mechanism of action. Diarrhea can range from mild, transient episodes to a more severe and persistent condition. It is imperative to determine the degree of severity to effectively manage this side effect, which often begins within the first two weeks of Linzess treatment.

Understanding diarrhea severity, its impact on electrolyte balance, and potential strategies for symptom management is crucial. Managing Linzess-induced diarrhea involves striking a balance between therapeutic effects and tolerability to avoid compromising quality of life. Individual tolerance levels and the impact on quality of life should be considered in each treatment plan. For instance, people with a history of gastrointestinal sensitivity may be more prone to Linzess-induced diarrhea. As diarrhea is linked to dehydration, maintaining adequate fluid intake while on Linzess is essential. Dietary adjustments, such as avoiding trigger foods or excessive fiber, may also help manage symptoms.

Higher doses increase the risk of diarrhea. Dosage adjustments should thus be considered for those experiencing severe symptoms. Starting with a low dose and gradually increasing can help the body adjust. 

Linzess and abdominal pain and swelling

Abdominal pain is a common Linzess side effect with diverse manifestations. Some individuals experience abdominal pain or discomfort. Others have a feeling of abdominal fullness, bloating, cramping, pressure, or distention. These are likely signs of the medication’s impact on intestinal activity.

The manifestation of abdominal pain varies widely among Linzess users. Individuals with pre-existing gastrointestinal conditions may be more susceptible. Detailed descriptions of the nature, location, and duration of pain episodes can aid healthcare professionals in determining whether this side effect is a temporary adjustment or a more significant concern. It is also helpful when patients can differentiate between cramping, bloating, and discomfort.

Higher doses may exacerbate abdominal pain in some individuals, but gradual dose titration can minimize the risk. Additionally, taking Linzess consistently with meals can reduce the intensity of abdominal pain. If your pain persists, consult with your healthcare provider for appropriate evaluation.

Linzess and flatulence/gas

Increased gas production is a common Linzess side effect. While generally considered a minor and harmless effect, it can be bothersome for some users, and its persistence can affect quality of life. People vary in their sensitivity to flatulence-inducing factors, and certain foods can contribute to increased gas production. Reducing intake of gas-producing foods, such as beans, cabbage, and carbonated drinks may help. Some individuals find relief from flatulence with probiotic supplements. Physical activity can also aid in the movement of gas through the digestive system.

Knowing when to consult a healthcare provider for persistent flatulence ensures timely intervention. Open communication about symptom management contributes to a positive treatment experience.

Less common side effects

Less common side effects of Linzess include heartburn, loss of appetite, nausea, vomiting, headaches, dehydration, and weakness.

Linzess and headaches

Linzess may cause headaches in some individuals. While less common, headaches are a notable side effect. Some individuals are more prone to headaches, and inadequate fluid intake can exacerbate them. Persistent headaches can interfere with medication adherence. Proper hydration, stress reduction techniques, and over-the-counter pain relievers may provide relief.

Linzess and nausea

Although less common, some Linzess users experience nausea. Persistent nausea should be reported to a healthcare provider. Strategies for managing nausea, such as adjusting the timing of Linzess intake or taking it with food, contribute to patient comfort. Some patients find relief from nausea with ginger supplements or ginger-containing foods.

Linzess and vomiting

In rare cases, Linzess causes vomiting. Prolonged and severe diarrhea may also increase the risk of vomiting. In such cases, a healthcare provider may consider adjusting Linzess dosage. Immediate medical attention is essential for severe cases of vomiting.

Linzess and dehydration

Because Linzess-induced diarrhea can lead to dehydration, it is essential to stay well hydrated, especially if diarrhea is persistent. Elderly individuals are especially vulnerable to dehydration. Regular monitoring for signs of dehydration, such as dark urine and lethargy, is important. In severe cases, electrolyte replacement solutions may be necessary.

Rare and severe side effects of Linzess

Serious side effects are uncommon when taking Linzess but include severe diarrhea, allergic reactions, gastrointestinal obstruction, and rectal bleeding.

Linzess and severe diarrhea

Prolonged and severe diarrhea can lead to complications, including electrolyte imbalances and dehydration. Elderly individuals are at higher risk. If diarrhea persists, it is crucial to consult a healthcare professional. Starting with a low dose and gradually increasing can help the body adjust. Ensuring sufficient fluid intake and replacing electrolytes when necessary are crucial. Regular communication with healthcare providers is necessary for ongoing management.

Linzess and gastrointestinal obstruction

In rare instances, Linzess may cause a blockage in the intestines. This is a potentially serious side effect, and timely recognition and intervention are critical to prevent complications. Symptoms include severe stomach pain, bloating, and vomiting. Elderly individuals and those with a history of gastrointestinal conditions may be at higher risk of gastrointestinal obstruction.

Linzess and rectal bleeding

Unexplained bleeding from the rectum is a serious side effect and should be addressed promptly with a healthcare provider. Elderly individuals and those with preexisting gastrointestinal conditions are more prone to rectal bleeding. Individuals taking Linzess should monitor for any signs of rectal bleeding, report promptly if it occurs, and consider alternative treatments if it persists. Understanding the urgency of this symptom ensures that appropriate interventions are initiated promptly.

Linzess and allergic reactions

Allergic reactions to Linzess are rare. Symptoms include rash, itching, swelling, severe dizziness, or difficulty breathing. Individuals with a history of allergies and those who have had previous adverse reactions to medications are at higher risk. It is important that healthcare providers conduct a thorough patient history to identify potential risks before prescribing Linzess. Any signs of an allergic reaction should receive immediate medical attention. Timely response to an allergic reaction ensures patient safety. Individuals with a known history of allergies may need an alternative medication.

Please report adverse side effects by visiting or calling 1-800-FDA-1088.

Special considerations

Special considerations must be made for some patient populations—including pediatric and elderly patients and those pregnant or breastfeeding—due to their higher risk of more severe reactions to Linzess.

Can children take Linzess?

Pediatric populations have different sensitivities to medications. Linzess is not recommended for use in children under age 6, as safety and effectiveness below this age have not been established. It is contraindicated in patients under 2 due to the risk of serious dehydration. If gastrointestinal issues arise in pediatric patients, alternative treatments and approaches should be considered. Collaborating with pediatricians and adhering strictly to their guidance ensure a tailored and safe approach to managing gastrointestinal conditions in children.

Can the elderly take Linzess?

Elderly individuals are more susceptible to certain side effects and may face unique challenges and considerations due to age-related factors. Close monitoring and personalized care are advised for this demographic. A holistic approach to geriatric care involves considering comorbidities, polypharmacy, and lifestyle factors. Elderly individuals may be on multiple medications, increasing the risk of interactions. Regular review of medications is important to minimize these interactions, and dosage can be adjusted based on individual response.

Can I take Linzess if I am pregnant or planning to get pregnant?

The use of Linzess during pregnancy should be approached with caution. Adequate and well-controlled studies on this drug’s safety during pregnancy are limited. Before taking Linzess, inform your healthcare provider if you are pregnant or planning to become pregnant.

Can I take Linzess if I am breastfeeding?

It is not known whether Linzess passes into breast milk. Due to the lack of sufficient data on the safety of Linzess during breastfeeding, breastfeeding mothers should consult with their healthcare provider before taking Linzess. Healthcare providers can provide guidance on whether the benefits of the medication justify the potential risks to the baby.

Recommended dosage, available forms, and formulations of Linzess

Linzess is available in capsule form. The capsules are available in strengths of 72 mcg, 145 mcg, and 290 mcg. The recommended starting dosage for Linzess is 145 mcg orally once daily. Based on individual response and tolerability, healthcare providers may adjust the dosage to as high as 290 mcg once daily. Linzess is typically taken with water or applesauce on an empty stomach at least 30 minutes before the first meal of the day. If you have trouble swallowing capsules, carefully open the Linzess capsule and sprinkle all the beads into applesauce or 1 oz (30mL) of water.

Proper usage and dosage play a vital role in optimizing the benefits of Linzess. Factors such as meal timing, drug interactions, and individual patient differences contribute to its effectiveness. Tailored dosage recommendations based on medical history and specific conditions ensure the best possible outcomes. Thus, it is crucial to follow the prescribed dosage for effective management of IBS-C and CIC.

What if I miss my dose?

If you miss a dose of Linzess, take it as soon as you remember. However, if it’s almost time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Avoid taking a double dose to make up for a missed one.

What happens if I take too much Linzess?

Taking more than the prescribed amount of Linzess increases the risk of side effects, including severe diarrhea, dehydration, and electrolyte imbalances. Overdosing on Linzess may exacerbate common side effects and pose health risks. If you or someone else has taken an overdose, seek emergency medical attention immediately or call the Poison Help line at 1-800-222-1222.

Information on safe usage and avoiding overdose

  • Always take Linzess exactly as prescribed by your healthcare provider.
  • Follow the recommended dosage instructions and do not adjust the dose without consulting your healthcare provider.
  • Take Linzess on an empty stomach at least 30 minutes before the first meal of the day.
  • Be mindful of potential drug interactions. Inform your healthcare provider about all your medications, including over-the-counter and herbal supplements.
  • In the case of an overdose, tell your healthcare provider how much Linzess you ingested and any symptoms experienced.
  • Emergency medical care may be required to address dehydration, electrolyte imbalances, and other complications associated with Linzess overdose.

If you experience persistent side effects or have concerns about this medication, communicate openly with your healthcare provider. Understanding the proper usage, potential risks of overdose, and appropriate actions in case of a missed dose or overdose are key for responsible medication management.


Linzess can be an effective treatment for IBS-C and CIC; however, it is crucial to be aware of potential side effects. Always follow your healthcare provider’s instructions, report any unusual symptoms promptly, and attend regular checkups to monitor your health while using Linzess.

This comprehensive guide provides an in-depth exploration of Linzess side effects and offers detailed insights for patients and healthcare providers alike. The aim is to empower individuals with information so they can navigate the nuances of Linzess and work collaboratively with their healthcare team to optimize their treatment plan. With this guide, you can actively participate in and proactively monitor your healthcare journey, ensuring an optimal balance of therapeutic benefits and side effect management. However, while it serves as a valuable resource, this guide is not a substitute for professional and individualized medical advice. Consultation with your healthcare provider remains paramount for personalized guidance based on your medical history and current health status.

Frequently asked questions about Linzess side effects

How long can I stay on Linzess?

The duration of Linzess use will vary depending on your specific condition, medical history, and how well you respond to the medication. Some people use it for an extended period, while others switch to different treatments as their condition evolves. If you are experiencing any issues or concerns about using Linzess, such as side effects or changes in your condition, it’s crucial to contact your healthcare provider. They can provide personalized advice based on your health status and will adjust your treatment plan if necessary.

Why do people stop using Linzess?

People stop using Linzess for various reasons, but discuss any concerns with a healthcare provider before deciding to discontinue this medication. A common reason people stop using Linzess is ineffectiveness, as some do not experience significant relief from their symptoms. Others discontinue the medication because the side effects are severe or intolerable. The cost of the medication is another factor that causes discontinuation of Linzess. The Rx Advocates can help if cost is an issue. Contact us to discuss patient assistance programs. Some have concerns about the potential risks and unknowns associated with extended Linzess use. Finally, if one’s diagnosis changes or their symptoms evolve, their treatment plan may need to be adjusted.

Is Linzess a high-risk medication?

Linzess is generally considered safe for most people, particularly when used as prescribed by a healthcare professional. Whether it is a high-risk medication depends on individual health factors. Like any medication, it comes with potential risks and side effects. It’s important to discuss with your healthcare provider your medical history, existing health conditions, and other medications or supplements you are taking before starting Linzess.

What makes Linzess’ side effects worse?

Certain factors, such as dosage, individual sensitivity, pre existing conditions, and interactions with other medications, can exacerbate the severity of Linzess’ side effects. If you are experiencing Linzess side effects or have concerns about its tolerability, talk with your healthcare provider. They can evaluate your individual situation, adjust the dosage if necessary, or explore alternative treatment options that may better suit your needs.

What should I avoid while taking Linzess?

Here are some things you should avoid or be cautious about while taking Linzess: high-fiber foods; grapefruit and grapefruit juice; prescription medications, supplements, and over-the-counter drugs that are known to interact with Linzess; medications that affect bowel function; and laxatives. Additionally, although specific interactions with Linzess are not documented, excessive caffeine and alcohol intake can contribute to dehydration. Always follow your healthcare provider’s instructions and discuss any concerns or questions you have about dietary habits, medications, or other lifestyle choices while taking Linzess.

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