If you have certain types of constipation, your doctor might suggest Trulance as a treatment option. It’s a prescription medication usually used long term in adults to treat:

Trulance comes as a tablet you swallow and contains the active ingredient plecanatide. (An active ingredient is what makes a drug work.)

For more information about Trulance, including details about its uses, see this in-depth article.

Like other drugs, Trulance can cause mild to serious side effects. Keep reading to learn more.

Some people may experience mild to serious side effects during their Trulance treatment. The most commonly reported side effect of this drug is mild diarrhea. (To learn more about this side effect, see the “Side effects explained” section below.)

Examples of mild side effects that have been reported with Trulance include:

*To learn more about this side effect, see the “Side effects explained” section below.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And don’t stop taking Trulance unless your doctor recommends it.

Trulance may cause mild side effects other than the ones listed above. See the drug’s prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Trulance, visit MedWatch.

Serious side effects of Trulance are rare. Those that have been reported include:

If you develop serious side effects while taking Trulance, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

*To learn more about this side effect, see the “Side effects explained” section below.
†An allergic reaction is possible after using Trulance. But this side effect wasn’t reported in studies.

Get answers to some frequently asked questions about Trulance’s side effects.

Does Trulance cause weight gain or weight loss?

Trulance hasn’t been reported to cause weight gain or weight loss. These side effects weren’t seen in studies of Trulance.

If you have weight gain or weight loss with Trulance, this may be related to bloating. For example, ongoing constipation can sometimes cause bloating, which may cause a small amount of weight gain. Taking Trulance to relieve your constipation may also relieve any associated bloating you may have. So this could lead to a small amount of weight loss.

On the other hand, bloating was reported as a side effect of Trulance in some people. If you have bloating with Trulance, this could cause some weight gain.

Talk with your doctor if you have weight changes that bother you while you’re taking Trulance.

Can I see reviews by people who’ve taken Trulance?

Before trying something new, it’s common to look for reviews about the experiences of others. The manufacturer provides testimonials from people who’ve tried Trulance.

It’s important to keep in mind that the effect of the drug, as well as the side effects it may cause, can vary among people. Your experience with Trulance may differ from other people’s. If you have questions about what to expect from Trulance or whether it’s right for you, talk with your doctor.

Does Trulance work right away? If not, how long does it take to work?

No, Trulance doesn’t work right away to make you have a bowel movement. It typically takes about 1 week to start working to relieve constipation.

To learn more about how quickly Trulance may start working for you, talk with your doctor.

How long does Trulance stay in your system?

Trulance isn’t absorbed into your bloodstream after you take a dose. Instead, the drug works locally in your intestine. It isn’t known how long the drug stays in your intestine. But Trulance isn’t absorbed well into your body.

To learn more about how long Trulance may stay in your system, talk with your doctor.

Do side effects of Trulance go away on their own?

It depends. In most cases, side effects go away on their own as your body gets used to the medication. Or they may get better on their own if you stop taking Trulance. But in some cases, certain side effects may need treatment. Severe diarrhea is an example. (To read more about this, see “Side effects explained” just below.)

Learn more about some of the side effects Trulance may cause.


You may have diarrhea while taking Trulance. This is usually mild, but can sometimes be severe.

In studies, mild diarrhea was the most common side effect seen with Trulance. Most cases occurred within 4 weeks of starting the drug. Severe diarrhea was rare and most cases occurred within 3 days of starting treatment.

Diarrhea may cause symptoms such as:

Both mild and severe diarrhea can cause your body to lose large amounts of fluid and electrolytes (minerals such as potassium and sodium). This can lead to dehydration.* If dehydration isn’t treated, it can quickly lead to serious problems such as kidney failure or seizure.

Symptoms of dehydration include:

*Trulance has a boxed warning for the risk of serious dehydration in children. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see “Warnings for Trulance” below.

What might help

If you have diarrhea with Trulance, be sure to drink plenty of fluids to avoid getting dehydrated. Fluids you can try include water, sports drinks such as Gatorade, or rehydration drinks such as Pedialyte. These help to replace electrolytes as well as fluids that you lose with diarrhea.

If you have diarrhea that’s severe or lasts longer than a few days, you should call your doctor. They may recommend stopping Trulance until your diarrhea gets better. They may also recommend taking medication such as Imodium (loperamide) to treat the diarrhea.

If your diarrhea is severe or you have symptoms of dehydration, your doctor may advise going to the hospital. You may need treatment with medications to stop the diarrhea. And you may also need an intravenous (IV) infusion (an injection into a vein given over time) of fluids.

Bloating or tenderness of your belly

You may have bloating or tenderness in your belly while taking Trulance. But in studies, these side effects were rare.

Bloating or tenderness may be related to diarrhea, which is a common side effect of Trulance (see just above). It may also be related to gas, which is a rare side effect of Trulance. Bloating and tenderness can also be symptoms of the types of constipation that Trulance is used to treat.

Keep in mind that if you have severe bloating, swelling, and pain in your belly, this could be a symptom of a blockage in your bowel. In this case, you’d also likely be unable to pass stool. You may also have nausea, vomiting, and loss of appetite.

What might help

If you have bloating or tenderness in your belly that’s new, worse than usual, or bothers you while taking Trulance, talk with your doctor. They may want to investigate the cause of your symptoms. If these side effects are especially bothersome, your doctor may recommend switching to a different treatment.

If you have symptoms of a blockage in your bowel, you should stop taking Trulance and see your doctor right away.

Unusual results in liver function tests

Some people may have unusual results in liver function tests while taking Trulance, but this is rare. Liver function tests are blood tests that doctors use to check the health of your liver. They measure levels of proteins called liver enzymes. If you have increased levels of liver enzymes, this can sometimes suggest there’s a problem with your liver.

But liver problems weren’t reported in Trulance studies, nor have they been reported since the drug came on the market.

It’s not known why some people had increased liver enzymes while taking Trulance. Unlike many drugs, Trulance isn’t broken down by your liver and doesn’t enter your bloodstream. It’s broken down in your intestine and works there to treat your condition.

What might help

If you have unusual results in liver function tests while taking Trulance, be sure your doctor knows you’re taking this drug. They can discuss the best approach for treating this side effect.

Allergic reaction

Like most drugs, Trulance can cause an allergic reaction in some people. This side effect wasn’t reported in studies. But allergic reactions have happened since Trulance was approved for use.

Symptoms of an allergic reaction can be mild to serious and can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin, usually in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

  • an antihistamine you take by mouth, such as Benadryl (diphenhydramine)
  • a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to Trulance, they’ll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Trulance, they may have you switch to a different treatment.

Keeping track of side effects

During your Trulance treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how it affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how Trulance affects you. They can then use this information to adjust your treatment plan if needed.

Trulance may not be suitable for everyone. It comes with a few warnings about its use.

Boxed warning: Risk of severe dehydration in children

Trulance has a boxed warning for the risk of severe dehydration in children. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Trulance may increase the risk of severe dehydration in children. In animal studies, this drug caused severe dehydration that led to death in some young animals. But animal studies don’t always predict what will happen in people. It hasn’t been studied and is not approved for use in children under the age of 18 years. So it’s not known if it’s safe or effective in this age group.

Due to the risk of severe dehydration, Trulance must not be used in children under 6 years old. And due to this risk, doctors usually will not prescribe Trulance for older children either.

Other warnings

Trulance may not be right for you if you have certain medical conditions. (This is known as a drug-condition interaction.) Other factors may also affect whether Trulance is a good treatment option for you. Talk with your doctor about your health history before starting Trulance. Below are a few factors to consider.

Blockage in your stomach or intestine. If you have a blockage in your stomach, intestine, or bowel, or your doctor suspects you have, they’ll likely not prescribe Trulance for you. Ask them about other treatments that might be better options for you.

Allergic reaction. If you’ve had an allergic reaction to Trulance or any of its ingredients, your doctor will likely not prescribe it for you. Ask them about other medications that might be better options for your condition.

Alcohol and Trulance

Alcohol isn’t known to interact with Trulance. But drinking alcohol may increase your risk of certain Trulance side effects, such as:

Alcohol may also worsen constipation, which Trulance is used to treat.

If you drink alcohol, talk with your doctor about how much is safe while taking Trulance.

Pregnancy and breastfeeding while taking Trulance

It’s not known if Trulance is safe to take during pregnancy. If you’re pregnant or plan to become pregnant, talk with your doctor about whether Trulance is right for you.

Trulance doesn’t pass into breast milk, so it may be safe to take it while breastfeeding. If you’re breastfeeding or plan to breastfeed, talk with your doctor about the best way to feed your child if you take Trulance.

Side effects aren’t common with Trulance. In most cases, side effects are mild and easily managed. If you have questions about the possible side effects of Trulance, talk with your doctor. They can help you determine if this treatment is a good option for you.

Here are some examples of questions you might want to ask:

  • Is my risk of diarrhea higher when I first start treatment with Trulance?
  • Do other medications I take increase my risk of side effects with Trulance?
  • Is it safe to take Trulance for a long time?

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.