Trulance (plecanatide) is structurally similar to uroguanylin, which is a substance released naturally by the walls of our intestine. Just like uroguanylin, Trulance results in an increase in the secretion of chloride and bicarbonate into the intestine, a decrease in the reabsorption of sodium, and an influx of water into the intestines. Some experts believe an upset in the fluid balance within the gastrointestinal tract contributes to chronic IBS-C.

The combined influx of water and higher concentration of sodium helps to soften and loosen stools and increase bowel movements. In addition activation of certain receptors (called GC-C-receptors) by Trulance may help decrease pain and inflammation within the intestines. Trulance exerts its effects mainly in the small bowel.

Trials have shown that Trulance significantly reduces abdominal pain and improves stool frequency and consistency. It reduces straining with bowel movements, with 4% of people reporting diarrhea as a side effect.

Trulance is a tablet taken once daily for the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). It belongs to the class of medicines known as guanylate cyclase-C (GC-C) agonists. GC-C receptors are found in the lining of the gastrointestinal tract. They help to maintain the normal function of the gut, including helping to maintain the balance of fluid and ions in the gut. They are activated by two hormones called uroguanylin and guanylin. Trulance has the same effect as uroguanylin, which is to increase the secretion of fluid into the gut enabling more frequent bowel movements of softer stools.

Trulance was approved in January, 2018 for the treatment of adults with IBS-C.