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Am Fam Physician. 2022;105(6):656-658

Author disclosure: No relevant financial relationships.

Tenapanor (Ibsrela) is labeled for the treatment of irritable bowel syndrome with constipation (IBS-C) in adults.1 It is a sodium/hydrogen exchanger 3 inhibitor that acts on the surface of the small intestine and colon to block the absorption of dietary sodium, resulting in increased water secretion. This leads to more frequent and softer bowel movements. Tenapanor also decreases visceral hypersensitivity, leading to reduced abdominal pain.

DrugDosageDose formCost of full course
Tenapanor (Ibsrela)50 mg twice daily, taken immediately before first meal of the day and before dinner50-mg tabletsPrice not yet available


In two randomized, double-blind, placebo-controlled trials involving 1,199 adult patients, the most concerning adverse effect was severe diarrhea, which occurred in approximately 2.5% of patients taking tenapanor, compared with 0.2% of those taking placebo.13 Treatment with tenapanor should be discontinued if severe diarrhea occurs, and the patient should promptly rehydrate. Tenapanor should not be used in patients with suspected mechanical bowel obstruction. No adverse fetal effects have been reported in animal studies. The use of tenapanor by a small number of pregnant patients has not identified any major birth defects, miscarriages, or adverse maternal or fetal outcomes. Tenapanor should not be used in children.1
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STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, assistant medical editor.

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