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Difference between Zelnorm (tegaserod) and Motegrity (prucalopride)


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Jeffrey Roberts

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This briefly describes the differences between Zelnorm (tegaserod) and Motegrity (prucalopride) for IBS-C and chronic constipation, as both medications are very similar.
 
Both medications are 5-HT4 serotonin receptor agonists, meaning that they increase the amount of serotonin in the bowel which then causes the bowel to move, causing a spontaneous bowel movement.
 
Zelnorm is approved for IBS-C for women under the age of 65.
 
Motegrity is approved for Chronic Constipation sufferers for both women and men.
 
Zelnorm has the potential risk of cardiac events, albeit it's a small risk that is rarely seen.
 
Motegrity does not have the risk of cardiac events.
 
Zelnorm was previously marketed from 2002-2007 in the US and elsewhere.
 
Motegrity has been widely available worldwide except in the US, since 2009.


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Have you tried either one of these?  Does one generally work better than the other?

Are they basically the same drug?  Reason I'm asking is because I have noticed that Trulance and Linzess have nearly identical effects on me and I think they are 98% the same.  I wonder if Prucalopride and Tegaserod are comparably similar to each other in the same way.

I'm going to try to get my GI to write me a prescription for Motegrity when I see him in the middle of the month.

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Jeffrey Roberts

Technically, no they are not the same drug, but they act on the same serotonin 5-HT4 agonists. One may work better for you than the other. Since this is the first time that Zelnorm and Motegrity are on the market at the same time, I'm sure patients will determine which works better pretty quickly. :)

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  • 2 months later...

I took Zelnorm for IBS before it was taken off the market. It changed my quality of life significantly. No side effects at all. Devastated when it was no longer available. Benefits way outweighed risks. Now it’s back, but I turned 65 this year and my doc won’t write a prescription and prescribed Motegrity instead. I’m afraid of the side effects. I know it’s wrong to consult “Dr. Google,” but user reviews seem more negative and discouraging than not. I’m already suffering, so the thought of additional discomfort from medication side effects for even 12 hours has me extremely reluctant to try Motegrity. Any one have any thoughts, encouragement? Thank you.

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Jeffrey Roberts

Like you, there were many people very upset when Zelnorm was taken off the market. I kind of agree with your Doctor. There isn't any safety data for people over the age of 65 so it's kind of an unknown. If you were over 65 when you took it before and didn't have any serious side effects, that would be a different situation.

Motegrity is also a 5-HT4 medication, like Zelnorm, and for all intense purposes might work exactly as Zelnorm did for you. I would give it a try.

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  • 2 weeks later...

I also took Zelnorm years ago and it  was a miracle drug for me! It significantly improved my quality of life-there is nothing else like it.  I tried Motegrity this year in January (as I didn't know about the return of Zelnorm at that point).  I was so hopeful and thought it was going to be the same - but it wasn't. For me it had all of the side effects without the benefits. 

Is Zelnorm available now? I've searched on-line but haven't been able to find a specific date of when it will be available for prescription? Thank you.

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Thank you so much for your reply. I have been having a really bad flare up of my IBS-C for over a week now and nothing is really helping to alleviate it; fiber, probiotics, Prilosec, yoga, hot tub, Advil, etc........  This news gives me hope that I may be able to feel good again in the near future.  I'm going to talk to my Dr. about it.  Thanks again!

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Jeffrey Roberts

I hope Zelnorm provides you the same relief as before. There are many people very relieved that it is returning.

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  • 1 month later...

I used Zelnorm when it was available several years ago and it was wonderful. Since then, I've gone through Linzess and Trulance, neither of which did a great job. I just started two weeks ago on Motegrity, and I am not impressed. I was excited because I was told it worked like Zelnorm did. Nope, I had bad side effects, but just the first day. After that, no side effects whatsoever. Sadly, also no "action" whatsoever! Going on day 7 with no bowel movement even though I feel like I need to go, am uncomfortable, and keep trying. Motegrity is obviously not doing the trick. I'm devastated.

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  • 2 months later...

I have slow transit colon and my doctor prescribed motegrity. It is awful medicine made me depressed and has horrible side effects and NO bowel movement. I went back to her and she was going to give me Zelnorm she said it worked better than motegrity but I had a history of palpitations benign palpitations. I have no history of cardiac disease and under 65 she snatched the samples away . If I can’t use either one I’m going for a consultation for removal of my Bowel can’t live using preps every week to clean out . I had to leave my job and go on disability. I’m disgusted and my bowels run my life no more these doctors should be realizing this is an awful way to live 

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Jeffrey Roberts

I'm so sorry to read that Motegrity didn't work for you and you literally had no bowel movements. I've not heard anyone having side effects like that. I think it was wise of your doctor to not try you on Zelnorm. While the cardiac signals are there for Zelnorm, it's not worth the potential risk. That being said, I am not sure you would have any better results from Zelnorm. For all intense purposes, it is the same compound as Motegrity.

Before going to the extreme consultation of removing your bowel, have you considered an SSRI medication? The side effect could be a looser stool.

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I have tried both medicines and while I'm more of a fan of Zelnorm, I have been told that the side effects do get better. It is entirely up to you if you can stick it out. As far as it not working, there are two strengths. I'm curious if the doctor told you how to take it. I have always heard four hours after eating or at least an hour before breakfast.  Are the palpitations only at the doctors office? It's always possible a new doctor is in order. Sometimes by not helping us, we find someone who can. Happened to me and I'm grateful.

Please don't lose hope, there are other options.

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  • 2 weeks later...

Resolor/Motegrity can be used in conjunction with Linzess - in my case the Resolor eliminated all my gastric pain but did nothing for motility. The Linsess has worked much less violently now that it is combined with Resolor....but Linzess carries a gastric reflux side effect that I now struggle with and we're going to do a Zelnorm trial.  I took Zelnorm before, it was like a gift from God...but the dosage is now twice daily. That's a shift, I only took it once a day - anyone else seen this?  I don't know if it will work, not being on it for ten years and having nothing made my situation much worse.  But no side effects from Motegrity for me - it just did nothing for motility. It sure did eliminate the constant nagging pain that I always had, and it got the Linzess to work in a way I could handle. Alone Linzess turned me inside out.  

What a problem to have. So hard to deal with and so little recognition from providers. Zelnorm's likelihood of cardiac effects applied to those already diagnosed. As far as I have found the "not over 65" designation is due to the assumption that anyone over 65 will have cardiac problems, and it's a liability clause that the insurance companies could use to not pay for the drug as well.  Not everyone over 65 has cardiac problems, but that's their reasoning.  

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Jeffrey Roberts

A note on Zelnorm and over 65. I believe that is part of the medication label because there is no research data for that age group. I don't believe it has to do with cardiac effects in that group.

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  • 2 months later...

Hello,  so I started taking Motegrity May 2019.  At first, lots of side effects (bloating/gas) but for me that meant things were working.  Things were going great up until November/December.  Basically, it feels like it’s not working as good as it used to.  Not getting that urge to have a bowel movement, but still “going”.  Started getting some hard stool with soft stool and I just feel constipated even though I’m going once a day along with abdominal pain.  I’m considering trying Zelnorm but I’m wondering if it will be the same?  Have you guys heard of Motegrity losing it’s effectiveness?  I’ve also been experiencing extreme depression especially since things aren’t working the same.  I’m at a loss because doctors don’t know what to do for me.  (I’ve been checked...colonoscopy, ct scan....). I’m thinking about starting an antidepressant but wondering if it will affect motegrity?  I’ve asked my GI doctors but they don’t seem to know.  Ughhhhhh

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9 hours ago, Bee said:

Has anybody had extreme mood swings with Motegrity?  I feel like I have never been this angry and irrational in my life.  Going to stop taking it tomorrow.

I’ve been noticing I’ll be fine one minute and then all the sudden I’m crying.  My husband even mentioned this to me.  Are you taking an antidepressant??  I’m considering starting one.  These GI issues are overtaking me. :(

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Yes, I take Wellbutrin XL 150 mg and have for some time now, and I was okay before taking the Motegrity.  The Motegrity seems to amp me up too much -- like I go from 1 to 10 in no time.  I feel enraged by my husband and daughter, and that is very uncommon for me.  I am trying a week without it to be sure that it is the Motegrity, but already not taking it this morning seems to have me a bit calmer.  BTW, my BM have been the same with or without the Motegrity (I only took it 11 days at 1 mg), but I felt hungry for the first time in a long time.  Finally my stomach was fully emptying.  But it is not worth it if it is going to make me destroy my relationship with my family!

 

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  • 3 weeks later...

I’ve been taking Zelnorm for 3 days. It’s helping the bowels but I seem to be getting very depressed and fatigued. It’s very disconcerting as this is not like me. I’m considering stopping it and trying Motegrity. Does Motegrity carry the risk of depression too. I’m already on an SNRI.  

Edited by Shygal110!$!
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Jeffrey Roberts
31 minutes ago, Shygal110!$! said:

I’ve been taking Zelnorm for 3 days. It’s helping the bowels but I seem to be getting very depressed and fatigued. It’s very disconcerting as this is not like me. I’m considering stopping it and trying Motegrity. Does Motegrity carry the risk of depression too. I’m already on an SNRI.  

I would let your doctor know about this.

That's unfortunate about Zelnorm and I'm sorry you are feeling this way. Both medications have similar labels about the risk of depression and suicide. You are the first person that I have ever heard from that has had that reaction. It's on the label for the drugs, so it seems to be a risk.

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  • 1 month later...

I have been given Motegrity samples (2 mg) by my gastro.  I, too, was on Zelnorm years ago before it disappeared.  I had no ill side effects from it.  I am very sensitive to medications and I do recall when I started the Zelnorm that I had to be cut back because I had very strong urge with very little notice.  I would prefer to try the Motegrity  on a smaller dose and am wondering if I can split the 2 mg tablet?    Also, I have put off trying the Motegrity because of the many side effects.  I have done a bit of searching and am unable to find the side effects that would have been originally listed for Zelnorm.  Were the listed side effects for both drugs about the same?

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Jeffrey Roberts

The general rule is that unless a tablet is "scored" to break the tablet, you really should not break it in half.

The common side effects for Motegrity are:

headache, stomach area (abdominal) pain or bloating, nausea, diarrhea, dizziness, vomiting, gas and fatigue. If reported, diarrhea or headache typically occurred within the first week of treatment and resolved within a few days of continued use.

Headache and diarrhea were the most common side effects seen with Zelnorm.

Diarrhea was an occasional side effect of treatment with Zelnorm. Most people who got diarrhea had it during the first week after starting Zelnorm. Typically, diarrhea went away with continued therapy. If you get bad diarrhea, or if you get diarrhea together with bad cramping, abdominal pain, fainting, or dizziness, tell your doctor. Your doctor may tell you to stop taking Zelnorm or suggest other ways to manage your diarrhea.

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  • 1 year later...
On 1/27/2020 at 11:33 PM, Bee said:

Has anybody had extreme mood swings with Motegrity?  I feel like I have never been this angry and irrational in my life.  Going to stop taking it tomorrow.

I am noticing a depressive effect after 6 weeks. Thinking of stopping because it doesn't work all that well anyway, especially for the price. 

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