Tenapanor
IBSRELA
Pronunciation: ten-A-pa-nor (ibs-REL-a)
What it isNHE3 inhibitor reducing intestinal sodium and phosphate absorption; IBS with constipation and hyperphosphatemia in dialysis.
Why this oneIt reduces phosphate absorption rather than binding it, so it is not a binder and the pill burden is small.
What limits itDiarrhea is dose-limiting and is the mechanism. Contraindicated under age 6.
FDA-approved for
- IBS with constipation (2019)
- hyperphosphatemia in dialysis (2023)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperphosphatemia in CKD on dialysis (add-on/intolerant to binders) | Adults | 30 mg BID | 30 mg BID | 30 mg BID |
Renal Undefined
Hepatic Undefined
Instructions
- Take orally BID just before the morning and evening meals
- Do not take right before a hemodialysis session — take before the next meal after dialysis
- Adjust dose to manage GI tolerability; skip missed dose
Available strengths
- tab 20, 30, 50 mg
Contraindications
- Pediatric patients under 6 years of age (risk of diarrhea and serious dehydration)
- Known or suspected mechanical GI obstruction
Cautions
- Severe diarrhea (up to 53% of patients; may cause dehydration and hyponatremia) — discontinue if severe
Adverse reactions
- Diarrhea (43–53%)
Pregnancy Essentially non-absorbed; maternal use not expected to result in fetal exposure; available data show no drug-associated risk
Lactation Not detected in human milk; maternal use not expected to expose infant
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 20 mg | tab | 60 BID | not offered | |
| 30 mg | tab | 60 BID | not offered | |
| 50 mg | tab | 60 BID | not offered |
Generic entry2034 est.
⚠ BOXED WARNING
- Contraindicated in patients under 6 years
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.