Skip to main content


Medically reviewed by Last updated on Apr 26, 2020.


(ten A pa nor)

Index Terms

  • Ibsrela
  • Tenapanor Hydrochloride

Pharmacologic Category

  • Sodium/Hydrogen Exchanger 3 (NHE3) Inhibitor


Tenapanor is a sodium/hydrogen exchanger 3 inhibitor, which acts locally to reduce sodium absorption from the small intestine and colon. Reduced sodium absorption results in increased intestinal lumen water secretion, accelerating intestinal transit time, and softening stool consistency. Tenapanor also decreases intestinal permeability and visceral hypersensitivity in animal models, which may reduce abdominal pain.




Hepatic via CYP3A4/5 primarily to inactive metabolite M1.


Feces (65% as unchanged drug); urine (~9% as metabolites).

Protein Binding


Use: Labeled Indications

Irritable bowel syndrome with constipation: Treatment of irritable bowel syndrome with constipation in adults.


Patients <6 years of age; known or suspected mechanical GI obstruction.

Dosing: Adult

Irritable bowel syndrome with constipation: Oral: 50 mg twice daily.

Missed dose: If a dose is missed, skip the missed dose and administer the next dose at the regular time. Do not administer 2 doses at the same time.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Adjustment for Toxicity

Severe diarrhea: Discontinue treatment.


Oral: Administer immediately prior to breakfast or the first meal of the day and immediately prior to dinner.


Store at 20°C to 25°C (68°F to 77°F) in original container; protect from moisture. Do not subdivide, repackage, or remove desiccant from bottle.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Gastrointestinal: Diarrhea (15% to 16%)

1% to 10%:

Central nervous system: Dizziness (2%)

Gastrointestinal: Flatulence (3%), severe diarrhea (3%), abdominal distension (2% to 3%), abnormal bowel sounds (<2%)

Hematologic & oncologic: Rectal hemorrhage (<2%)

ALERT: U.S. Boxed Warning

Risk of serious dehydration in pediatric patients

Tenapanor is contraindicated in patients <6 years of age; in nonclinical studies in young juvenile rats, administration of tenapanor caused deaths presumed to be due to dehydration. Avoid use of tenapanor in patients 6 to <12 years of age; the safety and effectiveness of tenapanor have not been established in patients <18 years of age.


Concerns related to adverse effects:

• Diarrhea: May cause diarrhea; discontinue and rehydrate if severe diarrhea occurs.

Disease-related concerns:

• Renal impairment: May increase the risk for adverse reactions, including diarrhea and hyperkalemia (requiring hospitalization).

Special populations:

• Risk of serious dehydration in pediatric patients: [US Boxed Warning]: Tenapanor is contraindicated in patients <6 years of age; in nonclinical studies in young juvenile rats (approximate human age equivalent of <2 years of age), administration of tenapanor caused decreased body weight and deaths presumed to be due to dehydration. Avoid use of tenapanor in patients 6 to <12 years of age; safety and effectiveness of tenapanor have not been established in patients <18 years of age.

Monitoring Parameters

Frequency of bowel movements; signs and symptoms of dehydration in patients with diarrhea; serum potassium in patients with renal impairment.

Pregnancy Considerations

Tenapanor has limited systemic absorption following oral administration. Use during pregnancy is not expected to result in significant exposure to the fetus.

Patient Education

What is this drug used for?

• It is used to treat irritable bowel syndrome with constipation (IBS-C).

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Diarrhea

• Passing gas

• Dizziness

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Abdominal swelling

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

More about tenapanor

Consumer resources

Other brands

Professional resources

Related treatment guides

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.