Recommendation 9: In adults with CIC who do not respond to OTC agents, the panel recommends the use of plecanatide over management without plecanatide (strong recommendation, moderate certainty of evidence).

Implementation considerations Can be used as a replacement or as an adjunct to OTC agents Duration of treatment in trials was 12 weeks, but the drug label does not provide a limit. May be associated with side effects of diarrhea leading to discontinuation of treatment