psyllium

Therapeutic Classification: laxatives

Pharmacologic Classification: bulk forming agents

Indications ⬆ ⬇

REMS

Management of simple or chronic constipation, particularly if associated with a low-fiber diet.
Useful in situations in which straining should be avoided (after MI, rectal surgery, prolonged bed rest).
Used in the management of chronic watery diarrhea.

Action ⬆ ⬇

Combines with water in the intestinal contents to form an emollient gel or viscous solution that promotes peristalsis and reduces transit time.

Therapeutic effects:

Relief and prevention of constipation.

Pharmacokinetics ⬆ ⬇

Absorption: Not absorbed from the GI tract.

Distribution: No distribution occurs.

Metabolism/Excretion: Excreted in feces.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(laxative effect)

ROUTE	ONSET	PEAK	DURATION
PO	12–24 hr	2–3 days	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Abdominal pain, nausea, or vomiting (especially when associated with fever);
Serious adhesions;
Dysphagia.

Use Cautiously in:

Some dosage forms contain sugar, aspartame, or excessive sodium and should be avoided in patients on restricted diets;
OB: Has been used safely.

Adv. Reactions/Side Effects ⬆ ⬇

GI: cramps, intestinal or esophageal obstruction, nausea, vomiting

Resp: bronchospasm

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of warfarin, salicylates, or digoxin.

Route/Dosage ⬆ ⬇

PO (Adults ): 1–2 tsp/packet/wafer (3–6 g psyllium) in or with a full glass of liquid 2–3 times daily. Up to 30 g daily in divided doses.
PO (Children >6 yr): 1 tsp/packet/wafer (1.5–3 g psyllium) in or with 4–8 oz glass of liquid 2–3 times daily. Up to 15 g daily in divided doses.

Availability ⬆ ⬇

(Generic available)

Powder: 3.3–3.5 g/dose or packet^OTC
Effervescent powder: 3–3.5 g/dose or packet^OTC
Granules: 2.5 g/dose^OTC
Wafers: 3.4 g/dose^OTC

Assessment ⬆ ⬇

Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
Assess color, consistency, and amount of stool produced.

Lab Test Considerations:

May cause elevated blood glucose levels with prolonged use of preparations containing sugar.

Implementation ⬆ ⬇

Packets are not standardized for volume, but each contains 3–3.5 g of psyllium.
PO: Administer with a full glass of water or juice, followed by an additional glass of liquid. Solution should be taken immediately after mixing; it will congeal. Do not administer without sufficient fluid and do not chew granules.

Patient/Family Teaching ⬆ ⬇

Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake, and increasing mobility. Normal bowel habits are individualized and may vary from 3 times/day to 3 times/wk.
May be used for long-term management of chronic constipation.
Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present.

Evaluation/Desired Outcomes ⬆ ⬇

A soft, formed bowel movement, usually within 12–24 hr. May require 3 days of therapy for results.

US Brand Names ⬆ ⬇

Alramucil, Cillium, Effer-Syllium, Fiberall, Fibrepur, Hydrocil, Konsyl, Metamucil, Modane Bulk, Mylanta Natural Fiber Supplement, Naturacil Caramels, Perdiem, Pro-Lax, Reguloid Natural, Serutan, Siblin, Syllact, Vitalax, V-Lax

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Pronunciation ⬇

Classifications ⬆ ⬇