psyllium

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.

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.

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

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.

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

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.

Classifications ⬆ ⬇

Therapeutic Classification: laxatives

Pharmacologic Classification: bulk forming agents

Pharmacokinetics ⬆ ⬇

Absorption: Not absorbed from the GI tract.

Distribution: No distribution occurs.

Metabolism/Excretion: Excreted in feces.

Half-Life: Unknown.

Canadian Brand Names ⬆ ⬇

Karacil, Natural Source Fibre Laxative, Prodiem

Time/Action Profile ⬆ ⬇

(laxative effect)

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

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.

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Indications ⬇