psyllium
Fiberall, Genfiber, Hydrocil Instant, Konsyl, Konsyl-D, Metamucil, Modane Bulk, Perdiem Fiber Therapy, Reguloid, Serutan, Syllact

Available forms
Available without a prescription
Granules: 2.5 g/teaspoonful, 4 g/teaspoonful
Powder: 3.3 g/teaspoonful, 3.4 g/packet, 3.4 g/teaspoonful, 3.4 g/tablespoonful, 3.5 g/teaspoonful, 3.5 g/scoopful, 6 g/packet, 6 g/teaspoonful
Wafers: 3.4 g/wafer

Indications and dosages
 Constipation, bowel management, irritable bowel syndrome. Adults: 1 to 2 rounded teaspoons P.O. in full glass of liquid daily, b.i.d., or t.i.d., then second glass of liquid; or 1 packet P.O. dissolved in water daily; or 2 wafers b.i.d. or t.i.d.
Children older than age 6: 1 level teaspoon P.O. in 1/2 glass of liquid h.s.

Pharmacodynamics
Laxative action: Adsorbs water in the gut; also serves as a source of indigestible fiber, increasing stool bulk and moisture, thus stimulating peristaltic activity and bowel evacuation.

Pharmacokinetics
Absorption: Acts locally; not absorbed.
Distribution: Distributed locally in gut.
Metabolism: Not metabolized.
Excretion: Excreted in feces.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug; in those with abdominal pain, nausea, vomiting, or other symptoms of appendicitis; and in those with intestinal obstruction or ulceration, disabling adhesions, or difficulty swallowing.

Interactions
Drug-drug. Anticoagulants, cardiac glycosides, salicylates: Psyllium may adsorb oral drugs. Separate administration times by at least 2 hours.

Adverse reactions
GI: nausea, vomiting, diarrhea (with excessive use); esophageal, gastric, small intestinal, and rectal obstruction when drug is taken in dry form; abdominal cramps, especially in severe constipation.

Effects on lab test results
None reported.

Overdose and treatment
No cases of overdose have been reported. Probable clinical effects of overdose include abdominal pain and diarrhea.

Special considerations
• Before administering drug, add at least 8 oz (240 ml) of water or juice and stir for a few seconds (improves drug’s taste). Have patient drink mixture immediately to prevent it from congealing; then have him drink another glass of fluid.
• Drug may reduce appetite if administered before meals.
• Psyllium and other bulk laxatives most closely mimic natural bowel function and don’t cause laxative dependence; they are especially useful for patients with postpartum constipation or diverticular disease, for debilitated patients, for irritable bowel syndrome, and for chronic laxative users.
• Give diabetic patients a sugar-free and sodium-free psyllium product.
Breast-feeding patients
• Because drug isn’t absorbed, it’s presumably safe for use in breast-feeding women.

Patient education
• Warn patient not to swallow drug in dry form; he should mix it with at least 8 oz (240 ml) of fluid, stir briefly, drink immediately (to prevent mixture from congealing), and then drink another 8 oz of fluid.
• Explain that drug may reduce appetite if taken before meals. Recommend taking drug 2 hours after meals and any other oral drug.
• Advise diabetic patient and patient with restricted sodium or sugar intake to avoid psyllium products containing salt or sugar. Advise patient who must restrict phenylalanine intake to avoid psyllium products containing aspartame.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use