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Psyllium

Pronunciation

Pronunciation

(SIL i yum)

Index Terms

  • Plantago Seed
  • Plantain Seed
  • Psyllium Husk
  • Psyllium Hydrophilic Mucilloid

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Konsyl: 520 mg [gluten free, sugar free]

Natural Fiber: 0.52 g

Reguloid: 0.52 g [contains fd&c yellow #6 aluminum lake]

Generic: 400 mg

Packet, Oral:

Konsyl: 28.3% (1 ea) [gluten free, kosher certified; contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]

Konsyl: 28.3% (30 ea) [gluten free, kosher certified; contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow); orange flavor]

Konsyl: 60.3% (1 ea, 30 ea) [gluten free, kosher certified, sugar free; contains aspartame, fd&c yellow #6 (sunset yellow); orange flavor]

Konsyl: 100% (1 ea, 30 ea, 100 ea) [gluten free, kosher certified, sugar free; bland flavor]

Metamucil MultiHealth Fiber: 58.12% (1 ea, 30 ea, 44 ea) [gluten free, sugar free; contains aspartame, fd&c yellow #6 (sunset yellow); orange flavor]

Powder, Oral:

Dietary Fiber Laxative: 28.3% (283 g, 300 g, 425 g, 660 g) [contains fd&c yellow #6 (sunset yellow)]

Fiber Therapy: 58.6% (283 g) [sugar free; contains aspartame, fd&c yellow #6 (sunset yellow)]

Geri-Mucil: 68% (368 g)

Geri-Mucil: 68% (368 g) [contains fd&c yellow #6 aluminum lake]

Geri-Mucil: 68% (284 g) [sugar free]

Geri-Mucil: 68% (283 g) [sugar free; contains aspartame, fd&c yellow #6 aluminum lake]

Konsyl: 28.3% (538 g) [gluten free, kosher certified; contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow); orange flavor]

Konsyl: 30.9% (397 g) [gluten free, kosher certified; contains fd&c yellow #6 (sunset yellow); orange flavor]

Konsyl: 60.3% (450 g) [gluten free, kosher certified, sugar free; contains aspartame, fd&c yellow #6 (sunset yellow); orange flavor]

Konsyl: 71.67% (300 g); 100% (300 g, 450 g) [gluten free, kosher certified, sugar free; bland flavor]

Konsyl: 60.3% (283 g) [sugar free; contains aspartame, fd&c yellow #6 (sunset yellow); orange flavor]

Konsyl-D: 52.3% (500 g [DSC]) [flavor free]

Konsyl-D: 52.3% (397 g) [flavor free; sweet flavor]

Laxmar Natural Vegetable Laxat: 58.6% (397 g [DSC]) [sugar free]

MetaFiber: 30.9% (368 g [DSC]); 48% (368 g [DSC]) [contains sucrose]

MetaFiber: 30.9% (398 g [DSC]); 48.57% (398 g [DSC]) [stimulant free]

MetaFiber: 58.6% (284 g [DSC]) [stimulant free, sugar free]

Metamucil MultiHealth Fiber: 58.6% (425 g [DSC]) [gluten free, sugar free; contains aspartame, brilliant blue fcf (fd&c blue #1), fd&c red #40]

Metamucil MultiHealth Fiber: 63% (660 g) [gluten free, sugar free]

Natural Fiber Therapy: 30.9% (368 g, 539 g); 48.57% (368 g, 538 g)

Natural Psyllium Seed: 100% (480 g) [animal products free, gelatin free, gluten free, kosher certified, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Natural Vegetable Fiber: 48.57% (368 g)

Reguloid: 48.57% (369 g, 540 g)

Reguloid: 28.3% (369 g, 540 g) [contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake; orange flavor]

Reguloid: 58.6% (284 g, 426 g) [sugar free; natural flavor]

Reguloid: 58.6% (284 g, 426 g) [sugar free; contains aspartame, fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake]

Sorbulax: 100% (420 g)

Powder, Oral [preservative free]:

Evac: (480 g) [dye free]

Brand Names: U.S.

  • Dietary Fiber Laxative [OTC]
  • Evac [OTC]
  • Fiber Therapy [OTC]
  • Geri-Mucil [OTC]
  • Konsyl [OTC]
  • Konsyl-D [OTC]
  • Laxmar Natural Vegetable Laxat [OTC] [DSC]
  • MetaFiber [OTC] [DSC]
  • Metamucil MultiHealth Fiber [OTC]
  • Natural Fiber Therapy [OTC]
  • Natural Fiber [OTC]
  • Natural Psyllium Seed [OTC]
  • Natural Vegetable Fiber [OTC]
  • Reguloid [OTC]
  • Sorbulax [OTC]

Pharmacologic Category

  • Antidiarrheal
  • Fiber Supplement
  • Laxative, Bulk-Producing

Pharmacology

Psyllium is a soluble fiber. It absorbs water in the intestine to form a viscous liquid which promotes peristalsis and reduces transit time.

Absorption

None; small amounts of grain extracts present in the preparation have been reportedly absorbed following colonic hydrolysis

Onset of Action

Relief of constipation: 12-72 hours

Use: Labeled Indications

OTC labeling: Dietary fiber supplement; treatment of occasional constipation; reduce risk of coronary heart disease (CHD)

Use: Unlabeled

Treatment of diarrhea, chronic constipation, irritable bowel syndrome

Contraindications

Hypersensitivity to psyllium or any component of the formulation; fecal impaction; GI obstruction

Dosing: Adult

General dosing guidelines; consult specific product labeling.

Adequate intake for total fiber: Oral: Note: The definition of “fiber” varies; however, the soluble fiber in psyllium is only one type of fiber which makes up the daily recommended intake of total fiber.

Adults 19-50 years: Males: 38 g/day; Females: 25 g/day

Adults ≥51 years: Males: 30 g/day; Females: 21 g/day

Pregnancy: 28 g/day

Lactation: 29 g/day

Constipation: Oral: Psyllium: 2.5-30 g per day in divided doses

Reduce risk of CHD: Oral: Soluble fiber ≥7 g (psyllium seed husk ≥10.2 g) per day (DHHS, 1998)

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

General dosing guidelines; consult specific product labeling.

Adequate intake for total fiber: Oral: Note: The definition of “fiber” varies; however, the soluble fiber in psyllium is only one type of fiber which makes up the daily recommended intake of total fiber.

Children 1-3 years: 19 g/day

Children 4-8 years: 25 g/day

Children 9-13 years: Males: 31 g/day; Females: 26 g/day

Children 14-18 years: Males: 38 g/day; Females: 26 g/day

Constipation: Oral:

Children 6-11 years: Psyllium: 1.25-15 g per day in divided doses

Children ≥12 years: Refer to adult dosing.

Reduce risk of CHD: Oral: Children ≥12 years: Refer to adult dosing.

Administration

Inhalation of psyllium dust may cause sensitivity to psyllium (eg, runny nose, watery eyes, wheezing). Drink at least 8 ounces of liquid with each dose. Powder must be mixed in a glass of water or juice. Capsules should be swallowed one at a time. When more than one dose is required, they should be divided throughout the day. Separate dose by at least 2 hours from other drug therapies.

Dietary Considerations

Products should be taken with at least 8 ounces of fluids. Some products may contain phenylalanine, potassium, sodium, as well as additional ingredients. Check individual product information for caloric and nutritional value.

When used to reduce the risk of CHD, the amount of soluble fiber from psyllium should be ≥7 g/day and it should be used in conjunction with a diet low in saturated fat and cholesterol.

Storage

Store at room temperature; protect from moisture (consult product labeling for specific information).

Drug Interactions

There are no known significant interactions.

Adverse Reactions

Frequency not defined.

Gastrointestinal: Abdominal cramps, constipation, diarrhea, esophageal or bowel obstruction

Respiratory: Bronchospasm

Miscellaneous: Anaphylaxis upon inhalation in susceptible individuals, rhinoconjunctivitis

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Hypersensitivity reactions have been reported with ingestion or inhalation of psyllium in susceptible individuals.

Disease-related concerns:

• Coronary heart disease (CHD): To reduce the risk of CHD, the soluble fiber from psyllium should be used in conjunction with a diet low in saturated fat and cholesterol.

• Gastrointestinal disease: Use with caution in patients with esophageal strictures, ulcers, stenosis, or intestinal adhesions or difficulty swallowing

Special populations:

• Elderly: Use with caution in the elderly; may have insufficient fluid intake which may predispose them to fecal impaction and bowel obstruction.

Dosage form specific issues:

• Calcium: Some products may contain calcium.

• Phenylalanine: Some products may contain phenylalanine.

• Potassium: Some products may contain potassium.

• Sodium: Some products may contain sodium.

• Soy lecithin: Some products may contain soy lecithin.

Other warnings/precautions:

• Administration: Products must be taken with at least 8 ounces of fluid in order to prevent choking.

• Self-medication (OTC use): When used for self-medication (OTC), do not use in the presence of abdominal pain, nausea, or vomiting. Notify healthcare provider in case of sudden changes of bowel habits which last >2 weeks or in case of rectal bleeding. Not for self-treatment of constipation lasting >1 week.

Pregnancy Considerations

Psyllium is not absorbed systemically. When administered with adequate fluids, use is considered safe for the treatment of occasional constipation during pregnancy (Wald, 2003).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience bloating or abdominal cramps. Have patient report immediately to prescriber dysphagia, severe nausea, severe vomiting, severe abdominal pain, rectal bleeding, or rectal pain (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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