Active substance(s): ISPAGHULA HUSK / ISPAGHULA HUSK / ISPAGHULA HUSK
NAME OF THE MEDICINAL PRODUCT
QUALITATIVE AND QUANTITATIVE COMPOSITION
A sachet contains 3.5 g ispaghula husk BP. For the full list of excipients, see section
Clinical Indication: for the treatment of patients requiring a high fibre
regimen: for example, for the relief of constipation, including constipation in
pregnancy and the maintenance of regularity; for the management of bowel
function in patients with colostomy, ileostomy, haemorrhoids, anal fissure,
chronic diarrhoea associated with diverticular disease, irritable bowel
syndrome and ulcerative colitis.
Posology and Method of Administration
If there have been no bowel movements after three days of treatment a doctor
or healthcare professional should be consulted. (See section 4.4 ‘Special
warnings and precautions for use’)
Adults: One sachet, morning and evening
Elderly: There is no indication that dosage needs to be modified for the
Children over 12 years: One sachet, morning and evening.
Children aged 6 to 12 years: Half to one level 5 ml spoonful depending on
size and age, morning and evening.
Children under 6 years: The use in children under 6 years of age is not
recommended (See section 4.4 ‘Special warnings and precautions for use’).
The effects start 12-24 hours later.
Method of Administration
Fybogel Lemon is intended for oral administration as a suspension in a full
glass of water (See section 4.4) the granules should be stirred into a glass of
water and taken as soon as possible, preferably after meals.
The product should be taken during the day at least ½ to 1 hour before or after
intake of other medicines and should not be taken immediately before going to
When preparing the product for administration, it is important to try to avoid
inhaling any of the powder in order to minimize the risk of sensitisation to the
Hypersensitivity to ispaghula husk or to any of the excipients listed in 6.1 (See
Section 4.4 Special warnings and precautions for use),
Patients with a sudden change in bowel habit that has persisted more than two
Undiagnosed rectal bleeding and failure to defecate following the use of a
Patients suffering from abnormal constrictions in the gastro-intestinal tract,
with diseases of the oesophagus and cardia, intestinal obstruction, faecal
impaction, natural or drug-induced reduction of gut motility and colonic atony
such as senile mega-colon.
Patients who have difficulty in swallowing or any throat problems.
Special Warnings and Special Precautions for Use
The product should not be taken dry and should always be taken mixed with fluid (5
fluid ounces or 150 mL of water or other liquid per sachet).
Ispaghula husk should not be used by patients with faecal impaction and symptoms
such as abdominal pain, nausea and vomiting unless advised by a doctor because
these symptoms can be signs of potential or existing intestinal blockage (ileus).
If abdominal pain occurs or in cases of any irregularity of faeces, the use of psyllium
seed should be discontinued and medical advice must be sought.
When taken with inadequate fluid amounts, bulk forming agents can cause
obstruction of the throat and oesophagus with choking and intestinal obstruction.
Symptoms can be chest pain, vomiting, or difficulty in swallowing or breathing.
The treatment of debilitated patients and / or elderly patients requires medical
In order to decrease the risk of gastrointestinal obstruction ispaghula husk should not
be used together with medicinal products known to inhibit peristaltic movement (e.g.
opioids) and then only under medical supervision.
The last dose should not be taken immediately before going to sleep since impaired or
reduced gastric motility may impair the intestinal passage and then cause subobstruction.
Due to its aspartame content Fybogel Lemon should not be given to patients with
If symptoms persist longer than 3 days, the patient should consult a doctor or
Warning on hypersensitivity reactions: In individuals with continued occupational
contact to powder of Plantago ovata seeds (e.g. healthcare workers, caregivers)
allergic sensitisation may occur due to inhalation, this is more frequent in atopic
individuals. This sensitisation usually leads to hypersensitivity reactions which could
be serious (see 4.8 Undesirable effects).
It is recommended to assess clinically the possible sensitisation of individuals at risk
and, if justified, to perform specific diagnostic tests.
In case of proven sensitisation leading to hypersensitivity reactions, exposure to the
product should be stopped immediately and avoided in the future (see 4.3
Use is not recommended in children below 6 years of age due to insufficient data on
safety and efficacy. Laxative bulk producers should be used before using other
purgatives if change of nutrition is not successful.
Interaction with other Medicinal Products and other Forms of Interaction
Enteral absorption of concomitantly administered medicines such as minerals,
vitamins (B12), cardiac glycosides, coumarin derivatives, carbamazepine and
lithium may be delayed. For this reason the product should not be taken ½ to 1
hour before or after intake of other medicinal products.
Diabetic patients should take ispaghula husk only under medical supervision
because adjustment of anti-diabetic therapy may be necessary.
Use of ispaghula husk concomitantly with thyroid hormones requires medical
supervision because the dose of the thyroid hormones may have to be adjusted.
Pregnancy and Lactation
There are limited amount of data (less than 300 pregnancy outcomes) from the
use of ispaghula husk in pregnant women. Animal studies are insufficient with
respect to reproductive toxicity (see section 5.3 Preclinical safety data).
The use of ispaghula husk may be considered during pregnancy and lactation,
if necessary and if change of nutrition is not successful. Laxative bulk
producers should be used before using other purgatives
No known effects
Effects on Ability to Drive and Use Machines
Fybogel Lemon has no or negligible influence on the ability to drive and use
Special attention should be given to individuals manipulating the powder
formulations routinely (see 4.4 Special warnings and precautions for use).
Adverse events which have been associated with ispaghula husk are given below,
tabulated by system organ class and frequency. Frequencies are defined as: Very
common (≥1/10); Common (≥1/100 and <1/10); Uncommon (≥1/1000 and <1/100);
Rare (≥1/10,000 and <1/1000); Very rare (< 1/10,000); Not known (cannot be
estimated from the available data). Within each frequency grouping, adverse events
are presented in order of decreasing seriousness.
System Organ Class
Immune System Disorders
Respiratory, Thoracic and
Skin and Subcutaneous Tissue
Flatulence, abdominal distension,
intestinal obstruction, oesophageal
obstruction, faecal impaction3
Description of Selected Adverse Reactions
Including rash, anaphylaxis, pruritus, and bronchospasm
Ispaghula/psyllium husk contains potent allergens. The exposure to these allergens
is possible through oral administration, contact with the skin and, in the case of
powder formulations, also by inhalation. As a consequence to this allergic potential,
individuals exposed to the product can develop hypersensitivity reactions such as
rhinitis, conjunctivitis, bronchospasm and in some cases, anaphylaxis. Cutaneous
symptoms such as exanthema and/or pruritus have also been reported.
A small amount of flatulence and abdominal distension may sometimes occur
during the first few days of treatment, but should diminish during continued
treatment. Abdominal distension and risk of intestinal or oesophageal obstruction and
faecal impaction may occur, particularly if swallowed with insufficient fluid.
Reporting of Suspected Adverse Reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is
important. It allows continued monitoring of the benefit/risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via the Yellow Card Scheme at: http://www.mhra.gov.uk/yellowcard.
Overdose with ispaghula husk may cause abdominal discomfort, flatulence
and intestinal obstruction.
And attention should be paid to maintaining an adequate fluid intake and
management should be symptomatic.
Pharmacotherapeutic Group: Ispaghula (Psyllia Seeds); ATC Code:
A06AC01 Bulk producer
The active ingredient ispaghula husk consists of the episperm and collapsed
adjacent layers removed from the seeds of Plantago ovata Forssk (Plantago
ispaghula Roxb.). Ispaghula husk is particularly rich in alimentary fibres and
mucilages, ts mucilage content being higher than that of other Plantago
species. Ispaghula husk is capable of absorbing up to 40 times its own weight
in water. Ispaghula husk consists of 85% water-soluble fibre; it is partly
fermentable (in vitro 72 % unfermentable residue) and acts by hydration in the
Gut motility and transit rate can be modified by ispaghula husk through
mechanical stimulation of the gut wall as a result of the increase in intestinal
bulk by water and the decrease in viscosity of the luminal contents. When
taken with a sufficient amount of liquid (at least 30 ml per 1 g of herbal
substance) ispaghula husk produces an increased volume of intestinal contents
due to its highly bulking properties and hence a stretch stimulus, which
triggers defecation; at the same time the swollen mass of mucilage forms a
lubricating layer, which makes the transit of intestinal contents easier.
Progress of action: ispaghula husk usually acts within 12 to 24 hours after
single administration. Sometimes the maximum effect is reached after 2 to 3
The material hydrates and swells to form a mucilage because it is only
partially solubilised. Polysaccharides, such as those which dietary fibres are
made of, must be hydrolysed to monosaccharides before intestinal uptake can
occur. The sugar residues of the xylan backbone and the side chains are joined
by ß-linkages, which cannot be broken by human digestive enzymes.
Less than 10% of the mucilage gets hydrolysed in the stomach, with formation
of free arabinose. Intestinal absorption of the free arabinose is approximately
85% to 93%.
To varying degrees, dietary fibre is fermented by bacteria in the colon,
resulting in production of carbon dioxide, hydrogen, methane, water, and
short-chain fatty acids, which are absorbed and brought into the hepatic
circulation. In humans, such fibre reaches the large bowel in a highly
polymerised form that is fermented to a limited extent, resulting in increased
faecal concentration and excretion of short-chain fatty acids.
Pre-clinical Safety Data
In a study on fertility, embryo-foetal development and pre- and postnatal
development (multigeneration study) ispaghula husk (0, 1, 2.5, or 5% (w/w) of the
diet) was administered to rats continuously through two generations. For fertility and
foetal development and teratogenesis the no-observed-adverse-effects-limit (NOAEL)
was 5% of the diet, while for offspring growth and development the NOAEL was
given with 1% of the diet based on reductions in pup weights.
The study on embryo-foetal development in rabbits (ispaghula husk as 0, 2.5, 5 or
10% (w/w) of diet) has to be considered as preliminary. Conclusions cannot be
The non-clinical data on toxicology of ispaghula husk preparations are incomplete,
but available data indicate no signals of toxicological concern. Adequate tests on
reproductive toxicity, genotoxicity and carcinogenicity have not been performed.
List of excipients
Riboflavine sodium phosphate
Lemon flavour no. 1
Lemon flavour no. 4
Silica colloidal anhydrous
Special Precautions for Storage
Store below 30°C in a dry place.
Nature and Contents of Container
Sachets of paper/aluminium foil/polythene laminate. One, seven, ten or thirty
sachets in a cardboard outer. (Pack sizes printed in bold are currently sold).
Instructions for Use, Handling and Disposal
Fybogel Lemon granules are to be dispersed in water forming a drink.
MARKETING AUTHORISATION HOLDER
Reckitt Benckiser Healthcare (UK) Limited,
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION / RENEWAL OF
24th April, 1995 / 20th August, 1997.
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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