Ispaghula Husk

1. Introduction

Ispaghula husk, also known as psyllium, is a bulk-forming laxative derived from the seed husks of the Plantago ovata plant. It is used to relieve constipation, regulate bowel movements, and manage conditions like irritable bowel syndrome (IBS). It works by absorbing water in the intestines to form a gel-like substance that softens stools and promotes regularity.

2. Indications

  • Approved Indications:
    • Constipation (acute or chronic).
    • Diarrhoea (to help solidify stools).
    • Irritable bowel syndrome (IBS).
    • Haemorrhoids (to ease stool passage).
  • Off-Label Uses:
    • Lowering cholesterol levels.
    • Assisting in glycaemic control in type 2 diabetes.

3. Dosage

  • Adults:
    • Constipation: 3.5 g (1 sachet or 1 heaped teaspoon) mixed in 150 mL of water or juice 1–3 times daily.
    • Diarrhoea: 3.5 g once or twice daily as needed.
  • Children (6–12 years):
    • 1.75 g (half a sachet) mixed in 150 mL of water once or twice daily.
  • Children (<6 years):
    • Not recommended unless prescribed by a healthcare provider.

4. Administration

  • Mix the powder with a full glass of water or juice (minimum 150 mL) and drink immediately.
  • Follow with an additional glass of water to prevent intestinal obstruction.
  • Take ispaghula husk 30 minutes to 1 hour before or after other medications to avoid absorption interference.

5. Forms Available

  • Granules/Sachets: 3.5 g per dose.
  • Powders: Various bulk packaging options.

6. Side Effects

6.1. Common Side Effects

  • Bloating.
  • Flatulence.
  • Abdominal cramping.

6.2. Less Common Side Effects

  • Mild diarrhoea.
  • Constipation (if inadequate water is consumed).

6.3. Rare but Serious Side Effects

  • Intestinal obstruction or impaction (if taken without sufficient water).
  • Allergic reactions (e.g., rash, itching, difficulty breathing).

7. Warnings

  • Choking Hazard: Ensure adequate fluid intake to avoid oesophageal or intestinal obstruction.
  • Fibre Sensitivity: Some individuals may develop allergic reactions or intolerance to ispaghula.

8. Precautions

  • Avoid use in patients with:
    • Dysphagia or difficulty swallowing.
    • Intestinal obstruction or severe faecal impaction.
  • Use cautiously in patients with diabetes, as ispaghula may lower blood sugar levels.

9. Interactions

  • Drug-Drug Interactions:
    • May delay the absorption of medications such as digoxin, warfarin, and carbamazepine.
    • Avoid taking with iron supplements simultaneously, as absorption may be reduced.
  • Drug-Food Interactions:
    • No significant interactions, but ensure consistent hydration with its use.

10. Monitoring Parameters

  • Relief of constipation or diarrhoea.
  • Bowel movement frequency and consistency.
  • Signs of obstruction (e.g., severe abdominal pain, vomiting).

11. Use in Children

  • Safe for use in children aged 6 years and older. Dose adjustments are required for younger children, and use should be under medical supervision.

12. Use in Pregnancy

  • Category A: Safe to use during pregnancy for managing constipation or regulating bowel movements. Ensure adequate hydration.

13. Use in Elderly

  • Safe for elderly patients, but hydration status should be closely monitored to prevent impaction.

14. Use in Kidney Disease

  • Safe for use, but ensure sufficient fluid intake to avoid complications like impaction.

15. Use in Liver Disease

  • Safe for use; no dose adjustment is required.

16. Patient Counselling Points

  • Take ispaghula husk with a full glass of water or juice and drink immediately. Follow with an additional glass of water.
  • Do not take it dry, as this can cause choking.
  • Ensure regular hydration throughout the day when using ispaghula husk.
  • Inform your doctor if constipation persists or if you experience severe abdominal pain or vomiting.
  • Take ispaghula husk at least 30 minutes before or after other medications to avoid interference with absorption.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
FybogelReckitt Benckiser$10–15 (30 sachets, 3.5 g each)
IspagholQarshi$5–10 (100 g pack)
Generic Psyllium HuskVarious manufacturers$2–8 (100 g pack)

18. FAQs (15 Questions)

  1. What is ispaghula husk used for?
    It is used to treat constipation, diarrhoea, and manage IBS symptoms by regulating bowel movements.
  2. How does ispaghula husk work?
    It absorbs water in the intestines, forming a gel-like substance that softens stools and makes them easier to pass.
  3. How long does it take for ispaghula husk to work?
    Relief from constipation may occur within 12–24 hours but can take up to 3 days in some cases.
  4. Can ispaghula husk cause side effects?
    Yes, common side effects include bloating, gas, and abdominal cramping, especially during initial use.
  5. Is ispaghula husk safe during pregnancy?
    Yes, it is safe and commonly used during pregnancy for constipation relief.
  6. How should ispaghula husk be taken?
    Mix with water or juice and drink immediately, followed by an additional glass of water.
  7. Can ispaghula husk be taken daily?
    Yes, it can be taken daily as directed, but long-term use should be monitored by a healthcare provider.
  8. Does ispaghula husk interact with medications?
    Yes, it may delay the absorption of certain medications like digoxin or warfarin. Take it 30 minutes before or after other medications.
  9. Can ispaghula husk be used for diarrhoea?
    Yes, it can help solidify stools in mild to moderate diarrhoea.
  10. Is ispaghula husk safe for children?
    Yes, it is safe for children aged 6 years and older, with appropriate dosage adjustments.
  11. What happens if I take ispaghula husk without water?
    It can cause choking or oesophageal obstruction. Always take it with sufficient water.
  12. Can ispaghula husk help with weight management?
    It may aid in weight management by promoting satiety, but it is not a primary weight loss solution.
  13. How should ispaghula husk be stored?
    Store in a cool, dry place, away from moisture and direct sunlight.
  14. Can ispaghula husk cause dehydration?
    No, but inadequate fluid intake during its use may lead to constipation or impaction.
  15. Is ispaghula husk gluten-free?
    Yes, it is naturally gluten-free and safe for individuals with coeliac disease.