psyllium

Action and Spectrum

Psyllium acts as a bulk-forming laxative by absorbing water in the gut, forming a gel that adds volume and softens stool. This helps stimulate bowel movements and shortens the time it takes for stool to pass through the intestines. 

Drug Interaction

Adverse Reaction

Adverse drug reactions:

1-10%

Flatulence

Abdominal cramping

Constipation

Frequency Not Defined

Impaction

Black Box Warning

Taking psyllium without enough fluid may cause it to swell and block the throat or esophagus, leading to choking. Do not use this product if you have difficulty swallowing. Always take with adequate fluid to prevent obstruction. 

Contraindication / Caution

Allergy: Avoid if allergic to psyllium or any of its components. 

Drug Interactions: Do not take digoxin, aspirin (or other salicylates), or nitrofurantoin within 3 hours of psyllium. Inform your doctor of all medications, including supplements and OTC drugs. 

Medical Conditions: Use with caution in individuals with diabetes, heart disease, high blood pressure, kidney disease, rectal bleeding, intestinal obstruction, or difficulty swallowing. 

Pregnancy/Breastfeeding: Inform your doctor if pregnant, planning pregnancy, or breastfeeding. 

Dietary Restrictions: Inform your provider if on a low-sugar or low-sodium diet. 

Inhalation Risk: Avoid inhaling psyllium powder when preparing doses, as it may cause allergic reactions. 

Pregnancy / Lactation

Pregnancy warnings:  

• US FDA pregnancy category: Not assigned.

Breastfeeding warnings:

• The release of the drug into the human breastmilk is Unknown

Pregnancy Categories:    

Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first trimester or the later trimester.

Category B: No evidence shown of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women

Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a result in humans must take care of potential risks in pregnant women

Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits

Category X: Drugs listed in this category outweigh risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.

Category N: There is no data available for the drug under this category

Pharmacology

Psyllium is an oral bulk-forming laxative available in various forms (powder, granules, capsules, liquid, wafers). It absorbs water in the intestines to form a gel-like mass that adds bulk to stools and promotes bowel movements. For effective action and to prevent choking, it must be taken with at least 8 oz (240 mL) of liquid. Proper hydration is essential for its safe use. 

Pharmacokinetics 

Absorption 

Psyllium is not systemically absorbed. It acts locally in the gastrointestinal (GI) tract. 

Distribution 

Since psyllium is not absorbed into the bloodstream, distribution is limited to the GI tract. 

Metabolism 

Psyllium undergoes partial fermentation by colonic bacteria, producing short-chain fatty acids. However, much of it remains unchanged as it passes through the colon. 

Elimination/Excretion 

It is excreted in the feces, largely unchanged, along with the water it absorbs. 

Pharmacodynamics 

Psyllium acts as a bulk-forming laxative by absorbing water in the intestines, forming a gel-like mass. This increases stool volume, softens the stool, and stimulates intestinal motility, leading to easier and more regular bowel movements. It also helps lower cholesterol and improve glycemic control by delaying glucose absorption. 

Adminstartion

Psyllium should be taken 1 to 3 times daily with at least 8 ounces (240 mL) of water or other liquid. The powder or granules must be mixed with liquid just before use. Wafers must be chewed thoroughly. Adequate fluid intake is essential to prevent choking or intestinal blockage. 

Patient Information Leaflet

Patient information leaflet  

Generic Name: psyllium 

Pronounced: SIL-ee-um  

Why do we use psyllium?  

Psyllium is primarily used to treat constipation, manage irritable bowel syndrome (IBS), and support regular bowel movements. It may also help in lowering cholesterol levels, controlling blood sugar in diabetes, and improving heart health.