ispaghula husk: clinical use

Prescribing considerations

• Exclude obstruction, faecal impaction or unexplained rectal bleeding before use.
• Review persistent sudden changes in bowel habit and abdominal symptoms.
• Ensure the patient can swallow safely and maintain adequate fluid intake.
• Debilitated or older patients may require closer supervision.
• Consider occupational sensitisation in people repeatedly handling psyllium powder.

Contraindications and cautions

• Hypersensitivity to ispaghula husk or an excipient
• Difficulty swallowing or throat, oesophageal or cardia disorders
• Gastrointestinal strictures or obstruction
• Faecal impaction
• Colonic atony or natural or medicine-induced reduction in gut motility
• Unexplained rectal bleeding or failure to defecate after laxative use
• A sudden bowel-habit change persisting beyond two weeks

Monitoring

• Response and changes in stool pattern
• New abdominal pain, vomiting, distension or swallowing difficulty
• Fluid intake and obstruction risk
• Potential treatment changes with diabetes medicines or thyroid hormones
• Allergic symptoms in patients or staff exposed repeatedly to powder

Clinical pharmacology

Plantago ovata husk contains predominantly soluble, partly fermentable polysaccharide fibre. Hydration produces swollen mucilage that increases luminal bulk, provides a stretch stimulus and lubricates intestinal contents; systemic absorption of intact fibre is negligible.

Formulation and product differences

• The selected product is plain granules for oral suspension supplied in sachets.
• It contains aspartame, a source of phenylalanine, so suitability must be checked in phenylketonuria.
• It contains a small amount of potassium and is described as essentially sodium-free.
• Flavoured ispaghula products may have different excipients; check the specific product information.