II. Indications
III. Background
- Take at least 2 hours before or 2 hours after other medications
- All of these should be mixed with a large glass of water, and then followed with a second glass of water
- Onset of bowel stimulation is typically 12 to 72 hours
IV. Precautions
- Use with 64 oz/day (>1.8 Liters/day) non-caffeinated fluid
- Poorly tolerated in atonic colon (e.g. Megacolon)
V. Medications: Bulk-Forming agents (Bulk Laxative)
- Psyllium (Metamucil)
- Nondigested plant cell wall absorbs water in the Gastrointestinal Tract, promoting stool softening
- Adults (and age >=12 years): 10 grams per day
- Take 1-2 tsp (or 2.4 grams soluble fiber) in 8 ounces of water or juice orally three times daily
- Follow each dose with another glass of fluid
- Child (ages 6 to 11 years)
- Give 1.2 grams soluble fiber orally in 4 to 8 ounces of water or juice orally three times daily
- Follow each dose with another glass of fluid
- Methylcellulose (Citrucel)
- Derived from cellulose, with similar activity to Psyllium
- Nondigested Carbohydrate absorbs water in the Gastrointestinal Tract, promoting stool softening
- Adults (and age >=12 years): 6 grams per day
- Take 2 grams in 8 ounces liquid orally three times daily
- Calcium Polycarbophil (Fibercon)
- Synthetic bulk agent containing polyacrylic acid
- Dose: Two 625 mg tablets orally three times daily
VI. Medications: Alternative
- See Dietary Fiber
- Dietary sources with as much fiber at 10% of cost
- Wheat bran, oat bran or all-bran cereal
- Lima, Navy, Kidney and baked beans
VII. Adverse Effects
- Bowel Obstruction
- Abdominal cramping or Gas (bloating, Abdominal Distention, Flatulence)
- More common if started too quickly with high dosing
- Reduced by gradually increasing fiber intake to 225-30 grams per day
- Side effects more likely with dyssynergic Defecation
- Side effects are more common with insoluble fiber
- Insoluble fiber examples include (Methylcellulose, Citrucel, wheat bran)
- In contrast, soluble fiber (psyillium, Metamucil, oat bran) is associated with less gas
VIII. Drug Interactions
- May interfere with absorption of medications
- Do not take medications at the same time as Psyllium
- Space Psyllium several hours apart from medications
- Agents known to be affected