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
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Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D011620 |
English | metamucil, Metamucil |
Ontology: Methylcellulose (C0025729)
Definition (NCI) | The methyl ether of cellulose with laxative activity. Methylcellulose is not absorbed by the intestines and attracts large amounts of water into the colon, thereby increasing viscosity, producing a softer and bulkier stool and stimulating the constriction of intestinal smooth muscles. |
Definition (MSH) | Methylester of cellulose. Methylcellulose is used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. |
Definition (CSP) | methylester of cellulose; used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry and is used therapeutically as a bulk laxative. |
Concepts | Pharmacologic Substance (T121) , Indicator, Reagent, or Diagnostic Aid (T130) , Carbohydrate (T118) |
MSH | D008747 |
SnomedCT | 317492003, 317350009, 322018001, 24504000, 387131008 |
English | Cellulose, Methyl, Methyl Cellulose, Cellulose, methyl ether, Methylcellulose [GI bulk lax], Methylcellulose [antidiarrh], Methylcellulose [appet suppres, Methylcellulose [antidiarrheal], Methylcellulose [antidiarrhoeal], Methylcellulose [appetite suppressants], Methylcellulose [gastro-intestinal bulk laxative], methylcellulose (medication), ophthalmologicals artificial tears methylcellulose, Methylcellulose [Chemical/Ingredient], methyl cellulose, Methylcellulose, methylcellulose, Methylcellulose [gastro-intestinal bulk laxative] (product), Methylcellulose [antidiarrheal] (product), Methylcellulose [appetite suppressants] (product), Methylcellulose (product), Methylcellulose (substance), Methylcellulose [antidiarrheal] (substance), Methylcellulose [appetite suppressants] (substance), Methylcellulose [gastro-intestinal bulk laxative] (substance), METHYLCELLULOSE |
Swedish | Metylcellulosa |
Czech | methylcelulosa, hydroxypropylmethylcelulosa |
Finnish | Metyyliselluloosa |
Russian | METILTSELLIULOZA, МЕТИЛЦЕЛЛЮЛОЗА |
Japanese | メチルセルロース, セルロースメチルエーテル, セルロチル, コロゲル |
Croatian | METILCELULOZA |
Polish | Metyloceluloza |
Spanish | metilcelulosa (laxante expansor de volumen gastrointestinal) (producto), metilcelulosa [supresores del apetito], metilcelulosa [supresores del apetito] (producto), metilcelulosa [antidiarreico] (producto), metilcelulosa (laxante expansor de volumen gastrointestinal), metilcelulosa (laxante de volumen gastrointestinal), metilcelulosa [antidiarreico], metilcelulosa (producto), metilcelulosa (sustancia), metilcelulosa, Metilcelulosa |
French | Méthylcellulose |
German | Methylcellulose |
Italian | Metilcellulosa |
Portuguese | Metilcelulose |
Ontology: Psyllium (C0033979)
Definition (MSH) | Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. |
Concepts | Pharmacologic Substance (T121) , Biologically Active Substance (T123) , Organic Chemical (T109) |
MSH | D011620 |
SnomedCT | 52370008, 398702001 |
English | Psyllium gum, Psyllium Gum, Psyllium, Ispaghula, psyllium, Psyllium preparation, psyllium preparations (medication), stool softeners psyllium preparations psyllium, psyllium preparations, psyllium (medication), Psyllium [Chemical/Ingredient], Psyllium (product), Psyllium (substance), Psyllium preparation (substance), PSYLLIUM |
Spanish | psilio, psilio (sustancia), ispágula, preparado de psilium, preparado de psilio (sustancia), preparado de psilio, Psilio, psyllium (producto), psyllium, Psillium |
Swedish | Psyllium |
Czech | psyllium |
Finnish | Psyllium |
Russian | ISPAGULA, PSILLIUM, ИСПАГУЛА, ПСИЛЛИУМ |
Japanese | プシリウム種子, プランタゴ・プシリウム(車前子), プシリウム, シャゼンシ, プシリウム子, ヘラオオバコ(車前子), オオバコ(車前子), 車前子 |
Polish | Wyciąg z babki, Ispaghula, Psyllium |
Korean | 차전자 |
Portuguese | Psílio, Psyllium |
French | Plantago arenaria, Plantago psyllium, Psyllium |
German | Psyllium |
Italian | Psillio |
Ontology: calcium polycarbophil (C0054480)
Definition (NCI) | A loosely cross-linked synthetic polycarboxylic-type hydrophilic polymer resin, laxative and anti-diarrheal Calcium Polycarbophil increases stool frequency, fecal water content, and fecal weight in a dose-dependent manner. It is used for idiopathic constipation, secretory diarrhea, and irritable bowel syndrome. (NCI04) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C030312 |
SnomedCT | 326660003, 37433002, 400848002, 412106006, 412105005 |
English | calcium polycarbophil, polycarbofil, laxatives calcium polycarbophil, calcium polycarbophil (medication), polycarbophil (as calcium carbophil), calcium polycarbophil [Chemical/Ingredient], CALCIUM POLYCARBOPHIL, polycarbophil, POLYCARBOPHIL, Polyacrylic Acid Cross-Linked With Divinyl Glycol, polycarbophil calcium, Polycarbophil, Polycarbophil (product), Polycarbophil (substance), Polycarbophil [dup] (substance), Calcium polycarbophil (product), Calcium polycarbophil (substance), Calcium polycarbophil, POLYCARBOPHIL CALCIUM, Calcium Polycarbophil |
Spanish | policarbofilo de calcio, policarbófilo de calcio, policarbofilo de calcio (producto), policarbofilo de calcio (sustancia), policarbófilo de calcio (producto), policarbófilo de calcio (sustancia), policarbofil (producto), policarbofilo (sustancia), policarbofilo, policarbofil |
Ontology: Citrucel (C0305648)
Concepts | Pharmacologic Substance (T121) , Carbohydrate (T118) |
MSH | D008747 |
English | citrucel, Citrucel, SmithKline Beecham Brand of Methylcellulose |
Ontology: FiberCon (C0720432)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
English | FiberCon, fibercon, Fibercon |
Ontology: Bulk Laxatives (C1955900)
Concepts | Pharmacologic Substance (T121) |
MSH | D054368 |
English | Laxatives, Bulk, Bulk Laxatives |
French | Laxatifs de lest |
Italian | Lassativi di volume |
Czech | objemová projímadla, objemová laxativa |