III. Background

  1. Take at least 2 hours before or 2 hours after other medications
  2. All of these should be mixed with a large glass of water, and then followed with a second glass of water
  3. Onset of bowel stimulation is typically 12 to 72 hours

IV. Precautions

  1. Use with 64 oz/day (>1.8 Liters/day) non-caffeinated fluid
  2. Poorly tolerated in atonic colon (e.g. Megacolon)

V. Medications: Bulk-Forming agents (Bulk Laxative)

  1. Psyllium (Metamucil)
    1. Nondigested plant cell wall absorbs water in the Gastrointestinal Tract, promoting stool softening
    2. Adults (and age >=12 years): 10 grams per day
      1. Take 1-2 tsp (or 2.4 grams soluble fiber) in 8 ounces of water or juice orally three times daily
      2. Follow each dose with another glass of fluid
    3. Child (ages 6 to 11 years)
      1. Give 1.2 grams soluble fiber orally in 4 to 8 ounces of water or juice orally three times daily
      2. Follow each dose with another glass of fluid
  2. Methylcellulose (Citrucel)
    1. Derived from cellulose, with similar activity to Psyllium
    2. Nondigested Carbohydrate absorbs water in the Gastrointestinal Tract, promoting stool softening
    3. Adults (and age >=12 years): 6 grams per day
      1. Take 2 grams in 8 ounces liquid orally three times daily
  3. Calcium Polycarbophil (Fibercon)
    1. Synthetic bulk agent containing polyacrylic acid
    2. Dose: Two 625 mg tablets orally three times daily

VI. Medications: Alternative

  1. See Dietary Fiber
  2. Dietary sources with as much fiber at 10% of cost
    1. Wheat bran, oat bran or all-bran cereal
    2. Lima, Navy, Kidney and baked beans

VII. Adverse Effects

  1. Bowel Obstruction
  2. Abdominal cramping or Gas (bloating, Abdominal Distention, Flatulence)
    1. More common if started too quickly with high dosing
    2. Reduced by gradually increasing fiber intake to 225-30 grams per day
    3. Side effects more likely with dyssynergic Defecation
    4. Side effects are more common with insoluble fiber
      1. Insoluble fiber examples include (Methylcellulose, Citrucel, wheat bran)
      2. In contrast, soluble fiber (psyillium, Metamucil, oat bran) is associated with less gas

VIII. Drug Interactions

  1. May interfere with absorption of medications
    1. Do not take medications at the same time as Psyllium
    2. Space Psyllium several hours apart from medications
  2. Agents known to be affected
    1. Carbamazepine (Tegretol)
      1. Etman (1995) Drug Dev Ind Pharm 21:1901-6 [PubMed]
    2. Lithium
      1. Perlman (1990) Lancet 335:416 [PubMed]

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Related Studies

Ontology: Metamucil (C0025559)

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