Psyllium

psyllium, ispaghula

plantago arenaria, plantago ovata, plantago afra

Psyllium, derived from the seeds or seed husks of the Plantago plants, has been used as a laxative. The husks contain more soluble fibre than the seeds and are used more often in psyllium products.

The dosing of psyllium differs depending on which part of the plant (husk or seed) is used in the formulation.

When using psyllium seed, people over 12 years of age can use between 2.5 g and 40 g per day (not exceeding 13 g per dose); children between 6 and 12 years of age should use between 1.25 g and 25 g per day (not exceeding 8 g per dose).

When using the psyllium husk, people over 12 years of age can use between 2.5 g and 30 g per day (not exceeding 8 g per dose); children between 6 and 12 years of age should use between 1.25 g and 15 g per day (not exceeding 4 g per dose).

With any formulation of psyllium, drinking adequate amounts of water as described in the product instructions is extremely important. Each gram of psyllium should be mixed with 30 mL of liquid (e.g., water, milk, fruit juice). Try to avoid breathing in psyllium powder when mixing a dose to prevent allergic reactions. Effects of psyllium can generally be observed between 12 hours and 3 days.

Psyllium should be taken 2 hours before or after taking other medications.

Your health care provider may have recommended using this product in other ways. Contact a health care provider if you have questions.

People most often use psyllium to manage various gastrointestinal symptoms, including constipation, hemorrhoids, anal fissure, diarrhea, and irritable bowel syndrome. It has also been used for lowering cholesterol and blood pressure.

There is good scientific evidence showing that psyllium is effective as a bulk laxative and stool softener for treating constipation and improving symptoms related to hemorrhoids. The role of psyllium for other uses is not clear and requires further studies.

Several studies have shown that psyllium products can lower cholesterol by small amounts. Although psyllium products should not be used alone for treatment of high cholesterol, they can be used in conjunction with other lifestyle changes that can help lower cholesterol, as recommended by your health care provider.

Your health care provider may have recommended this product for other conditions. Contact a health care provider if you have questions.

Psyllium products are generally well tolerated for up to 6 weeks if taken as directed and with adequate water intake. The main side effects of psyllium products are related to stomach disturbances, including passing more gas, bloating, diarrhea, stomach pain, nausea, and vomiting. If you notice other symptoms while using psyllium, such as bleeding from the rectum, seek immediate medical attention.

Some people using psyllium products have experienced serious allergic reactions, including anaphylaxis resulting in sudden breathing problems. If you experience any difficulty breathing, vomiting, or chest pain, seek immediate medical attention. Do not use psyllium if you are allergic to psyllium, the Plantago lanceolata plant known as English plantains, any other member of the Plantaginaceae plant family.

You should also see your doctor if you:

• have persisting (more than 7 days) or worsening symptoms while taking psyllium
• are taking agents that can slow down intestinal movement (e.g., opioids, loperamide)
• have a disease of the esophagus
• have a blockage of the intestines
• had a recent abdominal surgery
• have hard stools that cannot be passed
• have inflammation of bowel or appendix
• have symptoms of nausea, vomiting, fever, and stomach pain

Psyllium must be taken with adequate amounts of fluid. Without enough water, psyllium can swell and block the throat or intestines and may cause choking and bowel obstruction.

People who have diabetes should use psyllium products with caution, since psyllium can lower blood sugar.

Women who are pregnant or breast-feeding should use psyllium only on the advice of a health care professional.

Do not use psyllium if you have:

• a sudden change in bowel movement patterns that has persisted for more than 2 weeks
• colorectal cancer
• diabetes with difficult-to-control blood sugar levels
• difficulty swallowing
• failure to have a bowel movement even after use of another laxative
• undiagnosed rectal bleeding

Psyllium products may interfere with the absorption of other medications and supplements, and so should be taken at least 2 hours before or after other medications. This is especially important for people taking medications such as carbamazepine, digoxin, lithium, metformin, and olanzapine where changes in the levels of these medications could result in how well the medication works and controls your symptoms. Psyllium products can also interfere with the absorption of medications that are slowly released from specially designed tablets or capsules. Ask your pharmacist if the medication you are taking may interfere with psyllium.

Before taking any new medications, including natural health products, speak to your physician, pharmacist, or other health care provider. Tell your health care provider about any natural health products you may be taking.

1. Health Canada. Drugs and Health Products. Psyllium – Plantago Afra. https://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=psyillium.plantago.afra&lang=eng.
2. Health Canada. Drugs and Health Products. Psyllium – Plantago Arenaria. https://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=psyllium.plantago.arenaria&lang=eng.
3. Health Canada. Drugs and Health Products. Psyllium – Plantago Ovata. https://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=psyllium.plantago.ovata&lang=eng.
4. Natural Medicines Comprehensive Database. Black Psyllium.
5. Natural Medicines Comprehensive Database. Blond Psyllium.