Psyllium
Place in Therapy
Place in Therapy
Psyllium is a fiber supplement used for the treatment of constipation and to lower cholesterol. For noninfectious diarrhea, psyllium is used as an off-label indication. (1) It acts by absorbing water in the intestine to form a viscous liquid promoting peristalsis and reducing transit time.(1) When diarrhea occurs in an individual there is too much water in their colon, the fiber will absorb this excess fluid in the bowel making the loose stool firm. The evidence for routine use of psyllium for noninfectious diarrhea is minimal. Two studies done by Homann et al. and Belknap et al. looked at the use of psyllium in enteral fed patients who often experience diarrhea and have to discontinue their enteral feedings.(2,3) The studies both indicated that the patents supplemented with psyllium in their diet had decreased incidence of experiencing diarrhea and had more normal stools. Therefore, there was less discontinuations of their enteral feeding, but there was increased incidence of flatulence.(2) Both studies were small and further large scale studies are recommended to look at using psyllium as prevention for diarrhea and extrapolating it to other patient populations. Regarding treatment of diarrhea, psyllium is recommended to be used for management by decreasing the amount of loose stools and it’s place in therapy is after antidiarrheal medications such as loperamide which are used for relief of debilitating symptoms. (4) However, self care recommends psyllium be used before anti-diarrheals in pregnancy to manage diarrhea because it is often self-limiting in this patient population.(4) Regarding safety, psyllium needs to be taken with a full glass of liquid at each dose to prevent swelling or blocking of the throat or esophagus. In patients, with any indication that they are dehydrated because of their diarrhea; psyllium should be avoided.(1) In conclusion, psyllium can be used as an off label indication for the treatment and prevention of mild diarrhea in patient’s who are able to drink fluids and are not dehydrated. There is minimal evidence in the literature for routine use of psyllium as a treatment for noninfectious diarrhea, but in the case of mild diarrhea it can absorb the excess water in the colon and make the bowel movements more firm decreasing the amount of diarrhea.
References:
Psyllium is a fiber supplement used for the treatment of constipation and to lower cholesterol. For noninfectious diarrhea, psyllium is used as an off-label indication. (1) It acts by absorbing water in the intestine to form a viscous liquid promoting peristalsis and reducing transit time.(1) When diarrhea occurs in an individual there is too much water in their colon, the fiber will absorb this excess fluid in the bowel making the loose stool firm. The evidence for routine use of psyllium for noninfectious diarrhea is minimal. Two studies done by Homann et al. and Belknap et al. looked at the use of psyllium in enteral fed patients who often experience diarrhea and have to discontinue their enteral feedings.(2,3) The studies both indicated that the patents supplemented with psyllium in their diet had decreased incidence of experiencing diarrhea and had more normal stools. Therefore, there was less discontinuations of their enteral feeding, but there was increased incidence of flatulence.(2) Both studies were small and further large scale studies are recommended to look at using psyllium as prevention for diarrhea and extrapolating it to other patient populations. Regarding treatment of diarrhea, psyllium is recommended to be used for management by decreasing the amount of loose stools and it’s place in therapy is after antidiarrheal medications such as loperamide which are used for relief of debilitating symptoms. (4) However, self care recommends psyllium be used before anti-diarrheals in pregnancy to manage diarrhea because it is often self-limiting in this patient population.(4) Regarding safety, psyllium needs to be taken with a full glass of liquid at each dose to prevent swelling or blocking of the throat or esophagus. In patients, with any indication that they are dehydrated because of their diarrhea; psyllium should be avoided.(1) In conclusion, psyllium can be used as an off label indication for the treatment and prevention of mild diarrhea in patient’s who are able to drink fluids and are not dehydrated. There is minimal evidence in the literature for routine use of psyllium as a treatment for noninfectious diarrhea, but in the case of mild diarrhea it can absorb the excess water in the colon and make the bowel movements more firm decreasing the amount of diarrhea.
References:
- Lexi-comp. Psyllium. Available at:http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/ retrieve/docid/patch_f/7589. Updated July 3, 2014. Accessed June 23, 2014.
- Homann HH, Kemen M, Fuessenich C, Senkal M, Zumtobel V. Reduction in diarrhea incidence by soluble fiber in patients receiving total or supplemental enteral nutrition. J Parenter Enteral Nutr. 1994; 18(6): 486-90.
- Belknap D, Davidson LJ, Smith CR. The effects of psyllium hydrophilic mucilloid (PHM) on diarrhea in enterally fed patients. Heart Lung. 1997; 26(3): 229-37.!
- Forrster A. Diarrhea. In: Repchinsky C, Hutsul J, Jovaisas B, Lewis G et al. eds. Patient Selfcare. 2nd ed. Toronto, ON: Canadian Pharmacists Association; 2010: 281-295.