Psyllium
Place In Therapy
In reviewing of the available literature, there is a considerable amount of evidence to support the use of psyllium for the management of chronic constipation in the self-care population. Several primary literatures have demonstrated the efficacy of psyllium in increasing stool frequency andconsistency compared to placebo in the adult population. (1) Moreover, compared with docusate sodium, psyllium was shown to have superior stool softening effect with significantly greater increases in stool water content. (2) When compared to lactulose, psyllium was non-inferior in the management of constipation symptoms. (3) Increases in total stool output and stool weight were also consistently noted with the use of psyllium. (1)(3)(4) Regarding the safety of psyllium use, literature indicates that psyllium is well-tolerated with minor side effects comparable with placebo.(2) It is important, however, to be cognisant of the limitations of these studies as some exhibit flaws in the methodological design (Ex. Short study duration, small sample size) which may negatively impact the validity of the studies.
Due to its overall favourable efficacy and safety, psyllium has been recommended widely as the first-line agent in the management of chronic
constipation in the adult population. (4)(5)(6) Although the efficacy of psyllium has only been studied for a short-term, expert opinion and clinical experience suggest that the therapeutic effect of psyllium can be maintained for the long term. (4) Psyllium should not be used in patients with gastrointestinal abnormalities such as bowel or esophegeal obstruction. (5) These patients were excluded from the studies in which the efficacy and safety of psyllium use is unknown. (1)(2) The efficacy and safety of psyllium use in special populations such as infants, children and pregnant women have not been demonstrated. However, expert opinion and some tertiary literatures suggest that its use is
deemed appropriate in these populations. (5)
1. McRorie JW, Daggy BP, Morel JG et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998;12(5):491-7.
2. Ashraf W, Park F, Lof J et al. Effects of psyllium therapy on stool characteristics, colon transit and
anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther
1995;12:639-47.
3. Brandt LJ, Prather CM, Eamonn MM et al. Systematic review on the management of chronic constipation in North
America. Am J Gastroenterol 2005;100:S5-22.
4. Pare P, Bridges R, Champion M et al. Recommendations on chronic constipation (including constipation
associated with irritable bowel syndrome) treatment. Can J Gastroenterol
2007;21(Suppl B):3B-22B
5. Bowles-Jordan, J. Constipation. In: Canadian Pharmacists Association. Patient Self-Care, 2nded. Ottawa, ON: Canadian Pharmacist Association, 2010:262-80.
6. Liu, LWC. Chronic constipation: current treatment options. Can J Gastroenterol
2011;25(Suppl B):22B-28B.
Due to its overall favourable efficacy and safety, psyllium has been recommended widely as the first-line agent in the management of chronic
constipation in the adult population. (4)(5)(6) Although the efficacy of psyllium has only been studied for a short-term, expert opinion and clinical experience suggest that the therapeutic effect of psyllium can be maintained for the long term. (4) Psyllium should not be used in patients with gastrointestinal abnormalities such as bowel or esophegeal obstruction. (5) These patients were excluded from the studies in which the efficacy and safety of psyllium use is unknown. (1)(2) The efficacy and safety of psyllium use in special populations such as infants, children and pregnant women have not been demonstrated. However, expert opinion and some tertiary literatures suggest that its use is
deemed appropriate in these populations. (5)
1. McRorie JW, Daggy BP, Morel JG et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998;12(5):491-7.
2. Ashraf W, Park F, Lof J et al. Effects of psyllium therapy on stool characteristics, colon transit and
anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther
1995;12:639-47.
3. Brandt LJ, Prather CM, Eamonn MM et al. Systematic review on the management of chronic constipation in North
America. Am J Gastroenterol 2005;100:S5-22.
4. Pare P, Bridges R, Champion M et al. Recommendations on chronic constipation (including constipation
associated with irritable bowel syndrome) treatment. Can J Gastroenterol
2007;21(Suppl B):3B-22B
5. Bowles-Jordan, J. Constipation. In: Canadian Pharmacists Association. Patient Self-Care, 2nded. Ottawa, ON: Canadian Pharmacist Association, 2010:262-80.
6. Liu, LWC. Chronic constipation: current treatment options. Can J Gastroenterol
2011;25(Suppl B):22B-28B.