Ispaghula

Bisacodyl is a stimulant laxative that does not take long to act and is therefore useful in acute constipation. The bulk-forming laxative ispaghula husk takes longer to act when compared with bisacodyl but is useful for long-term administration. Lactulose, which is an osmotic laxative, has a lag time of about 48 hours before onset of action. Loperamide and kaolin and morphine mixture are antidiarrhoeals used in acute diarrhoea. 

Prior, A., and P. J. Whorwell. Double blind study of Ispaghula in irritable bowel syndrome. Gut 1987 28 1510-1513. 

Bulk forming agents Ispaghula, methylcellulose, psyllium... 

Ispaghula is believed to have demulcent and laxative properties. Traditionally, ispaghula has been used in the treatment of chronic constipation, dysentery, diarrhea, and cystitis. It may applied topically as a poultice for furunculosis. 

Plantago ispaghula, or Light Indian Psyllium, is cultivated in India. Seeds are boatshaped, with one end sharper than the other, and grey-brown in colour, A small brown spot is a feature of the convex side. Transparent mucilage surrounds the seeds when kept in water. 

Bulk-forming laxatives (such as ispaghula husk), which work by increasing faecal mass, but they may take several days to become fully effective. They are of most use in those patients that pass small stools and have a diet lacking in fibre (but they should not replace dietary lifestyle measures)... 

Medical treatments of IBS are limited. Laxatives (particularly dietary fibre and bulking laxatives such as ispaghula) and antidiarrhoeals (loperamide and sometimes codeine) are prescribed to manage the symptoms of altered bowel habit. Colestyramine is of use in those with diarrhoea caused by bile salt... 

As Mrs P has been referred to a hospital clinic, it is likely that dietary measures have been tried. Therefore a bulking laxative such as ispaghula may be of benefit. As she suffers from cramping an antimuscarinic antispasmodic such as dicycloverine may be of benefit, although some caution is needed, as it may exacerbate her constipation. 

Certain bulk-forming laxatives, such as ispaghula husk and psyllium, can impair the absorption of lithium (654). 

Plantago seeds are widely used as bulk laxatives under the names of psyllium (from P. psyllium or P. indica) and ispaghula (from P. ovata). The possibility that the intestinal absorption of lithium and other drugs may be inhibited should also be considered (658). 

Aluminium salts Dicyclomine (dicyclovcrine) Ispaghula Procaine... 

Viscous (soluble) fibres, e.g. ispaghula, are effective and more palatable than bran. Ispaghula husk contains mucilage and hemicelluloses which swell rapidly in water. Methylcellulose takes up water to swell to a colloid about 25 times its original volume and sterculia, similarly, swells when mixed with water. 

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