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Finely ground bran,
though more palatable,
has poorer
water-retaining properties,
but
can be taken as bran
bread or biscuits in appropriately increased quantities.
Oat bran is also used.
Methylcellulose, ispaghula, and sterculia are useful in
patients who cannot tolerate bran. Methylcellulose also
acts as a faecal softener.
ISPAGHULA HUSK
Indications
see notes above
Cautions
adequate fluid intake should be maintained
to avoid intestinal obstruction—it may be necessary
to supervise elderly or debilitated patients or those
with intestinal narrowing or decreased motility
Contra-indications
difficulty in swallowing,
intestinal
obstruction,
colonic atony,
faecal impaction
Side-effects
flatulence,
abdominal distension, gastro-
intestinal obstruction or impaction;
hypersensitivity
reported
Dose
. See preparations below
Counselling
Preparations that swell
in contact with liquid
should always be carefully swallowed with water and should
not be taken immediately before going to bed
Fibrelief
c
(Manx)
Granules
,
sugar- and gluten-free,
ispaghula husk
3.5 g/sachet (natural or orange flavour),
net price 10
sachets = £1.23,
30 sachets = £2.07.
Label:
13, coun-
selling,
see above
Excipients
include aspartame (section 9.4.1)
Dose
ADULT and CHILD over 12 years, 1–6 sachets daily in water
in 1–3 divided doses, preferably after meals
Fybogel
c
(Reckitt Benckiser)
Granules
,
buff, effervescent,
sugar- and gluten-free,
ispaghula husk 3.5 g/sachet (low Na
+
),
net price 30
sachets (plain,
lemon,
or orange flavour) = £1.84.
Label:
13,
counselling,
see above
Excipients
include aspartame 16 mg/sachet (see section 9.4.1)
Dose
1 sachet or 2 level 5-mL spoonfuls in water twice daily
preferably after meals;
CHILD (but see section 1.6) 2–12 years ½–1
level 5-mL spoonful in water,
twice daily preferably after meals
(
CHILD 2–6 years on specialist practitioner’s advice only)
Isogel
c
(Potters)
Granules
,
brown,
sugar- and gluten-free,
ispaghula
husk 90%.
Net price 200 g = £2.67.
Label:
13,
coun-
selling,
see above
Dose
constipation, 2 level 5-mL spoonfuls in water once or twice
daily,
preferably at mealtimes;
CHILD (but see section 1.6) 2–12
years,
1 level 5-mL spoonful in water once or twice daily,
pre-
ferably at mealtimes
Diarrhoea (section 1.4.1),
1 level 5-mL spoonful
3 times daily
Note
May be difficult to obtain
Ispagel Orange
c
(LPC)
Granules
,
beige, effervescent, sugar- and gluten-free,
ispaghula husk 3.5 g/sachet,
net price 30 sachets =
£2.10.
Label:
13, counselling,
see above
Excipients
include aspartame (section 9.4.1)
Dose
1 sachet in water 1–3 times daily,
preferably after meals;
CHILD (but see section 1.6) 2–12 years see
BNF for Children
Regulan
c
(Procter & Gamble)
Powder
, beige, sugar- and gluten-free, ispaghula husk
3.4 g/5.85-g sachet (orange or lemon/lime flavour).
Net price 30 sachets = £2.44.
Label:
13, counselling,
see above
Excipients
include aspartame (section 9.4.1)
Dose
1 sachet in 150 mL water 1–3 times daily,
preferably after
meals;
CHILD (but see section 1.6) 2–6 years, see
BNF for
Children
; 6–12 years 2.5–5 mL in water 1–3 times daily, preferably
after meals
METHYLCELLULOSE
Indications
see notes above
Cautions
see under Ispaghula Husk
Contra-indications
see under Ispaghula Husk; also
infective bowel disease
Side-effects
see under Ispaghula Husk
Dose
. See preparations below
Counselling
Preparations that swell
in contact with liquid
should always be carefully swallowed with water and should
not be taken immediately before going to bed
Celevac
c
(Amdipharm)
Tablets
,
pink,
scored,
methylcellulose ‘450’
500 mg,
net price 112-tab pack = £3.22. Counselling, see above
and dose
Dose
constipation and diarrhoea,
3–6 tablets twice daily;
in
constipation the dose should be taken with at least 300 mL liquid;
in diarrhoea, ileostomy, and colostomy control, avoid liquid intake
for 30 minutes before and after dose;
CHILD 7–12 years see
BNF
for Children
STERCULIA
Indications
see notes above
Cautions
see under Ispaghula Husk
Contra-indications
see under Ispaghula Husk
Side-effects
see under Ispaghula Husk
Dose
. See under preparations below
Counselling
Preparations that swell
in contact with liquid
should always be carefully swallowed with water and should
not be taken immediately before going to bed
Normacol
c
(Norgine)
Granules
,
coated,
gluten-free,
sterculia 62%.
Net
price 500 g = £5.94;
60 7-g sachets = £4.99.
Label:
25,
27,
counselling,
see above
Dose
1–2 heaped 5-mL spoonfuls, or the contents of 1–2 sachets,
washed down without chewing with plenty of liquid once or twice
daily after meals;
CHILD (but see section 1.6) 6–12 years half adult
dose
Normacol Plus
c
(Norgine)
Granules
,
brown,
coated, gluten-free,
sterculia 62%,
frangula (standardised) 8%.
Net price 500 g = £6.34;
60 7 g sachets = £5.34.
Label:
25,
27,
counselling,
see above
Dose
constipation and after haemorrhoidectomy, 1–2 heaped 5-
mL spoonfuls
or
the contents of 1–2 sachets washed down with-
out chewing with plenty of liquid once or twice daily after meals;
CHILD 6–12 years see
BNF for Children
1.6.2
Stimulant laxatives
Stimulant laxatives include bisacodyl, sodium picosul-
fate, and members of the anthraquinone group, senna
and dantron.
The indications for dantron are limited
(see below)
by its potential
carcinogenicity (based on
rodent
carcinogenicity studies)
and evidence of
geno-
toxicity. Powerful stimulants such as cascara (an anthra-
quinone) and castor oil are obsolete. Docusate sodium
probably acts both as a stimulant
and as a softening
agent.
Stimulant laxatives increase intestinal motility and often
cause abdominal
cramp;
they should be avoided in
intestinal
obstruction.
Excessive use of
stimulant laxa-
tives can cause diarrhoea and related effects such as
hypokalaemia;
however,
prolonged use may be justifi-
able in some circumstances (see section 1.6 for the use
of stimulant laxatives in children).
68
1.6.2 Stimulant laxatives
BNF 61
1
Gastro-intestinal system