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Ispaghula

 

Ispaghula is a bulk-forming laxative and is high in both fiber and mucilage. Psyllium seeds contain 10-30% mucilage. The laxative properties of psyllium are due to the swelling of the husk when it comes in contact with water. This forms a gelatinous mass and keeps the feces hydrated and soft. The resulting bulk stimulates a reflex contraction of the walls of the bowel, followed by emptying.This Ayurvedic herb is found in India and Iran.

Species

Family:
Plantago ovata Forsk. (Plantaginaceae).

Synonyms and Part Used

Synonyms
Plantago ovata Forsk. (Plantaginaceae).

Part Used
Seed, husk.

Constituents

Alkaloids
Monoterpene–type. (+)-Boschniakine (indicaine), (+)-boschniakinic acid (plantagonine) and indicainine.

Mucilages
10–30%. Mucopolysaccharide consisting mainly of a highly branched arabinoxylan with a xylan backbone and branches of arabinose, xylose and 2-O-(galacturonic)-rhamnose moieties. Present mainly in the seed husk.

Other constituents
Aucubin (iridoid glucoside), sugars (fructose, glucose, sucrose), planteose (trisaccharide), protein, sterols (campesterol, β-sitosterol, stigmasterol), triterpenes (α- and β-amyrin), fatty acids (e.g. linoleic, oleic,palmitic, stearic), tannins.

Uses

Food Use
In food manufacture, ispaghula may be used as a thickener or stabiliser.

Herbal Use
Ispaghula is stated to possess demulcent and laxative properties. Traditionally, ispaghula has been used in the treatment of chronic constipation, dysentery, diarrhoea and cystitis. Topically, a poultice has been used for furunculosis.This can be used for chronic constipation and disorders in which bowel movements with loose stool are desirable, e.g. patients with anal fistulas, haemorrhoids, pregnancy, secondary medication in the treatment of various forms of diarrhoea and in the treatment of irritable bowel syndrome.

The core SPC (Summary of Product Characteristics) includes the following indications:
(a) treatment of habitual constipation; conditions in which easy defecation with soft stools is desirable, e.g.in cases of painful defecation after rectal or anal surgery;
(b) adjuvant symptomatic therapy in cases of diarrhoea from various causes;
(c) conditions which need an increased daily fibre intake, e.g. as an adjuvant in irritable bowel syndrome.

Dosage
Seeds :
5–10 g (3 g in children) three times daily; 12–40 g per day, husk 4–20 g; 3–5 g.Children 6–12 years, half adult dose. Children under 6 years, treat only under medical supervision.Seeds should be soaked in warm water for several hours before taking.

Liquid extract :
2–4 mL (1 : 1 in 25% alcohol) three times daily.

Husk :
3–5 g.Seeds and husk should be soaked in warm water for several hours before administration.

Pharmacological Actions

The principal pharmacological actions of ispaghula can be attributed to the mucilage component.
In vitro and animal studies
An alcoholic extract lowered the blood pressure of anaesthetised cats and dogs, inhibited isolated rabbit and frog hearts, and stimulated rabbit, rat and guinea–pig ileum.The extract exhibited cholinergic activity.A mild laxative action has also been reported in mice administered iridoid glycosides, including aucubin. Four–week supplementation of a fibre–free diet with isphagula seeds (100 or 200 g/kg) was compared with that of the husks and wheat bran in rats.

The seeds increased faecal fresh weight by up to 100% and faecal dry weight by up to 50%. Total faecal bile acid secretion was stimulated, and β-glucuronidase activity reduced, by ispaghula. The study concluded that ispaghula acts as a partly fermentable, dietary fibre supplement increasing stool bulk, and that it probably has metabolic and mucosa–protective effects.

Ispaghula husk depressed the growth of chickens by 15% when added to their diet at 2%.

Ispaghula seed powder is stated to have strongly counteracted the deleterious effects of adding sodium cyclamate (2%), FD & C Red No. 2 (2%), and polyoxyethylene sorbitan monostearate (4%) to the diet of rats.

Clinical studies

Ispaghula is used as a bulk laxative. The swelling properties of the mucilage enable it to absorb water in the gastrointestinal tract, thereby increasing the volume of the faeces and promoting peristalsis. Bulk laxatives are often used for the treatment of chronic constipation and when excessive straining must be avoided following ano rectal surgery or in the management of haemorrhoids. Ispaghula is also used in the management of diarrhoea and for adjusting faecal consistency in patients with colostomies and in patients with diverticular disease or irritable bowel syndrome.

Laxative effect
Ispaghula increases water content of stools and total stool weight in patients,thus promoting peristalsis and reducing mouth–to–rectum transit time.

The effect of adding water–soluble fibre to a diet low in total fats, saturated fat and cholesterol to treat hypercholesterolaemic children and adolescents has been reviewed.The review summarised that reductions in LDL cholesterol concentrations ranged from 0 to 23%. This wide range may be related to dietary intervention and to clinical trial conditions. It was proposed that additional trials with larger numbers of well–defined subjects are needed.

Hypoglycaemic effect
Several studies have shown that ispaghula husk lowered blood glucose concentrations due to delayed intestinal absorption. In one crossover study, patients with non–insulin–dependent diabetes received ispaghula (Metamucil) or placebo twice (immediately before breakfast and dinner) during each 15–hour crossover phase.For meals eaten immediately after ispaghula ingestion, maximum postprandial glucose elevation was reduced by 14% at breakfast and 20% at dinner.Postprandial serum insulin concentrations measured after breakfast were reduced by 12%, relative to placebo. Second–meal effects after lunch showed a 31% reduction in postprandial glucose elevation, relative to placebo. No significant differences in effects were noted between patients whose diabetes was controlled by diet alone and those whose diabetes was controlled by oral hypoglycaemic drugs. It was concluded that the results indicate that ispaghula as a meal supplement reduces proximate and second–meal postprandial glucose and insulin in non–insulin dependent diabetics.

Other effects
Ispaghula husk has been used to treat small numbers of patients with left–sided diverticular disease.Marked motility was observed for the right colon, but was not as pronounced for the left colon. The effects of ispaghula in this condition may be worth further investigation.

Side–effects, Toxicity
In common with all bulk laxatives, ispaghula may temporarily increase flatulence and abdominal distension, and may cause intestinal obstruction. If swallowed dry, ispaghula may cause oesophageal obstruction. In rare cases, allergic reactions may occur.

Contra–indications, Warnings
In common with all bulk laxatives, ispaghula should not be gven to patients with intestinal obstruction or conditions that may lead to intestinal obstruction, such as spastic bowel conditions. Ispaghula should always be taken with plenty of fluid to avoid oesophageal obstruction or faecal impaction. Bulk laxatives lower the transit time through the gastrointestinal tract and therefore may affect the absorption of other drugs.Absorption of currently administered drugs may be delayed. There may be a need to reduce insulin dosage in diabetics who are insulin dependent.

Interaction with other medicinal products and other forms of interaction Enteral absorption of concomitantly administered medicines such as minerals (e.g. calcium, iron, lithium, zinc), vitamins (B12), cardiac glycosides and coumarin derivatives may be delayed. For this reason the product should not be taken 0.5–1 hour before, or after, intake of other drugs. If the product is taken together with meals in the case of insulin–dependent diabetics, it may be necessary to reduce the insulin dose.

Pregnancy and lactation
Ispaghula may be used during pregnancy and lactation.

Pharmaceutical Comment

The characteristic component of ispaghula is the mucilage which provides it with its bulk laxative action. Many of the herbal uses are therefore supported although no published information was located to justify the use of ispaghula in cystitis or infective skin conditions. Adverse effects and precautions generally associated with bulk laxatives apply to ispaghula. Clinical evidence exists for hypocholesterolaemia effects but it has been recommended that reduction in dietary fat intake is preferable to food supplements.

 

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