P. decumbens Forssk.; P. ispaghul Roxb; and others. Plantaginaceae Blond psyllium; Indian psyllium; isabgol; pale psyllium; spogel Plantaginis ovatae seminis tegumentum, Plantaginis ovatae testa (both refer to the husk); Plantaginis ovatae semen (seed) Husk; less often, whole seed Note: Flea (or fleawort) seeds (Psyllii semen), from P. indica L. (syn.: P. psyllium L.; P. arenaria Waldst. & Kit.), P. afra L., and P. orbignyana Steinh. ex Decne., are used for the same conditions and have similar pharmacognostic and phytotherapeutic profiles. The main constituents are water-soluble fibres and mucilages, mainly highly branched acidic arabinoxylan polysaccharides like D-xylose, L-arabinose, rhamnose and D-galacturonic acid (EMA 2013; ESCOP 2003). The husk also contains monoterpene alkaloids (indicaine and plantagonine), phenylethanoids forsythoside and acteoside. Sterols (campesterol, β-sitosterol, stigmasterol) and triterpenes (α- and β-amyrin) are also present (Williamson et al. 2013). In cases of simple and chronic constipation and among the elderly, the use of ispaghula husk is reported to be effective (Ashraf et al. 1997; Cheskin et al. 1995; McRorie et al. 1998). Its use as a bulking agent is well established, but many of the reported studies were only single-blinded. A systematic review on the use comparing non-bulk-forming laxatives (lactulose, lactitol, docusate, magnesium salts and bisocodyl) with fibre (ispaghula and bran) on chronic constipation in adults found that there was little evidence to establish which class of laxative was superior to another. Both improved the symptoms of constipation compared to placebo, with no severe side effects being reported (Tramonte et al. 1997). Similar results were reported by another review on laxative therapies for treatment of chronic constipation in older adults (Fleming and Wade 2010). A study investigating the use of ispaghula after haemorrhoidectomy found that it reduced pain and tenesmus rate and shortened postoperative hospital stay (Kecmanovic et al. 2006). A Cochrane review assessing different strategies for managing faecal incontinence and constipation in patients with neurological disease showed that ispaghula husk increased stool frequency in cases of Parkinson’s disease, but did not alter colonic transit time (Coggrave et al. 2014). No robust conclusions could be drawn as the study included a limited number of patients. Therefore, the role of fibre supplementation in neurogenic bowel management in this type of patients is yet to be determined.
Ispaghula Husk, Psyllium Husk
Plantago ovata Forssk.
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