Ispaghula husk, Sterculia

 Issues for Surgery

Risk of oesophageal or intestinal obstruction if taken immediately before operation (see Further Information).

Risk of constipation if omitted for prolonged period, which may further be exacerbated by medications administered perioperatively e.g. opioids.

  Advice in the Perioperative period

Elective and Emergency Surgery
Omit any dose(s) due on morning of operation (including combination products) – see Further Information.

Combination Products: -

Post-operative Advice
Resume post-operatively, if needed, once enteral intake resumed providing patient is not in a recumbent position and is maintaining adequate fluid intake (e.g., manufacturer of Fybogel® advises each sachet should be reconstituted with 150mL of fluid as inadequate fluid intake can result in oesophageal and intestinal obstruction1).

If concomitant use of opioids or other constipating medications – monitor response to treatment and adjust dose accordingly.

Review if patient develops reduced gastrointestinal motility (e.g., ileus) post-operatively.

Patients undergoing Colorectal Surgery
Review the need for bulk-forming laxatives post-operatively.

  Interaction(s) with Common Anaesthetic Agents

None1, 2, 3, 4,.

  Interaction(s) with other Common Medicines used in the Perioperative Period

None2, 3, 4; however, enteral absorption of concomitantly administered medicines may be delayed by ispaghula husk1. The manufacturer advises ispaghula husk should not be taken for 30-60 minutes before or after intake of other medicinal products to limit this effect1.

  Further Information

Safe Administration
Bulk-forming laxatives swell in contact with water; to prevent oesophageal or intestinal obstruction adequate fluid intake is essential and products should not be taken immediately before bed or if the patient is in a recumbent position1, 3.  


  1. Summary of Product Characteristics – Fybogel® Orange Granules (ispaghula husk). Forum Health Products Limited. Accessed via 05/03/2021 [date of revision of the text December 2020]
  2. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. [Accessed on 5th March 2021]
  3. Summary of Product Characteristics – Normacol® (sterculia). Norgine Limited. Accessed via 05/03/2021 [date of revision of the text December 2020]
  4. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. [Accessed on 5th March 2021]