1736 Gastrointestinal Drugs Espasmogress; Hiosinotil Compuesto†; Hiosultrina-F; Infafren Compuesto; ed by light. Soluble 1 in 0.5 of water and 1 in 5 of alcohol; prac- Ipomoea Resin Neo-Pasmonal; Ortran†; Pasmodil; Pirobutil; Precicol; Prestodol Compues- tically insoluble in ether. pH of a 1% solution in water is about Ipomoea, resina de; Mexican Scammony Resin; Scammony Resin. to; Retodol Compositum; Selpiran; Selpiran Compuesto; Serralpina Com- 5.3. puesta; Viladol Plus; Philipp.: Buscopan Plus; Pol.: Scopolan Compositum; CAS — 9000-34-4. Vegantalgin H; Port.: Buscopan Compositum N; S.Afr.: Buscopan Com- positum; Donnatal; Millerspas; Respinol; Respinol Compound; Scopex Co; Adverse Effects, Treatment, and Precau- Profile Virobis†; Spain: Buscapina Compositum; Midriati; Nolotil Compositum†; Ipomoea is the dried root of Ipomoea orizabensis (Convolvu- Oragalin Espasmolitico; Psico Blocan; Swed.: Spasmofen; Switz.: Nardyl; tions laceae). Ipomoea resin is a mixture of glycosidal resins obtained Thai.: Amcopan Plus; Buscopan Plus; Donnatal†; Pacopan; Spasgone; Uni- As for Atropine Sulfate, p.1219. gan; Turk.: Buscopan Compositum; Molit Plus; Skopolin; Spazmol Plus; from ipomoea and it has a drastic purgative and irritant action. It Tanko-Buskas; Tranko-Buskas; UK: Feminax; USA: Accuhist LA†; AeroHist has been superseded by less toxic laxatives. Plus; AeroKid; AH-chew; Alkabel; AllePak; AlleRx; Antispasmodic Elixir; Bar- Interactions bidonna†; Bellahist-D; Bellatal; Chlor-Mes; Chlor-Mes D; CPM PSE MSC; CPM/PE/MSC; DA Chewable; DA II; Dallergy; Dehistine; Dexphen M; Don- As for antimuscarinics in general (see Atropine Sul- natal; DriHist; Dura-Vent/DA; Durahist; Durahist D; Ex-Histine; Extendryl; fate, p.1220). Extendryl DM; Extendryl PEM; Hista-Vent DA; Histatab D; Histor-D Time- Irsogladine Maleate (rINNM) celles; Hyosophen; Mescolor†; Murocoll-2; Nacon; NoHist Plus; Norel DM; Irsogladine, Maléate d’; Irsogladini Maleas; Maleato de irsogladina; Omnihist LA; Pamine FQ Kit; Pannaz; PCM; Prehist D; PSE MSC; Ralix; Re- Uses and Administration dur-PCM; Relcof PSE; Rescon-MX; Ryneze; Stahist; Susano; Xiral†; Venez.: MN-1695. 2,4-Diamino-6-(2,5-dichlorophenyl)-S-triazine maleate. Brugesina; Buscapina Compositum; Buscapina Plus; Butilamina Compuesta; Hyoscyamine is a tertiary amine antimuscarinic with Ирсогладина Малеат Diezol Compuesto†; Fenopol†; Hioscinol Compuesto†; Sarifan Compues- the actions of atropine (which is racemic hyoscyamine, C H Cl N .C H O = 372.2. to†; Vuscobras. 9 7 2 5 4 4 4 see p.1219); hyoscyamine, the laevo-isomer, has about CAS — 57381-26-7 (irsogladine); 84504-69-8 (irsogla- twice the potency of atropine since the dextro-isomer dine maleate). has only very weak antimuscarinic activity. Hyo- (BAN) Hyoscyamine scyamine is used mainly in the relief of conditions as- Cl Hiosciamina; Hyoscyamin; (−)-Hyoscyamine; l-Hyoscyamine; Hy- sociated with visceral spasm. It has also been given for oscyaminum; Hyoskyamiini. (−)-(1R,3r,5S)-Tropan-3-yl (S)-tro- rhinitis and was formerly used in the treatment of par- N NH2 pate. kinsonism. Cl Гиосциамин Hyoscyamine is given in usual doses of 150 to N N C17H23NO3 = 289.4. 300 micrograms up to four times daily by mouth, but it CAS — 101-31-5. is more usually employed as the sulfate; the hydrobro- NH ATC — A03BA03. mide is also used. Suggested doses of hyoscyamine 2 ATC Vet — QA03BA03. sulfate are 125 to 250 micrograms orally or sublingual- (irsogladine) ly every four hours as needed, up to a maximum of 1.5 mg in 24 hours. Modified-release oral preparations Profile CH 3 of hyoscyamine sulfate are available in some coun- Irsogladine maleate is a cytoprotective drug that is used in the tries; dosage is specific to a particular formulation. Hy- treatment of peptic ulcer disease (p.1702) in a usual oral dose of N 4 mg daily. It has also been investigated for mucositis and mouth oscyamine sulfate has also been given by injection. ulceration. OH Preparations Mucositis. Irsogladine maleate 2 mg twice daily by mouth has 1 USP 31: Hyoscyamine Sulfate Elixir; Hyoscyamine Sulfate Injection; Hyo- been reported to reduce the incidence of aphthous stomatitis in O scyamine Sulfate Oral Solution; Hyoscyamine Sulfate Tablets; Hyoscyamine a small study in patients being treated with methotrexate for Ta bl e t s . rheumatoid arthritis. Proprietary Preparations (details are given in Part 3) 1. Yoshida T, Hirakata M. Therapeutic benefits of irsogladine O Canad.: Levsin†; Denm.: Egazil; Fin.: Egazil†; Fr.: Duboisine†; Hong maleate on aphthous stomatitis induced by methotrexate in rheu- Kong: Levsin; Norw.: Egazil; Swed.: Egazil; USA: A-Spas†; Anaspaz; Cyst- matoid arthritis. J Rheumatol 2003; 30: 2082–3. ospaz; Donnamar; ED-SPAZ; Gastrosed; IB-Stat; Levbid; Levsin; Levsinex; Preparations Description. Hyoscyamine is an alkaloid obtained from vari- Mar-Spas; Neosol; NuLev; Symax. ous solanaceous plants. It is the laevo-isomer of atropine into Multi-ingredient: Austral.: Donnagel; Donnalix; Donnatab; Braz.: Anal- Proprietary Preparations (details are given in Part 3) which it can be converted by heating or by the action of alkali. verin†; Neogrein; Ormigrein; Tropinal; Cz.: Solutan†; Indon.: Aludonna; Jpn: Gaslon N. Feminax; Ital.: Antispasmina Colica; S.Afr.: Donnatal; Millerspas; Switz.: Pharmacopoeias. In US. Nardyl; Thai.: Donnatal†; USA: Accuhist LA†; Alkabel; Antispasmodic Elix- USP 31 (Hyoscyamine). A white crystalline powder. M.p. 106° ir; Atrosept; Barbidonna†; Bellacane; Bellahist-D; Bellatal; Dolsed†; Donna- tal; Hyosophen; MHP-A; MSP-Blu; Phenazopyridine Plus; Prosed/DS; Pyrid- Isopropamide Iodide (BAN, rINN) to 109°. Slightly soluble in water and in benzene; freely soluble ium Plus; Stahist; Susano; Trac Tabs 2X†; Trellium Plus; UAA; Urelief Plus; in alcohol, in chloroform, and in dilute acids; sparingly soluble in Urelle; Uretron; Uridon Modified†; Urimar-T; Urimax; Urised; Uriseptic; Ioduro de isopropamida; Isopropamide, Iodure d’; Isopropamidi ether. Its solutions are alkaline to litmus. Store in airtight contain- UriSym†; Uritact; Uro Blue; Urogesic Blue; Utira. Iodidum. (3-Carbamoyl-3,3-diphenylpropyl)di-isopropylmethyl- ers. Protect from light. ammonium iodide. Изопропамида Йодид Hyoscyamine Hydrobromide (BANM) Indisetron Hydrochloride (rINNM) C23H33IN2O = 480.4. Bromidrato de Hiosciamina; Hiosciamina, hidrobromuro de; Hy- Hidrocloruro de indisetrón; Indisétron, Chlorhydrate d’; Indiset- CAS — 7492-32-2 (isopropamide); 71-81-8 (isopropa- oscyamine Bromhydrate. ron Dihydrochloride; Indisetroni Hydrochloridum; N-3389. N- mide iodide). ATC — A03AB09. endo H Гиосциамина Гидробромид (3,9-Dimethyl- -3,9-diazabicyclo[3.3.1]non-7-yl)-1 -inda- ATC Vet — QA03AB09. C17H23NO3,HBr = 370.3. zole-3-carboxamide dihydrochloride. CAS — 306-03-6. Индисетрона Гидрохлорид ATC — A03BA03. C17H23N5O,2HCl = 386.3. ATC Vet — QA03BA03. CAS — 141549-75-9 (indisetron); 160472-97-9 (indiset- H3C CH3 ron dihydrochloride). Pharmacopoeias. In US. H C USP 31 (Hyoscyamine Hydrobromide). White, odourless, crys- 3 N+ CH 3 − tals or crystalline powder. M.p. not less than 149°. Freely soluble I in water; soluble 1 in 2.5 of alcohol, 1 in 1.7 of chloroform, and H NH2 CH 1 in 2300 of ether. pH of a 5% solution in water is about 5.4. Store O 3 in airtight containers. Protect from light. H O N N CH3 NCH3 N Hyoscyamine Sulfate HN H Hiosciamina, sulfato de; Hiosciamino sulfatas; Hioscyjaminy siarc- Pharmacopoeias. In US. H . A white to pale yellow crystal- zan; Hioszciamin-szulfát; Hyoscyamin sulfát dihydrát; Hyo- USP 31 (Isopropamide Iodide) line powder. Soluble 1 in 50 of water, 1 in 10 of alcohol, and 1 in scyamine, sulfate d’; Hyoscyamine Sulphate (BANM); Hyoscyamini 5 of chloroform; very slightly soluble in ether and in benzene. sulfas; Hyoscyamini Sulfas Dihydricus; Hyoscyaminsulfat; Hyo- Protect from light. scyaminum Sulfuricum; Hyoskyamiinisulfaatti; Iosciamina Solfato. (indisetron) Profile Гиосциамина Сульфат Isopropamide iodide is a quaternary ammonium antimuscarinic (C17H23NO3)2,H2SO4,2H2O = 712.8. Profile with peripheral effects similar to those of atropine (p.1219). It CAS — 620-61-1 (anhydrous hyoscyamine sulfate); 6835- Indisetron is a 5-HT3-receptor antagonist with general properties has been used as an adjunct in the treatment of peptic ulcer dis- 16-1 (hyoscyamine sulfate dihydrate). similar to those of ondansetron (p.1756); it is also stated to be an ease, in the relief of gastrointestinal and urinary-tract disorders ATC — A03BA03. antagonist at 5-HT4 receptors. Indisetron hydrochloride is used associated with smooth muscle spasm, in rhinitis, and for the re- ATC Vet — QA03BA03. as an antiemetic in the management of nausea and vomiting as- lief of symptoms of colds. Pharmacopoeias. In Eur. (see p.vii) and US. sociated with chemotherapy. Isopropamide bromide has been used similarly. Ph. Eur. 6.2 (Hyoscyamine Sulphate). A white or almost white, Preparations crystalline powder or colourless needles. Very soluble in water; USP 31: Isopropamide Iodide Tablets. sparingly soluble or soluble in alcohol. A 2% solution in water Ipomoea has a pH of 4.5 to 6.2. Store in airtight containers. Protect from Proprietary Preparations (details are given in Part 3) light. Ipomoea Root; Mexican Scammony Root; Orizaba Jalap Root; Multi-ingredient: Arg.: Plidex†; Braz.: Ornatrol†; Canad.: Stelabid†; USP 31 (Hyoscyamine Sulfate). A white or almost white, crys- Scammony Root. Ital.: Raffreddoremed; Valtrax; Mex.: Stelabid. talline powder or colourless needles. It is deliquescent and affect- Ипомея Hyoscyamine/Jalap 1737 Ispaghula was fatal.9 In most patients, sensitisation was thought to have oc- Preparations curred during occupational exposure. BP 2008: Ispaghula Husk Effervescent Granules; Ispaghula Husk Granules; Egyiptomi útifu˝mag (ispaghula seed); Egyiptomi útifu˝maghéj (is- 1. Busse WW, Schoenwetter WF. Asthma from psyllium in laxative Ispaghula Husk Oral Powder; paghula husk); Ispaghul, graine d’ (ispaghula seed); Ispaghul manufacture. Ann Intern Med 1975; 83: 361–2. USP 31: Psyllium Hydrophilic Mucilloid for Oral Suspension. (graine d’), tégument de la (ispaghula husk); Ispagula; Ispagula Ka- 2. Gross R. Acute bronchospasm associated with inhalation of psyllium hydrophilic mucilloid. JAMA 1979; 241: 1573–4. Proprietary Preparations (details are given in Part 3) buğu; Ispagulafrö (ispaghula seed); Ispagulafröskal (ispaghula 3. Suhonen R, et al. Anaphylactic shock due to ingestion of psylli- Arg.: Agarol Fibras Naturales†; Agiofibras; Herbaccion Laxante†; Konsyl; husk); Ispagulansiemen (ispaghula seed); Ispagulansiemenkuori um laxative. Allergy 1983; 38: 363–5. Lostamucil; Metamucil; Motional; Mucofalk; Plantaben; Austral.: Agiofibe; (ispaghula husk); Kepek; Kiaušininiu gysločiu se˙klos (ispaghula Ford Fibre; Fybogel; Metamucil; Mucilax†; Natural Fibre†; Austria: Agiocur; ˛ ˛ 4. Zaloga GP, et al. Anaphylaxis following psyllium ingestion. J Laxans; Metamucil; Belg.: Colofiber; Fybogel†; Spagulax; Braz.: Agiofibra; seed); Kiaušininiu˛ gysločiu˛ se˙klu˛ luobele˙s (ispaghula husk); Allergy Clin Immunol 1984; 74: 79–80. Fibracare; Loraga†; Metamucil; Plantaben; Canad.: Laxucil; Metamucil; Mu- Łupina nasienna babki jajowatej (ispaghula husk); Nasienie babki 5. Kaplan MJ. Anaphylactic reaction to “Heartwise”. N Engl J Med cillium; Natural Source Laxative†; Novo-Mucilax; Prodiem Plain†; Chile: jajowatej (ispaghula seed); Osemení jitrocele vejčitého (ispaghula 1990; 323: 1072–3. Euromucil; Fibrasol; Metamucil†; Plantaben; Denm.: Vi-Siblin; Fin.: Agiocur; 6. Lantner RR, et al. Anaphylaxis following ingestion of a psylli- Laxamucil; Vi-Siblin; Fr.: Mucivital; Spagulax; Spagulax Mucilage; Transilane; husk); Plantaginis ovatae semen (ispaghula seed); Plantaginis ova- um-containing cereal. JAMA 1990; 264: 2534–6. Ger.: Agiocur; Flosa; Flosine; Laxiplant Soft†; Metamucil; Mucofalk; Pasco- tae seminis tegumentum (ispaghula husk); Psilio; Semeno 7. Freeman GL. Psyllium hypersensitivity. Ann Allergy 1994; 73: mucil; Hong Kong: Agiocur; Fibermate; Fybogel†; Metamucil; Mucofalk; jitrocele vejčitého (ispaghula seed); Zaragatona. Naturlax; Transilane; India: Isogel; Indon.: Mucofalk; Mulax; Irl.: Fybogel; 490–2. Regulan; Israel: Agiocur; Konsyl; Mucivital†; Planten†; Ital.: Agiofibre; Fi- Шелуха Исфагулы (ispaghula husk) 8. Vaswani SK, et al. Psyllium laxative-induced anaphylaxis, asth- brolax; Planten; Psyllogel; Malaysia: Fybogel; Mucofalk; Mex.: Agiofibra; ma, and rhinitis. Allergy 1996; 51: 266–8. Fibromucil; Finalax; Fybogel; Hormolax; Konsyl†; Metamucil; Mucilag; Mu- Pharmacopoeias. Monographs for the husk and seed are in- 9. Khalili B, et al. Psyllium-associated anaphylaxis and death: a gasin; Novagon; Plantaben; Siludane†; Neth.: Metamucil; Mucofalk; Regucol; cluded in Eur. (see p.vii) and US. case report and review of the literature. Ann Allergy Asthma Im- Volcolon; Norw.: Lunelax; Vi-Siblin; NZ: Isogel; Metamucil; Mucilax; munol 2003; 91: 579–84. Philipp.: Fibermate; Mucofalk; Pol.: Mucofalk; Port.: Agiocur; Laxat; Mu- Ph. Eur. 6.2 (Ispaghula Husk; Plantaginis Ovatae Seminis Tegu- cofalk; Prontolax; Vetilax; S.Afr.: Agiobulk; Agiogel†; Fybogel; Metamucil†; mentum). The episperm and collapsed adjacent layers removed Singapore: Fybogel; Mucilin; Mucofalk; Spain: Biolid; Cenat; Duphafibra; from the seeds of Plantago ovata (P. ispaghula). The powdered Interactions Laxabene; Laxisoft†; Metamucil; Plantaben; Swed.: Lunelax; Vi-Siblin; Switz.: Agiolax mite; Colosoft†; Laxiplant Soft; Metamucil; Mucilar; Val- drug loses not more than 12.0% of its weight on drying. Protect Ispaghula and other bulk-forming laxatives may delay verde regulateur du transit intestinal granules†; Thai.: Agiocur†; Fybogel; from light. or reduce the gastrointestinal absorption of other drugs Metamucil; Mucilin; Mucofalk†; Turk.: Otaci Musillium; UK: Fibrelief; Fybo- Ph. Eur. 6.2 (Ispaghula Seed; Plantaginis Ovatae Semen). The such as cardiac glycosides, coumarin derivatives, lithi- gel; Isogel; Ispagel; Konsyl†; Regulan; USA: Fiberall; Hydrocil Instant; Konsyl; dried ripe seeds of Plantago ovata (P. ispaghula). The powdered Konsyl-D; Metamucil; Mylanta Natural Fiber†; Reguloid; Serutan; Syllact; drug loses not more than 10.0% of its weight on drying. Protect um, or vitamins (such as vitamin B12) and minerals Venez.: Agiofibe; Siliumbran. from light. (such as calcium, iron, or zinc). Intervals of 30 minutes Multi-ingredient: Arg.: Agiolax; Cholesterol Reducing Plan†; Gelax; Isal- USP 31 (Psyllium Husk). The cleaned, dried seed coat (epider- to 1 hour are recommended between ispaghula and ax Fibras; Kronolax†; Medilaxan; Mermelax; Prompt†; Rapilax Fibras; Salu- taris; Austral.: Agiolax; Bioglan Psylli-Mucil Plus; Herbal Cleanse†; Nucolox; mis), in whole or in powdered form, separated by winnowing other drugs or food, although some recommend as PC Regulax†; Austria: Agiolax; Belg.: Agiolax; Spagulax K; Spagulax Sorb- and threshing from the seeds of Plantago ovata (known in com- much as 3 hours between bulk-forming laxatives and itol; Braz.: Agiolax; Parapsyl; Plantax†; Canad.: Prodiem Plus†; Chile: Bi- merce as Blond Psyllium, Indian Psyllium, or Ispaghula), or laxil; Cz.: Agiolax; Fin.: Agiolax; Fr.: Agiolax; Carres Parapsyllium; Filigel; from Plantago arenaria (Plantago psyllium), known in com- other drugs. The dose of insulin may need to be re- Imegul†; Parapsyllium; Spagulax au Citrate de Potassium; Spagulax au Sorb- duced in diabetic patients taking ispaghula. itol; Ger.: Agiolax; Hong Kong: Agiolax; Fybogel Mebeverine†; Irl.: Fybo- merce as Spanish or French Psyllium. gel Mebeverine; Israel: Agiolax; Ital.: Agiolax; Agioslim; Duolaxan†; Fibro- USP 31 (Plantago Seed). The cleaned, dried, ripe seed of Plan- Lithium. For reference to ispaghula possibly reducing the ab- lax Complex; Psyllogel Fermenti; Mex.: Agiolax; Psilumax; Neth.: Agiolax; Norw.: Agiolax; NZ: Nucolox†; Pol.: Agiolax; Laxamix; Otrebuski; Port.: tago ovata, or of Plantago psyllium, or of Plantago indica (P. sorption of lithium, see Gastrointestinal Drugs, p.405. arenaria). Agiolax; Excess†; S.Afr.: Agiolax; Spain: Agiolax; Swed.: Agiolax; Vi-Siblin S; Switz.: Agiolax; Mucilar Avena; Thai.: Agiolax; Turk.: Otaci Diyet Life Uses and Administration Psyllium Plus; UK: Cleansing Herbs; Fibre Dophilus; Fibre Plus; Fybogel Me- Psyllium Hemicellulose (USAN) beverine; Lion Cleansing Herbs; Manevac; USA: Perdiem; Senna Prompt; Ispaghula seed, ispaghula husk, and psyllium seed are Venez.: Agiolax; Avensyl; Fiberfull; Fibralax†; Senokot con Fibra†. CAS — 9034-32-6. bulk laxatives (p.1693). They absorb water in the gas- Pharmacopoeias. In US. trointestinal tract to form a mucilaginous mass which USP 31 (Psyllium Hemicellulose). The alkali soluble fraction of increases the volume of faeces and hence promotes Itopride Hydrochloride (rINNM) the husk from Plantago ovata consisting of highly substituted peristalsis. They are used in the treatment of constipa- arabinoxylan polysaccharides. These polysaccharides are linear HC-803; Hidrocloruro de itoprida; HSR-803; Itopride, Chlorhy- chains of xylose units to which are attached single units of arab- tion (p.1693), especially in diverticular disease drate d’; Itopridi Hydrochloridum. N-{p-[2-(Dimethylamino)eth- inose and additional xylose. Rhamnose, galactose, glucose, and (p.1695) and irritable bowel syndrome (p.1699), and oxy]benzyl}veratramide hydrochloride. rhamnosyluronic acid residues are also present as minor constit- when excessive straining at stool must be avoided, for Итоприда Гидрохлорид uents. It contains not less than 75.0% of dietary soluble fibre, cal- example after anorectal surgery or in the management C H N O ,HCl = 394.9. culated on the dried basis. Store in airtight containers at a temper- of haemorrhoids. The ability to absorb water and in- 20 26 2 4 ature of 25°, excursions permitted between 15° and 30°. CAS — 122898-67-3 (itopride). crease faecal mass means that they may also be used in the management of diarrhoea (p.1694) and for adjust- Psyllium Seed ing faecal consistency in patients with colostomies. O Blešníkové semeno; Bolhafu˝mag; Flea Seed; Loppfrö; Nasienie The usual oral dose is about 3.5 g one to three times płesznika; Psilio, semilla de; Psyllii semen; Psyllium, graine de; Psyl- N CH3 daily, although higher doses have been given. It should H liuminsiemen; Smiltyniniu˛ gysločiu˛ se˙klos. N ATC — A06AC01. be taken immediately after mixing in at least 150 mL O O CH3 water or fruit juice. The full effect may not be achieved ATC Vet — QA06AC01. H3C O for up to 3 days. CH3 Pharmacopoeias. In Eur. (see p.vii). Also in US under the title of Plantago Seed. Ispaghula is also given for mild to moderate hypercho- (itopride) Ph. Eur. 6.2 (Psyllium Seed). The ripe, whole, dry seeds of Plan- lesterolaemia as an adjunct to a lipid-lowering diet. tago afra (P. psyllium) or Plantago indica (P. arenaria). It loses The recommended dose is about 7 g daily. not more than 14.0% of its weight on drying. Protect from light Profile and moisture. Hyperlipidaemias. Preparations of ispaghula have been Itopride hydrochloride is a substituted benzamide with general USP 31 (Plantago Seed). The cleaned, dried, ripe seed of Plan- reported1-4 to lower serum-cholesterol concentrations in patients properties similar to those of metoclopramide (p.1747) that has tago ovata, or of Plantago psyllium, or of Plantago indica (P. with mild to moderate hypercholesterolaemia. They have also been used for its prokinetic and antiemetic actions in oral doses arenaria) (see also Ispaghula, above). been given with reduced doses of a bile-acid binding resin in the of 50 mg three times daily before meals. 5 treatment of hyperlipidaemia, which is reported to be effective ◊ References. and better tolerated than full doses of the resin alone. Similarly, Adverse Effects and Precautions psyllium supplementation with 10 mg of simvastatin was found 1. Holtmann G, et al. A placebo-controlled trial of itopride in func- Large quantities of ispaghula and other bulk laxatives to be as effective in lowering cholesterol as 20 mg of simvastatin tional dyspepsia. N Engl J Med 2006; 354: 832–40. may temporarily increase flatulence and abdominal alone.6 However, ispaghula or psyllium should be regarded as Preparations distension; hypersensitivity reactions have been report- adjuncts to dietary modification rather than substitutes for it. For Proprietary Preparations (details are given in Part 3) a discussion of the hyperlipidaemias and their management, see ed. There is a risk of intestinal or oesophageal obstruc- Cz.: Ganaton; India: Itoprid; Jpn: Ganaton; Malaysia: Ganaton. p.1169. tion and faecal impaction, especially if such com- 1. Anderson JW, et al. Cholesterol-lowering effect of psyllium hy- pounds are taken with insufficient fluid. Therefore, drophilic mucilloid for hypercholesterolemic men. Arch Intern they should always be taken with at least 150 mL of Med 1988; 148: 292–6. Jalap 2. Bell LP, et al. Cholesterol-lowering effects of psyllium hy- water or other liquid. Ispaghula and bulk laxatives drophilic mucilloid: adjunct therapy to a prudent diet for patients Jalap Root; Jalap Tuber; Jalapa; Jalapenwurzel; Vera Cruz Jalap. should not be taken immediately before going to bed with mild to moderate hypercholesterolemia. JAMA 1989; 261: because reduced gastric motility may impair intestinal 3419–23. Ялапа passage and cause obstruction. They should be avoided 3. Anderson JW, et al. Cholesterol-lowering effects of psyllium in- take adjunctive to diet therapy in men and women with hyperc- Jalap Resin by patients who have difficulty swallowing. holesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr 2000; 71: 472–9. Jalapa, resina de; Jalapenharz. Bulk laxatives should not be given to patients with pre- 4. Anderson JW, et al. Long-term cholesterol-lowering effects of existing faecal impaction, intestinal obstruction, or co- psyllium as an adjunct to diet therapy in the treatment of hyper- CAS — 9000-35-5. lonic atony. cholesterolemia. Am J Clin Nutr 2000; 71: 1433–8. Profile 5. Spence JD, et al. Combination therapy with colestipol and psyl- Jalap is the dried tubercles of Ipomoea purga (=Exogonium pur- lium mucilloid in patients with hyperlipidemia. Ann Intern Med Hypersensitivity. Hypersensitivity reactions associated with 1995; 123: 493–9. ga) (Convolvulaceae). Jalap resin is a mixture of glycosidal res- the ingestion or inhalation of ispaghula or psyllium have been ins obtained by extraction of jalap with alcohol and it has a dras- 1-9 6. Moreyra AE, et al. Effect of combining psyllium fiber with sim- reported. Symptoms have included rash, rhinitis, urticaria, vastatin in lowering cholesterol. Arch Intern Med 2005; 165: tic purgative and irritant action. It has been superseded by less bronchospasm, and anaphylactic shock; in one case, anaphylaxis 1161–6. toxic laxatives. The symbol † denotes a preparation no longer actively marketed The symbol ⊗ denotes a substance whose use may be restricted in certain sports (see p.vii)