From the Guidelines
The most effective alternative to Metamucil for treating constipation is polyethylene glycol (MiraLAX), taken as 17g dissolved in 8oz of water daily, as it has a strong recommendation and moderate certainty of evidence 1.
Alternatives to Metamucil
There are several alternatives to Metamucil for treating constipation, including:
- Fiber supplements like methylcellulose (Citrucel), calcium polycarbophil (FiberCon), or wheat dextrin (Benefiber) which add bulk to stool and draw water into the intestines
- Osmotic laxatives such as polyethylene glycol (MiraLAX) which pull water into the colon to soften stool
- Magnesium supplements like magnesium citrate or milk of magnesia which work osmotically
- Stool softeners such as docusate sodium (Colace) which decrease surface tension of stool to allow water penetration
- Stimulant laxatives like bisacodyl (Dulcolax) or senna (Senokot) for short-term use
Important Considerations
It is essential to note that among the evaluated fiber supplements, only psyllium appears to be effective, with very limited and uncertain data on bran and inulin 1. Adequate hydration should be encouraged with the use of fiber, and flatulence is a commonly observed side effect with the use of fiber 1. Lifestyle modifications, such as drinking 6-8 glasses of water daily, increasing physical activity, establishing a regular bathroom routine, and consuming more dietary fiber through fruits, vegetables, and whole grains, are also crucial in managing constipation.
Recommendations
The American Gastroenterological Association recommends the use of polyethylene glycol (PEG) compared to management without PEG for adults with chronic idiopathic constipation (CIC) 1. A trial of fiber supplement can be considered for mild constipation before PEG use or in combination with PEG 1. Response to PEG has been shown to be durable over 6 months, with side effects including abdominal distension, loose stool, flatulence, and nausea 1. The use of magnesium oxide is suggested over management without magnesium oxide for adults with CIC, with a conditional recommendation and very low certainty of evidence 1. Lactulose, bisacodyl, or sodium picosulphate can also be used as alternatives, but with varying levels of evidence and recommendations 1.
From the FDA Drug Label
Uses ▪ relieves constipation (irregularity) ▪ generally produces a bowel movement in 12 -72 hours USE(S) relieves occasional constipation this product generally produces bowel movement in 12 to 72 hours U ses relieves occasional constipation to help restore and maintain regularity this product generally produces bowel movement in 12 to 72 hours
Alternatives to Metamucil (psyllium husk) for treating constipation are:
- Methylcellulose 2
- Polycarbophil 3
- Calcium polycarbophil 4 These products generally produce a bowel movement in 12 to 72 hours.
From the Research
Alternatives to Metamucil for Treating Constipation
- Other fiber supplements such as calcium polycarbophil and wheat bran can be used as alternatives to Metamucil (psyllium husk) for treating constipation, although their effectiveness may vary 5.
- Loperamide, an anti-diarrheal medication, can also be used to treat fecal incontinence, which is sometimes associated with constipation, and has been compared to psyllium in clinical trials 6.
- Guar gum, a soluble dietary fiber, is another alternative to psyllium that can be used to promote bowel regularity and prevent constipation.
Mechanism of Action
- Psyllium works by sequestering water from liquid stools and increasing the ratio of fecal solids to fecal water, thereby improving stool consistency 5.
- Calcium polycarbophil and wheat bran, on the other hand, do not have the same effect on fecal consistency and viscosity as psyllium 5.
- Loperamide works by slowing down bowel movements and increasing the absorption of water and electrolytes from the gut, thereby reducing the frequency of fecal incontinence episodes 6.
Safety and Efficacy
- Psyllium is generally well-tolerated and safe for long-term use, but can cause esophageal obstruction in rare cases, especially in patients with underlying conditions such as Parkinson's disease 7.
- Loperamide can cause constipation and other adverse effects, especially when used in high doses or for extended periods 6.
- The effectiveness of alternative fiber supplements such as calcium polycarbophil and wheat bran may vary depending on the individual and the specific product used 5.