Mebeverine with ispaghula husk

How it works

Mebeverine relaxes intestinal smooth muscle to relieve spasm, while ispaghula husk is a soluble fibre that absorbs water to increase faecal bulk and normalise stool consistency and transit.

Prescribing in practice

• Ispaghula must be taken with plenty of fluid and avoided in patients with intestinal obstruction, faecal impaction or difficulty swallowing, as inadequate fluid can cause oesophageal or bowel obstruction.
• Mebeverine is contraindicated in paralytic ileus; the bulking component should not be taken immediately before lying down or going to bed.
• Bulk-forming fibre may reduce absorption of some co-administered oral drugs, so timing should be considered.

Monitoring

No routine laboratory monitoring is needed; assess bowel habit and symptom response and reconsider the diagnosis if alarm features arise.

Counselling the patient

• Take each dose with a full glass of water and not right before bedtime.
• It may take a little time to settle your bowel pattern; keep up your fluid intake.
• Report worsening pain, swallowing difficulty, bleeding or weight loss.

Evidence & guidelines

NICE supports soluble fibre such as ispaghula and antispasmodics in irritable bowel syndrome, while advising against insoluble bran, which can worsen symptoms.