1.6.1 Bulk-forming laxatives

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over-the-counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is infrequent constipation.

Many laxatives are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Ispaghula husk
  • Granules 3.5g/sachet (£2.73 = 30 sachets)



  • One sachet twice daily, with at least 150ml of water


  1. Time to effect: 2-3 days
  2. Useful as a first-line choice in adults when it is difficult to get enough fibre in the diet. Better tolerated than bran
  3. Must not be taken immediately before bed.

Adequate fluid intake is important, to prevent intestinal obstruction. This may be difficult for the frail or fluid restricted patients.


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