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Drug overview for COLOX (psyllium husk/laxative combination no.1):
Generic name: psyllium husk/laxative combination no.1
Drug class: Bulk Laxatives
Therapeutic class: Gastrointestinal Therapy Agents
Cellulose derivatives (methylcellulose), malt soup extract, and psyllium preparations are bulk-forming laxatives.
No enhanced Uses information available for this drug.
Generic name: psyllium husk/laxative combination no.1
Drug class: Bulk Laxatives
Therapeutic class: Gastrointestinal Therapy Agents
Cellulose derivatives (methylcellulose), malt soup extract, and psyllium preparations are bulk-forming laxatives.
No enhanced Uses information available for this drug.
DRUG IMAGES
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The following indications for COLOX (psyllium husk/laxative combination no.1) have been approved by the FDA:
Indications:
Constipation
Professional Synonyms:
None.
Indications:
Constipation
Professional Synonyms:
None.
The following dosing information is available for COLOX (psyllium husk/laxative combination no.1):
Bulk-forming laxatives are usually administered 1-3 times daily. To reduce the risk of esophageal obstruction in patients receiving large (e.g., the maximum daily dosage recommended by the manufacturer) dosages of bulk-forming laxatives, these laxatives should be administered in divided doses instead of a single daily dose. The usual dosages for the individual bulk-forming laxatives are below; for dosages in children younger than the ages listed, a physician should be consulted.
Bulk-forming laxatives are administered orally. Commercially available powders, flakes, granules, tablets, and liquids should be dissolved and/or diluted according to the instructions of the manufacturer. In the treatment of constipation, at least one full glass (250 mL) of liquid should be administered with each laxative dose. When used to increase the bulk of stools in patients with chronic, watery diarrhea, one manufacturer suggests that one-third of a glass (80 mL) of liquid be administered with each dose.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for COLOX (psyllium husk/laxative combination no.1):
There are 0 contraindications.
There are 5 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Selected Chemotherapy Agents/Turmeric (Curcumin) SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Curcumin, the major component of turmeric, has been shown to decrease chemotherapy-induced apoptosis by inhibition of reactive oxygen species generation and blockade of the c-Jun NH2-terminal kinase pathway.(1) CLINICAL EFFECTS: Concurrent use of turmeric (curcumin) may decrease the effectiveness of some chemotherapy agents.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients receiving cytotoxic therapy for breast cancer should be excluded from curcumin-based chemotherapy.(1) It would be prudent to instruct patients to avoid or limit consumption of curcumin or turmeric. DISCUSSION: In vitro studies in MCF-7 cancer cell lines showed that curcumin decreased camptothecin-induced, doxorubicin-induced, and mechlorethamine-induced apoptosis. In vivo tests in mice xenograft models of human breast cancer, dietary curcumin decreased cyclophosphamide-induced tumor regression.(1) |
ADRIAMYCIN, CAELYX, CAMPTOSAR, CYCLOPHOSPHAMIDE, CYCLOPHOSPHAMIDE MONOHYDRATE, DOXIL, DOXORUBICIN HCL, DOXORUBICIN HCL LIPOSOME, FRINDOVYX, HYCAMTIN, IRINOTECAN HCL, MECHLORETHAMINE HCL, ONIVYDE, TOPOTECAN HCL |
| Cladribine/Selected Inhibitors of BCRP SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inhibitors of BCRP may increase the absorption of cladribine.(1-2) CLINICAL EFFECTS: The concurrent administration of cladribine with an inhibitor of BCRP may result in elevated levels of cladribine and signs of toxicity.(1-2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of cladribine states concurrent use of BCRP inhibitors should be avoided during the 4- to 5-day cladribine treatment.(1-2) Selection of an alternative concurrent medication with no or minimal transporter inhibiting proprieties should be considered. If this is not possible, dose reduction to the minimum mandatory dose of the BCRP inhibitor, separation in timing of administration, and careful patient monitoring is recommended.(1-2) Monitor for signs of hematologic toxicity. Lymphocyte counts should be monitored. DISCUSSION: Cladribine is a substrate of BCRP. Inhibitors of this transporter are expected to increase cladribine levels.(1-2) BCRP inhibitors linked to this monograph include: capmatinib, clopidogrel, cobicistat, curcumin, danicopan, darolutamide, eltrombopag, elvitegravir, grazoprevir, lazertinib, oteseconazole, pacritinib, ritonavir, roxadustat, tafamidis, ticagrelor, turmeric, and vadadustat.(1-4) |
CLADRIBINE, MAVENCLAD |
| Trofinetide/Laxatives SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Trofinetide commonly causes diarrhea of mild to moderate severity. Laxatives may increase the incidence or severity of diarrhea.(1) CLINICAL EFFECTS: Concurrent use of laxatives with trofinetide may increase the risk of severe diarrhea.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients should stop laxatives before starting trofinetide. If diarrhea occurs, consider anti-diarrheal treatment and monitor hydration status. If severe diarrhea or dehydration occurs, interrupt, reduce dose, or discontinue trofinetide.(1) DISCUSSION: In clinical trials, 85% of patients on trofinetide developed diarrhea. Concurrent use of laxatives may increase this risk.(1) |
DAYBUE |
| Tenapanor/Laxatives; Stool Softeners SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Tenapanor commonly causes diarrhea of mild to moderate severity. Laxatives and stool softeners may increase the incidence or severity of diarrhea.(1) CLINICAL EFFECTS: Concurrent use of laxatives or stool softeners with tenapanor may increase the risk of severe diarrhea.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of tenapanor states that patients should be instructed to avoid stool softeners and laxatives with tenapanor. If severe diarrhea occurs, tenapanor should be discontinued.(1) DISCUSSION: In clinical trials, 43-53% of CKD patients on dialysis treated with tenapanor developed diarrhea. Diarrhea usually occurred soon after treatment initiation and was severe in 5% of patients.(1) |
XPHOZAH |
| Vincristine/P-glycoprotein (P-gp) Inducers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inducers of P-glycoprotein (P-gp) may reduce systemic exposure to vincristine.(1) CLINICAL EFFECTS: Concurrent or recent use of P-gp inducers may result in decreased effectiveness of vincristine.(1) PREDISPOSING FACTORS: Induction effects may be more likely with regular use of the inducer for longer than 1-2 weeks. PATIENT MANAGEMENT: The US manufacturer of vincristine states that concurrent use of P-gp inducers should be avoided.(1) Consider the use of agents with no or minimal induction potential if possible. Monitor patients for decreased response to therapy. DISCUSSION: Vincristine is transported by P-gp and inducers of this transporter are expected to decrease levels of vincristine.(1) Inducers of P-gp include linked to this monograph include: efavirenz, green tea, and lorlatinib.(2,3) |
VINCASAR PFS, VINCRISTINE SULFATE |
There are 3 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Nadolol/Green Tea SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Nadolol is a substrate of OATP1A2, an influx transporter found in intestinal epithelium. Green tea catechins inhibit several drug transporters, including OATP1A2, leading to decreased absorption of nadolol. P-glycoprotein may also be involved, however no studies have confirmed its role. CLINICAL EFFECTS: Concomitant use of nadolol with green tea or green tea catechins may decrease the effectiveness of nadolol.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Advise patients maintained on nadolol to avoid green tea and green tea supplements. DISCUSSION: In a randomized crossover study in 10 healthy subjects, concurrent use of nadolol (30 mg daily) and green tea (700 mL/day), decreased the maximum concentration (Cmax) and area-under-curve (AUC) of nadolol by 85.3% and 85%, respectively. Pharmacodynamic parameters assessed included pulse rate, systolic blood pressure, and diastolic blood pressure. Although all parameters were affected slightly, nadolol's systolic blood pressure lowering effect was significantly suppressed (p = 0.042).(1) |
CORGARD, NADOLOL |
| Migalastat/Caffeine-Containing Products SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The mechanism of this interaction is unknown. CLINICAL EFFECTS: Concurrent use of a caffeine-containing product may result in decreased levels and effectiveness of migalastat.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid coadministration of migalastat with caffeine-containing products. Do not administer caffeine-containing products within 2 hours before and 2 hours after taking migalastat.(1) DISCUSSION: Coadministration of migalastat with caffeine 190 mg decreased the migalastat maximum concentration (Cmax) by 60% and area-under-curve (AUC) by 55%.(1) |
GALAFOLD |
| Clozapine/Bulk Forming Laxatives SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Clozapine has potent anticholinergic properties and inhibits serotonin receptors, including 5-HT3.(1-4) Both of these properties may cause inhibition of gastrointestinal (GI) smooth muscle contraction, resulting in decreased peristalsis.(3,4) If fluid intake is inadequate, bulk forming laxatives can increase the risk of gastrointestinal obstruction.(1-6) CLINICAL EFFECTS: Concurrent use of clozapine and bulk forming laxatives with inadequate fluid intake may increase the risk of constipation (common) and serious bowel complications (uncommon), including complete bowel obstruction, fecal impaction, paralytic ileus and intestinal ischemia or infarction.(1-6) PREDISPOSING FACTORS: The risk for serious bowel complications is higher with increasing age, higher frequency of constipation, and in patients on higher doses of clozapine or multiple anticholinergic agents.(1,5) PATIENT MANAGEMENT: Concurrent use of bulk forming laxatives with clozapine may be used with caution in patients who can maintain adequate fluid intake. Evaluate the patient's bowel function regularly. If patient is unable to maintain adequate fluid intake and use bulk forming laxatives as prescribed, avoid the use of bulk forming laxatives with clozapine.(1-6) Monitor for symptoms of constipation and GI hypomotility, including having bowel movements less than three times weekly or less than usual, difficulty having a bowel movement or passing gas, nausea, vomiting, and abdominal pain or distention.(2) Consider a prophylactic laxative in those with a history of constipation or bowel obstruction.(2) Review patient medication list for anticholinergic agents which may have additive effects on decreased GI motility. When possible, decrease the dosage or number of prescribed anticholinergic agents, particularly in the elderly. Counsel the patient about the importance of maintaining adequate hydration. Encourage regular exercise and eating a high-fiber diet.(2) DISCUSSION: The concurrent use of clozapine and bulk forming laxatives has not been studied. Use of bulk forming laxatives with inadequate fluid intake has been associated with gastrointestinal obstruction. |
CLOZAPINE, CLOZAPINE ODT, CLOZARIL, VERSACLOZ |
The following contraindication information is available for COLOX (psyllium husk/laxative combination no.1):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 4 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Biliary calculus |
| Gallbladder disease |
| Gastrointestinal obstruction |
| Ileus |
There are 1 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Insomnia |
There are 4 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Anxiety disorder |
| Disease of liver |
| Gastroesophageal reflux disease |
| Hypertension |
The following adverse reaction information is available for COLOX (psyllium husk/laxative combination no.1):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 12 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Allergic dermatitis Anaphylaxis Bronchospastic pulmonary disease Conjunctivitis Drug-induced hepatitis Esophageal obstruction Gastrointestinal obstruction Intestinal impaction Pruritus of skin Rhinitis Skin rash Urticaria |
There are 13 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Abdominal distension Abdominal pain with cramps Constipation Diarrhea Dyspepsia Flatulence Gastritis Gastroesophageal reflux disease Nausea Pruritus of skin Tongue discoloration Urticaria Vomiting |
The following precautions are available for COLOX (psyllium husk/laxative combination no.1):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for COLOX (psyllium husk/laxative combination no.1):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for COLOX (psyllium husk/laxative combination no.1)'s list of indications:
| Constipation | |
| K59.0 | Constipation |
| K59.00 | Constipation, unspecified |
| K59.01 | Slow transit constipation |
| K59.03 | Drug induced constipation |
| K59.04 | Chronic idiopathic constipation |
| K59.09 | Other constipation |
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