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J Clin Endocrinol Metab 76:912917 Deacon CF, Nauck MA, Toft-Nielsen M et al

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[1] When to seek medical advice: Persistent abdominal pain or difficulty swallowing No bowel movement within three days of starting ispaghula Unexplained weight loss or rectal bleeding Signs of allergic reaction (rash, itching, swelling, difficulty breathing) Patients should consult their GP or pharmacist before starting ispaghula, especially if they have pre-existing medical conditions or are taking multiple medications