Limitations: This safety classification applies only to preparations containing a combination of ispaghula and senna glycosides. The same ATC-code (A06AC51) may in some countries be used for different combinations of ispaghula and other drugs which in theory may be porphyrinogenic. Please refer to the classification and monograph of each individual substance. If the combination contains a substance which is not classified (NC) or has been classified as porphyrinogenic (PRP or P), the safety classification of such a combination as PNP is no longer valid. Ispaghula and the senna constituents have no significant systemic exposure. There are no pharmacodynamic or physiological effects of relevance to acute porphyria.

Ispaghula, combination is used for treatment of constipation by increasing intestinal faecal volume and stimulating peristalsis. Adverse reactions that may be confused for porphyria symptoms include abdominal dicomfort and discoloration of urine.

Neither ispaghula nor the senna constituents are dependent of systemic absorption to exert their mode of action. Ispagula works as a bulking agent by absorption of water and by increasing the bacterial cell mass. The sennosides is not absorbed in the small intestine, but is converted by bacteria in the large intestine releasing the active anthrone fraction. This stimulates peristalsis.