Drug & supplement interaction

Black Psyllium + Saxagliptin, metformin XR

Saxagliptin, metformin XR brand name: Kombiglyze.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Saxagliptin, metformin XR falls into 2 drug categories that Black Psyllium can interact with; the most serious is rated moderate. Theoretically, black psyllium might increase the therapeutic and adverse effects of metformin.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Black Psyllium and Saxagliptin, metformin XR

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Black Psyllium interacts with whole categories of medication. Saxagliptin, metformin XR falls into 2 of those categories, so it can interact with Black Psyllium in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

METFORMIN (Glucophage)

1 of 2
Theoretically, black psyllium might increase the therapeutic and adverse effects of metformin.
Animal research shows that concurrent consumption of blond psyllium with metformin slows and increases the absorption of metformin. This interaction may also occur with black psyllium. To avoid changes in absorption, take psyllium 30-60 minutes after metformin.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Kombiglyze combines saxagliptin with extended-release metformin, both used to lower blood sugar in type 2 diabetes. The interaction we have on file is really about the metformin part. That thick gel psyllium forms in your gut can slow down how metformin gets absorbed, and in animal studies it actually pulled a bit more of it in over time. So in theory you could see a little stronger blood-sugar lowering, along with metformin's usual stomach complaints like nausea, loose stools, or low appetite.

Keep in mind this is based only on animal research, so it is a gentle theoretical concern, not a proven problem. A simple fix is spacing them out: take your Kombiglyze first, then your psyllium about 30 to 60 minutes later, and always with plenty of water. Check with your pharmacist if you have questions.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Diez R, Garcia JJ, Diez MJ, Sierra M, Sahagun AM, Fernandez N. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complement Altern Med. 2017 Jun 7;17(1):298. PubMed
Minor

ORAL DRUGS

2 of 2

Why this applies to Saxagliptin, metformin XR

Saxagliptin, metformin XR falls under ORAL DRUGS — the group Black Psyllium interacts with.

Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Psyllium seems to have variable effects on drug absorption. To avoid changes in absorption, take psyllium 30-60 minutes after oral medications. Animal research shows that blond psyllium delays and increases the absorption of metformin and ethinyl estradiol. Case reports and animal research suggest that blond psyllium might reduce absorption of lithium, digoxin, olanzapine, and carbamazepine. Finally, some pharmacokinetic studies show that psyllium does not affect the absorption of levothyroxine or warfarin. Although many of these studies evaluated blond psyllium, the fiber content in black psyllium may have similar effects.
Severity Minor Likelihood Possible Evidence B

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: black psyllium is a gel-forming fiber, and when it sits in your gut alongside a pill like Kombiglyze (saxagliptin with extended-release metformin), it can change how that medicine gets absorbed. This is mostly a timing issue, not a dangerous one. The research is theoretical and fairly weak, but it suggests fiber can slow down or shift how much metformin your body takes in.

Practically, that could mean your blood sugar control wanders a bit, either running higher or behaving unpredictably. An easy fix is spacing them out: take your Kombiglyze first, then your psyllium about 30 to 60 minutes later, always with plenty of water. Before changing anything, check with your pharmacist or doctor so your diabetes stays on track.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  4. Robinson DS, Benjamin DM, McCormack JJ. Interaction of warfarin and nonsystemic gastrointestinal drugs. Clin Pharmacol Ther 1971;12:491-5. PubMed
  5. Garcia JJ, Fernandez N, Diez MJ, et al. Influence of two dietary fibers in the oral bioavailability and other pharmacokinetic parameters of ethinyloestradiol. Contraception 2000;62:253-7. PubMed
  6. Semen plantaginis in: WHO Monographs on Selected Medicinal Plants, volume 1. World Health Organization, Geneva, 1999. Available at http://apps.who.int/medicinedocs/en/d/Js2200e/. Accessed November 26, 1026.
  7. Diez R, Garcia JJ, Diez MJ, Sierra M, Sahagun AM, Fernandez N. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complement Altern Med. 2017 Jun 7;17(1):298. PubMed
  8. Chiu AC, Sherman SI. Effects of pharmacological fiber supplements on levothyroxine absorption. Thyroid. 1998;8(8):667-71. PubMed
  9. Merrick C, Madden CA, Capurso NA. A Case of Blunted Orally Disintegrating Olanzapine Effect Due to Coadministered Psyllium. J Clin Psychiatry 2021;82(2):20cr13633. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Black Psyllium Also Interacts With Other Medications

Black Psyllium has 22 moderate, 2,002 minor known drug interactions in our database — the Saxagliptin, metformin XR one above is among them. If you take anything else, check it against the full list below.

Moderate 22 Minor 2,002 No known interaction 806 (incl. Saxagliptin, metformin XR)
Taking anything else?

Check Another of Your Medications Against Black Psyllium

Covers the 2,830 medications we’ve checked against Black Psyllium. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Saxagliptin, metformin XR

This page covers Black Psyllium only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Saxagliptin, metformin XR page lists 257 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Siberian Cocklebur (major), Acai (moderate), African Wild Potato (moderate) and Agaricus Mushroom (moderate).

By severity: 2 major · 217 moderate · 38 minor.

From our pharmacist’s overview on the Saxagliptin, metformin XR page

“For Kombiglyze (saxagliptin with metformin XR), this list deserves careful reading, not a skim. Most of the 257 supplements on file lower blood sugar on their own, and stacked on a diabetes drug that extra push can tip into hypoglycemia.”

Reviewed by 2 · Jul 18, 2026

Open the Saxagliptin, metformin XR interaction page

One more smart check

Taking Black Psyllium as Part of a Dietary Supplement Product? Check It for Interactions

We hold 5 real supplement products containing Black Psyllium, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Black Psyllium. Your product may carry other ingredients that interact with Saxagliptin, metformin XR too, on top of Black Psyllium — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Black Psyllium and Saxagliptin, metformin XR Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Black Psyllium
Top half

#373 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Saxagliptin, metformin XR
Top 5%

#128 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Black Psyllium

What is Black Psyllium?

Black Psyllium
  • Constipation
  • Diarrhea
  • High cholesterol
  • Digestive health
  • Blood sugar support
  • Weight management

Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. It is best known and most studied for relieving constipation and may modestly help lower cholesterol, but it must always be taken with plenty of water. Talk with your pharmacist or doctor before starting, especially if you have swallowing problems or bowel disorders.

Read the full Black Psyllium monograph & all interactions
Keep checking

Other Drugs & Black Psyllium

Browse every other medication we’ve checked against Black Psyllium — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
22Moderate
2,002Minor
805No known interaction
22 Moderate 2,002 Minor 805 No interaction
Moderate

22 interactions

Minor

2,002 interactions

Showing 60 of 2,002 minor interactions — see all 2,002 on the Black Psyllium page.

No interaction 805 drugs checked — show the list

We also checked Black Psyllium against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 805 medications checked with no known interaction — see the full Black Psyllium list.

See the full Black Psyllium interactions page
See every supplement checked against Saxagliptin, metformin XR, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Black Psyllium monograph › Uses, safety, and every drug interaction in one place Saxagliptin, metformin XR supplement interactions › Every supplement checked against Saxagliptin, metformin XR, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Black Psyllium and Saxagliptin, metformin XR Together: Common Questions

Can you take Black Psyllium with Saxagliptin, metformin XR?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Black Psyllium and Saxagliptin, metformin XR?
Saxagliptin, metformin XR belongs to more than one drug category, and Black Psyllium interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Black Psyllium and Saxagliptin, metformin XR interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.