Bisacodyl is a Stimulant Laxative. The physiologic effect of bisacodyl is by means of Increased Large Intestinal Motility, and Stimulation Large Intestine Fluid/Electrolyte Secretion. Bisacodyl is commonly used, an over-the-counter laxative used to treat constipation or bowel irregularity. Bisacodyl has not been associated with serum enzyme elevations during therapy or with a clinically apparent liver injury with jaundice.
Mechanism of Action of Bisacodyl
Bisacodyl is hydrolyzed by intestinal brush border enzymes and colonic bacteria to form an active metabolite [bis-(p-hydroxyphenyl) pyridyl-2 methane; (BHPM)] that acts directly on the colonic mucosa to produce colonic peristalsis. Bisacodyl is a synthetic pyridinylmethylene-diacetate ester derivative stimulant laxative, Bisacodyl acts with a parasympathetic effect directly on mucosal sensory nerves, increasing peristaltic contractions. It is used for occasional constipation, in pre- and postoperative treatment, and in conditions that require facilitation of defecation. (NCI04)
Indications of Bisacodyl
- Indicated for cleansing of the colon as a preparation for colonoscopy in adults.
- Bisacodyl is commonly used, an over-the-counter laxative used to treat constipation or bowel irregularity. Bisacodyl has not been associated with serum enzyme elevations during therapy or with a clinically apparent liver injury with jaundice.
- Constipation
- Bowel preparation therapy
- Occasional Constipation
- Chronic idiopathic constipation
- Opioid-induced constipation
- Constipation, drug-induced
- Improve symptoms such as bloating and abdominal discomfort
Therapeutic Uses
- Oral bulk-forming, lubricant, and stool softener laxatives are indicated prophylactically in patients who should not strain during defecation, such as those with an episiotomy wound, painful thrombosed hemorrhoids, fissures or perianal abscesses, body wall and diaphragmatic hernias, anorectal stenosis, or postmyocardial infarction.
- Oral laxatives are indicated for the short-term relief of constipation. Oral bulk-forming laxatives, stimulant laxatives, and carbon dioxide-releasing suppositories are indicated to facilitate defecation in geriatric patients with a diminished colonic motor response.
- Bisacodyl is useful as a laxative for the occasional relief of constipation and in bowel cleansing preparation for x-ray or endoscopic examination. Bisacodyl may be used as a laxative in postoperative, antepartum, or postpartum care or in preparation for delivery
- In severe cases of constipation, such as with fecal impaction, mineral oil and stool softener laxatives administered orally or rectally are indicated to soften the impacted feces. To help complete the evacuation of the impacted colon, a rectal stimulant or saline laxative may follow.
Contraindications of Bisacodyl
- Structured data covering drug contraindications. Each contraindication describes a scenario in which the drug is not to be used. Includes restrictions on co-administration, contraindicated populations, and more.
- Appendicitis
- Stomach or intestine blockage
- Unable to Control Bowel Movement
- Hypersensitivity to the active substance or to any of the excipients
- Bowel obstruction,
- Inflammatory bowel disease
- Intestinal obstruction disorders
- Acute surgical abdomen
- Diarrhea-predominant irritable bowel syndrome.
- Ischemic bowel syndrome
- Allergies to Bisacodyl
Dosage of Bisacodyl
Strengths: 5 mg; 10 mg
Constipation
Oral:
- TABLET: 5 to 15 mg orally once a day as needed
- Duration of therapy: Up to 1 week
Rectal: Enema
- 10 mg rectally once a day as needed
Suppository
- 10 mg (1 suppository) rectally once a day as needed
- Duration of therapy: Up to 1 week
Bowel Preparation
Oral: Tablet
- 5 to 15 mg orally once a day as needed
- Duration of therapy: Up to 1 week
Rectal: Enema
- 10 mg rectally once a day as needed
Suppository
- 10 mg (1 suppository) rectally once a day as needed
- Duration of therapy: Up to 1 week.
Pediatric
Constipation
Oral:
- Under 6 years: Dose adjustment(s) may be required; however, no specific guidelines have been suggested.
- 6 to less than 12 years: 5 mg orally once a day as needed
- 12 years and older: 5 to 15 mg orally once a day as needed
- Duration of therapy: Up to 1 week
Rectal: Enema
- Under 12 years: Not recommended.
- 12 years and older: 10 mg rectally once a day as needed
- Duration of therapy: Up to 1 week
SuppositoryUnder 6 years:
- 6 to less than 12 years: 5 mg (0.5 suppository) rectally once a day as neede
- 12 years and older: 10 mg (1 suppository) rectally once a day as needed
- Duration of therapy: Up to 1 week
Bowel Preparation
Oral: Tablet
- Under 6 years: Dose adjustment(s) may be required; however, no specific guidelines have been suggested.
- 6 to less than 12 years: 5 mg orally once a day as needed
- 12 years and older: 5 to 15 mg orally once a day as needed
- Duration of therapy: Up to 1 week.
Rectal: Enema
- Under 12 years: Not recommended.
- 12 years and older: 10 mg rectally once a day as needed
- Duration of therapy: Up to 1 week
Suppository
- Under 6 years: 6 to less than 12 years: 5 mg (0.5 suppositories) rectally once a day as needed
- 12 years and older: 10 mg (1 suppository) rectally once a day as needed
- Duration of therapy: Up to 1 week.
Side Effects of Bisacodyl
The most common
- Abdominal discomfort, anorectal discomfort, blood in stool/ hematochezia, vomiting
- Abdominal pain
- Allergic reaction or hypersensitivity (e.g., rash, hives, or itching)
- Abdominal spasm, colic, cramps/cramping, defecation, epigastralgia, proctitis, stomach discomfort, tenesmus
- Changes in electrolyte balance (e.g., numbness, skin tingling, muscle spasms, rapid heartbeat, muscle weakness, tremors)
- Diarrhea
- Dyspnea
- Nausea
- Diarrhea (that is not severe)
- Heartburn
- Vomiting
- Dry mouth
- A runny nose
- A cough
- Dizziness
- A headache
- Joint pain
- Back pain
- Trouble sleeping
More common
- Abdominal discomfort, anorectal discomfort, blood in stool/ hematochezia, vomiting
- blood in the stool
- rectal discomfort or pain
- symptoms of an allergic reaction (e.g., rash, itching)
- symptoms of irritation of the intestines (e.g., severe abdominal cramping, diarrhea)
- symptoms of a severe allergic reaction (e.g., hives, swelling of the face or throat)
- Diarrhea
- full or bloated feeling or pressure in the stomach
- a headache, severe and throbbing
- joint or back pain
- muscle aching or cramping
- muscle pains or stiffness
- chest pressure or squeezing pain in the chest
- excessive sweating
- sudden drowsiness or need to sleep
- coughing up blood
- liver problems–nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
- decreased amount of urine
Rare
- Anxiety
- Abdominal spasm,
- defecation, epigastralgia,
- proctitis, stomach discomfort, tenesmus
- change in vision
- chest pain or tightness
- confusion
- a cough
- Agitation
- arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- convulsions
- hallucinations
- a headache
- irritability
- lightheadedness
- cold and clammy skin
- fast and shallow breathing
- swelling of your feet, legs, or hands purple spot on your skin caused by internal bleeding
- fast or abnormal heart rate or palpitations
- loss of appetite
- lower back, side, or stomach pain
- mental depression
- muscle pain or cramps
- yellowing of your skin or the whites of your eyes
- upper stomach pain
Drug Interactions of Bisacodyl
Do not take other medications 2 hours before or 2 hours after taking bisacodyl tablets. Bisacodyl tablets may reduce the effectiveness of other medications.
may interact with following drugs, supplements, & may change the efficacy of the drug
- antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
- Aspirin Low Strength (aspirin)
- lorazepam
- diphenhydramine
- ondansetron
- corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
- digoxin
- diuretics (e.g., furosemide, hydrochlorothiazide)
- H2-antagonists (e.g., ranitidine, cimetidine)
- milk
- proton pump inhibitors (PPIs; e.g., omeprazole, pantoprazole)
- birth control pills
- bisphosphonates (e.g., alendronate, etidronate, risedronate)
- Others bulk-forming laxatives (e.g., psyllium, sodium picosulfate)
- calcitriol
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- calcium polystyrene sulfonate
- iron preparations and supplements
- levothyroxine
- medications are taken by mouth
- medications that affect water or electrolyte balance (e.g., diuretics, corticosteroids)
- medications that cause constipation (e.g., opioids, cholinergic)
- multivitamins with fluoride
- mycophenolate
- nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, naproxen)
- oral contraceptives
- phosphate supplements
- raltegravir
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, sertraline)
Pregnancy Category
FDA Pregnancy Risk Category: B
Pregnancy
- This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding
- This medication does not pass into breast milk. It is therefore considered safe to use while breast-feeding. The safety and effectiveness of this medication have not been established for children less than 6 years old. Do not give this medication to children unless recommended by your doctor.
References
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