Other Names/Brands

Dulcolax, Custodiol, Laxacod, Laxamex, Laxana, Prolaxan, Stolax.

Mechanism of Action

Bisacodyl is a medicine used to relieve constipation. It is also prescribed by doctors to help empty the bowels before radiological (imaging) examinations or intestinal surgery. Bisacodyl is classified as a stimulant laxative and works by increasing bowel movements, making it easier for stool to be passed.

Indications

Bisacodyl is used in patients with constipation. It may also be given as part of preparation for diagnostic tests, before and after surgery, and if they are indicated in procedures where defecation or bowel emptying is required.

Contraindications

Bisacodyl must not be used in patients with ileus (impaired or absent bowel movement), intestinal obstruction, acute abdominal conditions such as appendicitis, acute inflammatory bowel disease, severe abdominal pain accompanied by nausea and vomiting that may indicate a serious condition, severe dehydration, and known hypersensitivity or allergy to bisacodyl.

Side Effects

The most frequently reported side effects during bisacodyl treatment are abdominal pain and diarrhea. Other possible side effects include:

• Immune system disorders: anaphylactic reactions, angioedema, hypersensitivity reactions

• Metabolic and nutritional disorders: dehydration

• Nervous system disorders: dizziness, syncope or fainting. Dizziness and fainting reported after bisacodyl use are thought to be related to a vasovagal response (for example, due to abdominal cramps and defecation)

• Gastrointestinal disorders: abdominal cramps, abdominal pain, diarrhea, nausea, hematochezia (bloody stools), vomiting, abdominal discomfort, anorectal discomfort, colitis, including ischemic colitis

Preparations

Bisacodyl is available as enteric-coated tablets and as suppositories (medicines inserted into the rectum through the anus).

Dosage

Enteric-coated tablets for constipation:

• Adults and children over 10 years old: 1-2 enteric-coated tablets (5-10 mg) once daily.

   

• Children 6-10 years old: 1 enteric-coated tablet (5 mg) once daily.

   

• Children 10 years old or younger with chronic or persistent constipation should only be treated under a doctor’s supervision.

Directions for use: Tablets are preferably taken at night to stimulate bowel movements the following day. They should be swallowed whole with plenty of water and must not be chewed or crushed. Enteric-coated tablets should not be taken together with products that reduce the acidity of the upper gastrointestinal tract, such as milk, antacids, or proton pump inhibitors, to avoid breaking down the coating too early.

Suppositories for constipation:

• Adults and children over 10 years old: 1 suppository (10 mg) once daily.

• Children 6-10 years old: 1 paediatric suppository (5 mg) once daily.

• Children 10 years old or younger with chronic or persistent constipation should only use suppositories under medical supervision.

Directions for use (suppositories): Suppositories usually work within around 30 minutes. The suppository should be removed from its packaging and inserted fully into the rectum.

For bowel preparation before diagnostic tests, pre and post-surgical treatment, and certain medical conditions, bisacodyl must be used under a doctor’s advise. To achieve complete bowel emptying in adults, the recommended dose is 2-4 enteric-coated tablets taken the evening before the test, followed by 1 suppository the next morning. For children aged 6 years and older, the suggested regimen is 1 tablet at night and 1 paediatric suppository the following morning.

Safety of Drugs

• Pregnancy: There are no adequate data on the safety of bisacodyl use in pregnant women. Clinical experience has not shown clear evidence of harmful effects during pregnancy. However, as with all medications, bisacodyl should only be used during pregnancy on a doctor’s recommendation after considering potential risks and benefits.
• Breastfeeding: Clinical data indicate that bisacodyl is not excreted into breast milk. Therefore, it can generally be used during breastfeeding. Nevertheless, consult a doctor before using this medicine if you are breastfeeding.

Drug Interactions

Concurrent use of bisacodyl with diuretics or adrenocorticosteroids may increase the risk of electrolyte imbalance, especially if bisacodyl is taken in excessive doses. Electrolyte disturbances can in turn increase sensitivity to cardiac glycosides. The combined use of bisacodyl with other laxatives may also enhance gastrointestinal side effects.

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