Bisacodyl


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Constipation 5-10 mg daily before bedtime. Max: 20 mg. Bowel evacuation For preparation of diagnostic procedures and in pre- and postoperative treatment: 10 mg in the morning and evening, followed by 10 mg rectal supp/enema on the following morning. Rectal Constipation As supp or enema: 10 mg daily.
Dosage Details
Oral
Bowel evacuation
Adult: For preparation of diagnostic procedures and in pre- and postoperative treatment: 10 mg for 2 doses given in the morning and evening, followed by 10 mg rectal supp/enema on the following morning.
Child: >4-10 years 5 mg in the evening followed by 5 mg rectal supp on the following morning; >10 years Same as adult dose.

Oral
Constipation
Adult: 5-10 mg once daily before bedtime. Max: 20 mg.
Child: >4-10 years 5 mg once daily before bedtime; >10 years Same as adult dose.

Rectal
Constipation
Adult: As supp or enema: 10 mg daily preferably in the morning.
Child: >4-10 years As supp: 5 mg daily preferably in the morning; >10 years Same as adult dose.
Administration
Should be taken on an empty stomach. Do not take w/in 1 hr of antacids, milk or other dairy products.
Contraindications
Severe dehydration, ileus, intestinal obstruction, acute abdominal conditions (e.g. appendicitis, acute inflammatory bowel disease, severe abdominal pain). Rectal: Anal fissures, proctitis or ulcerated haemorrhoids.
Special Precautions
Patient with inflammatory bowel disease. Renal impairment. Children. Pregnancy and lactation. Avoid prolonged use (>5 days).
Adverse Reactions
Significant: Fluid and electrolyte imbalance e.g. metabolic acidosis or alkalosis, hypocalcaemia, hypokalaemia (prolonged use).
Gastrointestinal disorders: Abdominal pain, bloody diarrhoea, nausea, abdominal cramps, haematochezia, vomiting, abdominal discomfort, anorectal discomfort, rectal burning (suppository). Rarely, colitis.
Metabolism and nutrition disorders: Rarely, dehydration.
Nervous system disorders: Dizziness.
Patient Counseling Information
This drug may cause dizziness or syncope, if affected, do not drive or operate machinery.
Overdosage
Symptoms: Watery stools, abdominal cramps, fluid and electrolytes loss. Chronic case: Chronic diarrhoea, abdominal pain, hypokalaemia, secondary hyperaldosteronism, renal calculi, renal tubular damage, metabolic alkalosis, muscle weakness. Management: Perform gastric lavage or induce vomiting to minimise absorption. Fluid replacement and correction of electrolyte imbalance may be required.
Drug Interactions
High dose of bisacodyl may increase the risk of electrolyte imbalance with concomitant use of diuretics or adrenocorticosteroids. Enhanced gastrointestinal adverse effects with concomitant use of other laxatives. Decreased therapeutic effect and increased risk of dyspepsia and gastric irritation with antacids.
Food Interaction
Increased risk of dyspepsia and gastric irritation with milk products.
Action
Description: Bisacodyl, a diphenylmethane derivative, directly irritates the smooth muscle of the intestine, possibly the colonic intramural plexus, thereby stimulating peristalsis. It alters water and electrolyte secretion, producing net intestinal fluid accumulation and stimulates defaecation.
Onset: Laxative effect: 6-12 hours (oral); within 15-60 minutes (suppository); within 5-20 minutes (enema).
Pharmacokinetics:
Absorption: Systemic absorption: <5%.
Distribution: Volume of distribution: 289 L (active metabolite).
Metabolism: Metabolised in the colon to active metabolite, bis-(-p-hydroxyphenyl)-pydidyl-2-methane (BHPM), and further metabolised in the liver to a glucuronide salt.
Excretion: Via urine, bile (as BHPM). Elimination half-life: Approx 8 hours (BHPM).
Chemical Structure

Chemical Structure Image
Bisacodyl

Source: National Center for Biotechnology Information. PubChem Database. Bisacodyl, CID=2391, https://pubchem.ncbi.nlm.nih.gov/compound/Bisacodyl (accessed on Jan. 21, 2020)

Storage
Oral: Store between 20-25°C. Protect from humidity. Rectal: Store below 30°C.
ATC Classification
A06AB02 - bisacodyl ; Belongs to the class of contact laxatives.
References
Anon. Bisacodyl. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/10/2019.

Bisacodyl Enema (C.B. Fleet Company, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/10/2019.

Bisacodyl Enteric Coated Tablet (Major Pharmaceuticals). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/05/2016.

Bisacodyl Suppository (Pharmacy Value Alliance LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/10/2019.

Buckingham R (ed). Bisacodyl. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/10/2019.

Dulcolax Tablet (Boehringer Ingelheim Pharmaceuticals, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/10/2019.

Joint Formulary Committee. Bisacodyl. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/05/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Bisacodyl. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 19/05/2016.

Disclaimer: This information is independently developed by MIMS based on Bisacodyl from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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