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Bisacodyl

Pronunciation

Pronunciation

(bis a KOE dil)

Index Terms

  • Doxidan

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Enema, Rectal:

Fleet Bisacodyl: 10 mg/30 mL (37 mL)

Suppository, Rectal:

Bisac-Evac: 10 mg (1 ea, 8 ea, 12 ea, 50 ea, 100 ea, 500 ea, 1000 ea)

Bisacodyl Laxative: 10 mg (12 ea)

Biscolax: 10 mg (12 ea, 100 ea)

Dulcolax: 10 mg (4 ea, 8 ea, 16 ea, 28 ea, 50 ea)

Gentle Laxative: 10 mg (4 ea, 8 ea, 12 ea)

Laxative: 10 mg (12 ea, 100 ea)

The Magic Bullet: 10 mg (10 ea, 12 ea [DSC], 100 ea)

Generic: 10 mg (12 ea, 50 ea, 100 ea)

Tablet Delayed Release, Oral:

Bisac-Evac: 5 mg [DSC] [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Bisacodyl EC: 5 mg

Bisacodyl EC: 5 mg [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]

Bisacodyl EC: 5 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Bisacodyl EC: 5 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, methylparaben, propylparaben, sodium benzoate]

Correct: 5 mg

Ducodyl: 5 mg

Dulcolax: 5 mg [contains fd&c yellow #10 (quinoline yellow), methylparaben, propylparaben, sodium benzoate]

Ex-Lax Ultra: 5 mg [contains fd&c yellow #6 (sunset yellow), methylparaben]

Fematrol: 5 mg [DSC]

Fleet Laxative: 5 mg

Gentle Laxative: 5 mg

Stimulant Laxative: 5 mg

Stimulant Laxative: 5 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Womens Laxative: 5 mg

Womens Laxative: 5 mg [contains fd&c blue #1 aluminum lake, sodium benzoate, tartrazine (fd&c yellow #5)]

Brand Names: U.S.

  • Bisac-Evac [OTC]
  • Bisacodyl EC [OTC]
  • Bisacodyl Laxative [OTC]
  • Biscolax [OTC]
  • Correct [OTC]
  • Ducodyl [OTC]
  • Dulcolax [OTC]
  • Ex-Lax Ultra [OTC]
  • Fematrol [OTC] [DSC]
  • Fleet Bisacodyl [OTC]
  • Fleet Laxative [OTC]
  • Gentle Laxative [OTC]
  • Laxative [OTC]
  • Stimulant Laxative [OTC]
  • The Magic Bullet [OTC]
  • Womens Laxative [OTC]

Pharmacologic Category

  • Laxative, Stimulant

Pharmacology

Stimulates peristalsis by directly irritating the smooth muscle of the intestine, possibly the colonic intramural plexus; alters water and electrolyte secretion producing net intestinal fluid accumulation and laxation

Absorption

Oral, rectal: Systemic, <5% (Wald, 2003)

Metabolism

Bisacodyl is metabolized to an active metabolite (BHPM) in the colon; BHPM is then converted in the liver to a glucuronide salt (Friedrich, 2011)

Excretion

BHPM: Urine, bile (Friedrich, 2011)

Onset of Action

Oral: 6-10 hours; Rectal: 0.25-1 hour; Vd: BHPM: 289 L (after multiple doses) (Friedrich, 2011)

Half-Life Elimination

BHPM: ~8 hours (Friedrich, 2011)

Use: Labeled Indications

Treatment of constipation; colonic evacuation prior to procedures or examination

Contraindications

Hypersensitivity to bisacodyl or any component of the formulation; abdominal pain or obstruction, nausea, or vomiting

Dosage

Children:

Oral: >6 years: 5-10 mg (0.3 mg/kg) at bedtime or before breakfast

Rectal suppository:

<2 years: 5 mg as a single dose

>2 years: 10 mg

Adults:

Oral: 5-15 mg as single dose (up to 30 mg when complete evacuation of bowel is required)

Rectal suppository: 10 mg as single dose

Dosage adjustment in renal impairment: No dosage adjustment provided in manufacturer’s labeling. Use with caution in patients with impaired renal function.

Dosage adjustment in hepatic impairment: No dosage adjustment provided in manufacturer’s labeling.

Administration

Administer tablet with a glass of water on an empty stomach for rapid effect. To protect the enteric coating, tablet should not be administered within 1 hour of milk, any dairy products, or taking an antacid. Do not chew or crush tablets.

Dietary Considerations

To protect the enteric coating, tablet should not be taken within 1 hour of milk, any dairy products, or taking an antacid. Should be administered with a glass of water on an empty stomach for rapid effect.

Storage

Store enteric-coated tablets and rectal suppositories at <30°C.

Drug Interactions

Antacids: May diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Consider therapy modification

Adverse Reactions

<1% (Limited to important or life-threatening): Abdominal cramps (mild), electrolyte disturbance (metabolic acidosis or alkalosis, hypocalcemia), nausea, rectal irritation (burning), vertigo, vomiting

Pregnancy Considerations

Plasma concentrations of BHPM (the active metabolite of bisacodyl) are low (median: 61 ng/mL; range: 21-194 ng/mL) following doses of 10 mg/day for 7 days (Friedrich, 2011). Although not first choice for the treatment of constipation in pregnant women, short-term use of stimulant laxatives is generally considered safe in pregnancy; long-term use should be avoided (Cullen, 2007; Prather, 2004; Wald, 2003).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience abdominal cramps or rectal irritation. Have patient report immediately to prescriber severe dizziness, syncope, or significant dyspepsia (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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