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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:

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]

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]
  • 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)

Distribution

Vd: BHPM: 289 L (after multiple doses) (Friedrich 2011)

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 to 12 hours; Rectal: 0.25 to 1 hour (suppository), 5 to 20 minutes (enema)

Half-Life Elimination

BHPM: ~8 hours (Friedrich 2011)

Use: Labeled Indications

Bowel Cleansing (enema only): Bowel cleansing prior to rectal examination.

Constipation: Temporary relief of occasional constipation and irregularity.

Dosing: Adult

Bowel cleansing (enema only): Rectal: 10 mg (1 enema) as single dose

Constipation:

Oral: 5 to 15 mg once daily

Rectal: Enema, suppository: 10 mg (1 enema or suppository) once daily

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Constipation:

Bowel cleansing (enema only): Children ≥12 years and Adolescents: Rectal: Refer to adult dosing.

Constipation:

Oral:

Manufacturer's labeling:

Children 6 to <12 years: 5 mg once daily

Children ≥12 years and Adolescents: Refer to adult dosing.

Alternate dosing: Limited data available (Tabbers [NASPGHAN/ESPGHAN], 2014):

Children 3 to 10 years: 5 mg once daily

Children >10 years and Adolescents: 5 to 10 mg once daily

Rectal:

Manufacturer's labeling:

Suppository:

Children 6 to <12 years: 5 mg (1/2 suppository) once daily

Children ≥12 years and Adolescents: Refer to adult dosing.

Enema: Children ≥12 years and Adolescents: Refer to adult dosing.

Alternate dosing: Limited data available (Tabbers [NASPGHAN/ESPGHAN] 2014):

Enema, suppository:

Children 2 to 10 years: 5 mg (1/2 suppository) once daily

Children >10 years and Adolescents: 5 to 10 mg (1/2 to 1 enema or suppository) once daily

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

Oral: Administer with water. Swallow tablet whole; do not break, chew, or crush; do not administer within 1 hour of antacids, milk, or dairy products.

Rectal:

Enema: Shake well; remove protective shield, insert tip into rectum with slight side to side movement; squeeze the bottle until nearly all liquid expelled (some liquid will remain in unit after use). Gently remove the unit, a small amount of liquid will remain in unit after use.

Suppository: Remove foil, insert into rectum with pointed end first. Retain in rectum for 15 to 20 minutes.

Dietary Considerations

Tablet: Do not administer within 1 hour of milk, dairy products, or an antacid.

Storage

Oral: Store at 20°C to 25°C (68°F to 77°F); protect from humidity.

Rectal: Store at <30°C (86°F).

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

Warnings/Precautions

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

Other warnings/precautions:

• Appropriate use: Tablets: Do not chew or crush; do not use if you cannot swallow without chewing. Do not administer within 1 hour after taking an antacid, milk, or any dairy products.

• Appropriate use: Enema/Suppositories: For rectal use only, discontinue use and consult a health care provider if rectal bleeding occurs or if no bowel movement is produced after use.

• Self-medication (OTC use): Consult a health care provider prior to use if stomach pain, nausea, vomiting, or a sudden change in bowel movements lasting >2 weeks occurs, or if you have already used a laxative, including bisacodyl, for >1 week. Use may cause stomach discomfort, faintness, rectal burning, and mild cramps. Discontinue use and consult a health care provider if use >1 week is needed.

Pregnancy Considerations

Plasma concentrations of BHPM (the active metabolite of bisacodyl) are low (median: 61 ng/mL; range: 21 to 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, passing out, or severe abdominal pain (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 health care 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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