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Pronunciation
(bis a KOE dil)
Generic Available (U.S.)
Yes: Excludes enema
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of constipation; colonic evacuation prior to procedures or examination
Pregnancy Risk Factor
C
Breast-Feeding Considerations
Neither bisacodyl nor its active metabolite (BHPM) were detectable in breast milk following administration of bisacodyl 10 mg once daily for 7 days to eight lactating women (limit of detection: 1 ng/mL) (Friedrich, 2011).
Contraindications
Hypersensitivity to bisacodyl or any component of the formulation; abdominal pain or obstruction, nausea, or vomiting
Adverse Reactions
<1%:
Central nervous system: Vertigo
Endocrine & metabolic: Electrolyte and fluid imbalance (metabolic acidosis or alkalosis, hypocalcemia)
Gastrointestinal: Mild abdominal cramps, nausea, vomiting, rectal burning
Metabolism/Transport Effects
None known.
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. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Food: Milk or dairy products may disrupt enteric coating, increasing stomach irritation.
Mechanism of Action
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
Pharmacodynamics/Kinetics
Onset of action: Oral: 6-10 hours; Rectal: 0.25-1 hour
Vd: BHPM: 289 L (after multiple doses) (Friedrich, 2011)
Half-life: BHPM: ~8 hours (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)
Absorption: Oral, rectal: Systemic, <5% (Wald, 2003)
Excretion: BHPM: Urine, bile (Friedrich, 2011)
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
Administration: Oral
Administer 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.
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.
Geriatric Considerations
The chronic use of stimulant cathartics is inappropriate and should be avoided; although constipation is a common complaint from elderly, such complaints require evaluation; elderly are often predisposed to constipation due to disease, drugs, immobility, and a decreased fluid intake, partially because they have a blunted “thirst reflex” with aging; short-term use of stimulants is best; if prophylaxis is desired, this can be accomplished with bulk agents (psyllium), stool softeners, and hyperosmotic agents (sorbitol 70%); stool softeners are unnecessary if stools are well hydrated, soft, or “mushy”.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
None reported
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, rectal [enema]:
Fleet® Bisacodyl: 10 mg/30 mL (37 mL)
Suppository, rectal: 10 mg (12s, 50s, 100s)
Bisac-Evac™: 10 mg (8s, 12s, 50s, 100s, 500s, 1000s)
Biscolax™: 10 mg (12s, 100s)
Dulcolax®: 10 mg (4s, 8s, 16s, 28s, 50s)
Tablet, oral: 5 mg, 10 mg
Tablet, delayed release, oral: 5 mg
Doxidan®: 5 mg
Fleet® Stimulant Laxative: 5 mg
Tablet, enteric coated, oral: 5 mg
Alophen®: 5 mg
Bisac-Evac™: 5 mg
Correctol® Tablets: 5 mg
Dacodyl™: 5 mg
Dulcolax®: 5 mg
ex-lax® Ultra: 5 mg [contains sodium 0.1 mg/tablet]
Femilax™: 5 mg
Veracolate®: 5 mg
Pricing: U.S. (www.drugstore.com)
Suppository (Bisac-Evac)
10 mg (100): $18.97
Suppository (Bisacodyl)
10 mg (100): $25.99
References
Cullen G and O'Donoghue D, "Constipation and Pregnancy," Best Pract Res Clin Gastroenterol, 2007, 21(5):807-18.
Friedrich C, Richter E, Trommeshauser D, et al, "Absence of Excretion of the Active Moiety of Bisacodyl and Sodium Picosulfate Into Human Breast Milk: An Open-Label, Parallel-Group, Multiple-Dose Study in Healthy Lactating Women," Drug Metab Pharmacokinet, 2011, 26(5):458-64.
Prather CM, "Pregnancy-Related Constipation," Curr Gastroenterol Rep, 2004, 6(5):402-4.
Wald A, "Constipation, Diarrhea, and Symptomatic Hemorrhoids During Pregnancy," Gastroenterol Clin North Am, 2003, 32(1):309-22.
International Brand Names
Lexi-Comp.com
Last full review/revision March 2012
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