1. Introduction
Bisacodyl, marketed under brand names such as Dulcolax and Correctol, is a stimulant laxative used to treat constipation and to prepare the bowel for medical procedures. It works by stimulating bowel movements through irritation of the intestinal mucosa and increasing water secretion in the colon.
2. Indications
- Approved Indications:
- Relief of occasional constipation.
- Bowel preparation for diagnostic procedures, such as colonoscopy.
- Off-Label Uses:
- Management of opioid-induced constipation (in combination with stool softeners).
3. Dosage
- Adults and Children ≥12 years:
- Oral: 5–15 mg once daily as needed (maximum 30 mg/day).
- Rectal suppository: 10 mg once daily as needed.
- Children (6–12 years):
- Oral: 5 mg once daily as needed.
- Rectal suppository: 5–10 mg once daily.
- Bowel Preparation:
- Oral: 10–15 mg the evening before the procedure, followed by a rectal suppository the following morning.
4. Administration
- Oral Tablets:
- Swallow whole with water.
- Do not crush or chew to prevent gastric irritation.
- Take on an empty stomach for faster results.
- Rectal Suppository:
- Remove the foil wrapper.
- Insert the suppository gently into the rectum, pointed end first.
- Retain the suppository for as long as possible to ensure effectiveness.
5. Forms Available
- Oral tablets: 5 mg.
- Rectal suppositories: 5 mg, 10 mg.
6. Side Effects
6.1. Common Side Effects
- Abdominal cramps.
- Diarrhoea.
- Nausea.
6.2. Less Common Side Effects
- Rectal irritation (with suppository use).
- Dizziness.
6.3. Rare but Serious Side Effects
- Electrolyte imbalance (with prolonged or excessive use).
- Dehydration.
7. Warnings
- Do not use for more than 7 days unless directed by a healthcare provider.
- Overuse may lead to dependence and impaired bowel function.
- Avoid use in patients with undiagnosed abdominal pain, intestinal obstruction, or acute surgical abdomen.
8. Precautions
- Use with caution in elderly patients due to the risk of dehydration and electrolyte imbalances.
- Avoid use in patients with severe dehydration.
- Not recommended for use during severe diarrhoea.
9. Interactions
- Drug-Drug Interactions:
- Antacids and milk: May cause premature dissolution of enteric-coated tablets, increasing the risk of gastric irritation.
- Drug-Food Interactions:
- Avoid taking with milk or dairy products to prevent breakdown of the enteric coating.
10. Monitoring Parameters
- Relief of constipation within 6–12 hours of oral administration or 15–60 minutes after rectal administration.
- Watch for signs of dehydration or electrolyte imbalance, especially with prolonged use.
11. Use in Children
- Approved for use in children aged 6 years and above under medical supervision.
- Dosage adjustments are necessary based on age and weight.
12. Use in Pregnancy
- Considered safe for occasional use during pregnancy.
- Prolonged or excessive use is not recommended.
13. Use in Elderly
- Use with caution due to increased susceptibility to dehydration and electrolyte imbalances.
- Avoid prolonged use to prevent dependence.
14. Use in Kidney Disease
- Use cautiously in patients with renal impairment due to the risk of electrolyte imbalances.
15. Use in Liver Disease
- No specific dosage adjustments required, as bisacodyl has minimal systemic absorption.
16. Patient Counselling Points
- Advise patients to use bisacodyl only as directed and avoid overuse.
- Take oral tablets on an empty stomach with water.
- Do not chew or crush the tablets to prevent gastric irritation.
- Explain how to insert the rectal suppository correctly for effective results.
- Highlight the importance of maintaining adequate hydration, especially during diarrhoea.
- Inform patients to avoid taking bisacodyl with milk or antacids.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Dulcolax | Sanofi | $8–12 (30 tablets, 5 mg) |
Correctol | MSD | $6–10 (30 tablets, 5 mg) |
Generic Options | Various | $3–6 (30 tablets, 5 mg) |
18. FAQs (15 Questions)
- What is bisacodyl used for?
Bisacodyl is used to relieve constipation and prepare the bowel for medical procedures. - How does bisacodyl work?
It stimulates bowel movements by irritating the intestinal lining and increasing water secretion. - How long does bisacodyl take to work?
Oral tablets take 6–12 hours, while suppositories work within 15–60 minutes. - Can bisacodyl be used in children?
Yes, it is approved for children aged 6 years and above with proper dosage adjustments. - Is bisacodyl safe during pregnancy?
Occasional use is considered safe, but prolonged use should be avoided. - How should bisacodyl tablets be taken?
Swallow whole with water on an empty stomach; do not chew or crush. - Can bisacodyl be taken with milk?
No, milk and antacids can dissolve the enteric coating prematurely, causing stomach irritation. - What are the common side effects of bisacodyl?
Abdominal cramps, diarrhoea, and nausea. - How often can I use bisacodyl?
It should not be used for more than 7 consecutive days without medical advice. - Can bisacodyl cause dehydration?
Yes, especially with prolonged use or overuse, as it can lead to diarrhoea and fluid loss. - What should I do if I miss a dose?
Bisacodyl is typically used as needed, so missing a dose is not a concern. - Does bisacodyl interact with other medications?
Yes, it should not be taken with antacids or milk to avoid stomach irritation. - Can bisacodyl cause dependence?
Yes, overuse can lead to dependence and impaired natural bowel function. - How should bisacodyl be stored?
Store at room temperature, away from moisture and heat. - When should I avoid using bisacodyl?
Avoid in cases of undiagnosed abdominal pain, intestinal obstruction, or severe dehydration.