Bisacodyl is a medication primarily used to treat constipation and bowel irregularity. It belongs to a class of drugs known as stimulant laxatives. Bisacodyl works by increasing the movement of the intestines, helping to produce a bowel movement.

• Bowel cleaning (only by enema):
  • bowel preparation before a rectal examination
• Constipation:
  • Constipation and irregularity are temporarily relieved.

Bisacodyl Dose in Adults

Bisacodyl Use in the treatment of bowel cleansing (enema only):

• It's given as a 10 mg enema, which means it's administered through the rectum as a single dose.
• The enema helps to stimulate bowel movements, clearing out the intestines effectively.

Bisacodyl Use in the treatment of Constipation:

• When taken orally, the usual dose ranges from 5 to 15 mg once a day.
• Alternatively, it can be administered as a 10 mg enema or suppository once daily.
• These forms are inserted into the rectum to stimulate bowel movements, helping to relieve constipation effectively

Bisacodyl dose in children:

Bisacodyl Use in the treatment of constipation: Oral:

Oral Use:

• Manufacturer's Labeling:
  • Children 6 to <12 years: 5 mg once orally daily
  • Children ≥12 years and Adolescents: 5 to 15 mg once orally daily
• Alternate Dosing (Tabbers [NASPGHAN/ESPGHAN], 2014):
  • Children ≥3 years to 10 years: 5 mg once orally daily
  • Children >10 years and Adolescents: 5 to 10 mg once orally daily

Rectal Use:

• Manufacturer's Labeling:
  • Suppository:
    • Children 6 to <12 years: 5 mg (1/2 suppository) once daily
    • Children ≥12 years and Adolescents: 10 mg once daily
  • Enema:
    • Children ≥12 years and Adolescents: 10 mg once daily
• Alternate Dosing (Tabbers [NASPGHAN/ESPGHAN] 2014):
  • Suppository/Enema:
    • Children ≥2 to 10 years: 5 mg (1/2 suppository) once daily
    • Children >10 years and Adolescents: 5 to 10 mg once daily

Pregnancy and lactation:

• Systemic exposure to bisacodyl is minimal when used by pregnant women, with low levels of its active form, BHPM, in the bloodstream.
• Studies show that after oral doses of 10 mg/day for 7 days in women right after childbirth, BHPM levels vary greatly.
• When dealing with constipation during pregnancy, doctors usually advise similar treatments to those for non-pregnant individuals, preferring dietary and lifestyle adjustments initially over medication.
• While bisacodyl and other stimulant laxatives are not the first choice for long-term use due to potential side effects, they can be used intermittently when necessary, according to guidelines.

Bisacodyl use during breastfeeding:

• Bisacodyl's presence in breast milk is uncertain.
• Studies indicate that after administering bisacodyl 10 mg once daily for 7 days to eight breastfeeding women, neither bisacodyl nor its active metabolite, BHPM, were detectable in breast milk.
• This suggests that systemic exposure to bisacodyl through breast milk is minimal.

Bisacodyl Dose in Renal Disease:

• The manufacturer has not recommended any dose adjustments for patients with kidney disease when using bisacodyl.

Bisacodyl Dose in Liver Disease:

• No dose adjustments have been suggested by the manufacturer for patients with liver disease when using bisacodyl.

Bisacodyl's less common side effects include

• Vertigo
• Vomiting
• Electrolyte disturbance (metabolic acidosis or alkalosis, hypocalcemia)
• Nausea
• Abdominal cramps (mild)
• Rectal irritation (burning)

Contraindications to bisacodyl include:

Warnings/Precautions

Benzyl alcohol, and its derivatives:

• Benzyl alcohol and its derivatives are found in certain medication forms, and some may contain sodium benzoate or benzoic acid.
• It's important to note that benzoic acid, a metabolite of benzyl alcohol, can pose risks, especially in neonates.
• High doses of benzyl alcohol (≥99 mg/kg/day) have been linked to a potentially fatal condition known as "gasping syndrome" in newborns.
• This syndrome involves various serious symptoms such as metabolic acidosis, respiratory distress, CNS dysfunction like convulsions, intracranial hemorrhage, as well as hypotension and cardiovascular collapse.
• Additionally, there's data suggesting that benzoate might displace bilirubin from protein binding sites.
• Therefore, it's recommended to avoid or cautiously use medication forms containing benzyl alcohol derivatives in neonates.
• Always refer to the manufacturer's labeling for specific guidance.

Bisacodyl: Drug Interaction

How to administer Bisacodyl

Oral Administration:

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

Rectal Administration:

• Enema:
  • Instructions:
    • Shake well.
    • Remove protective shield.
    • Insert tip into rectum with slight side-to-side movement.
    • Squeeze the bottle until nearly all liquid is expelled (some liquid will remain in the unit after use).
    • Gently remove the unit; a small amount of liquid will remain in the unit after use.
• Suppository:
  • Instructions:
    • Remove foil.
    • Insert into rectum with pointed end first.
    • Retain in rectum for 15 to 20 minutes.

Mechanism of action of Bisacodyl:

• Bisacodyl works by stimulating peristalsis, which is the rhythmic contractions of the intestines that help move food along the digestive tract.
• It achieves this by directly irritating the smooth muscle of the intestine, possibly affecting the colonic intramural plexus, a network of nerves within the colon.
• Additionally, bisacodyl alters water and electrolyte secretion in the intestine, leading to a net accumulation of fluid in the intestines.
• This accumulation of fluid helps soften the stool and promotes bowel movements, aiding in laxation or relief from constipation.

Start of action:

• Oral: 6 to 12 hours
• Rectal:
  • Suppository: 0.25 to 1 hour
  • Enema: 5 to 20 minutes

Half-life:

• BHPM (active metabolite): Approximately 8 hours

Distribution:

• Volume of Distribution (Vd) for BHPM: 289 L (after multiple doses)

Metabolism:

• Bisacodyl is metabolized to an active metabolite called BHPM in the colon.
• BHPM is further converted in the liver to a glucuronide salt.

Absorption:

• Oral and rectal administration result in systemic absorption of less than 5%.

Excretion:

• BHPM is excreted in urine and bile.

International Brands of Bisacodyl:

• Bisac-Evac
• Bisacodyl EC
• Biscolax
• Correct
• Ducodyl
• Dulcolax
• Fleet Bisacodyl
• Fleet Laxative
• GoodSense Bisacodyl EC
• Womens Laxative
• Abilaxine
• Alaxa
• Alsylax
• Anan
• Anulax
• Atzirut X
• Bekunis B
• Bilaxine
• Bioyl
• Bisacod
• Bisadyl
• Bisakodils
• Bisalax
• Bisco
• Bolax
• Buscolax
• Camvolax
• Conlax-10
• Contalax
• Corlex-5
• Custodiol
• Danalax
• Dissilax
• Dulco
• Laxo
• Dulco-lax perles
• Dulcolan
• Dulcolax
• Dulcorax
• Dulxative
• Duralax
• Entrolax
• Fenolax
• Gencolax
• Johnlax
• Lax-Tab
• Laxabixal
• Laxacod
• Laxadyl
• Laxana
• Laxans-ratiopharm
• Laxatin
• Laxbene
• Laxcodyl
• Laxet
• Laxin
• Laxocodyl
• Longshutong
• Megalax
• Moderlax
• Mucinum
• Oralax
• Perilax
• Purgo-Pil
• Pyrilax
• Relaxium
• Satolax-10
• Stadalax
• Stolax
• Suben
• Tirgon N
• Toilax
• Vesilac
• Zu Zu Ton
• Zycolax

Bisacodyl Brands in Pakistan: