Bisacodyl

• Approved Indications:
• Treatment of constipation, including occasional and chronic constipation.
• Bowel preparation prior to medical or surgical procedures such as colonoscopy or radiologic examination of the colon.
• Off-label / Clinically Accepted Uses:
• Management of opioid-induced constipation.
• Adjunctive therapy in patients with slow-transit constipation or refractory constipation under specialist supervision.

• Route: Oral tablets or rectal suppository.
• Oral Dosage:
• Adults and adolescents (≥10 years): 5–15 mg once daily, preferably at bedtime.
• Typical dose for constipation: 10 mg once daily.
• For bowel prep: doses may be higher and divided as per procedure protocol.
• Rectal Dosage:
• Adults and adolescents: 10 mg suppository once daily.
• Insert rectally and retain as long as possible (usually 15–60 minutes).
• Onset typically within 15 to 60 minutes.
• Pediatrics (<10 years):
• Not generally recommended without medical supervision; if used, dose adjusted by weight and age.
• Elderly:
• Start with the lowest effective dose; monitor for electrolyte imbalance.
• Renal/Hepatic Impairment:
• No dose adjustment generally required, but caution advised in severe impairment due to electrolyte risks.

Bisacodyl is a stimulant laxative that acts primarily on the colon. After oral administration, it is converted by intestinal enzymes and gut bacteria into its active form, which stimulates enteric nerves to increase colonic peristalsis. It also induces fluid and electrolyte secretion into the bowel lumen, softening stool and promoting bowel movements. Rectal bisacodyl acts locally on the rectal mucosa to stimulate peristalsis.

• Absorption: Poorly absorbed systemically after oral administration; acts locally in the colon.
• Distribution: Minimal systemic exposure; acts mainly in the large intestine.
• Metabolism: Prodrug converted to active metabolite by intestinal flora and enzymes.
• Elimination: Active metabolite excreted primarily in feces; minimal renal excretion.
• Onset of Action:
• Oral: 6–12 hours (usually overnight).
• Rectal: 15–60 minutes.

• Pregnancy: Category C — Animal studies have shown no teratogenicity, but no adequate human studies; use only if clearly needed.
• Lactation: Limited data; generally considered compatible with breastfeeding due to minimal systemic absorption.

• Primary Class: Laxative
• Subclass: Stimulant laxative

• Known hypersensitivity to bisacodyl or formulation excipients.
• Acute abdominal conditions: intestinal obstruction, acute surgical abdomen, appendicitis, fecal impaction.
• Severe dehydration or electrolyte imbalance.
• Rectal bleeding of unknown origin.

• Prolonged use (>1 week) may cause electrolyte imbalance, dependence, or worsen underlying conditions.
• Avoid use in patients with undiagnosed abdominal pain.
• Use cautiously in patients with cardiac disorders due to electrolyte shifts.
• Monitor for signs of dehydration and hypokalemia during prolonged therapy.
• Not recommended for habitual use for constipation without medical supervision.

• Common:
• Abdominal cramps, pain, and discomfort
• Diarrhea
• Nausea
• Rectal irritation (with suppositories)
• Serious/Rare:
• Electrolyte imbalance (hypokalemia)
• Fluid depletion
• Allergic reactions (rash, pruritus)
• Dependence with chronic use

• May reduce absorption of drugs affected by increased gastrointestinal motility (e.g., digoxin, warfarin).
• Concomitant use with other laxatives or diuretics may increase risk of dehydration and electrolyte abnormalities.
• Avoid simultaneous use with antacids or dairy products as they may affect bisacodyl’s dissolution; separate administration by at least 1 hour.

• Current guidelines recommend bisacodyl as a second-line agent for constipation after lifestyle modifications and bulk-forming laxatives.
• Emphasis on avoiding chronic stimulant laxative use due to risk of dependency.
• Use in bowel prep protocols remains standard due to effective colon cleansing.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and heat.
• Keep tablets in tightly closed containers.
• Suppositories should be stored in cool, dry places, avoiding excessive heat.
• Keep out of reach of children.