• Bowel cleansing (enema only):
  • Bowel cleansing prior to rectal examination.
• Constipation:
  • Temporary relief of occasional constipation and irregularity.

Bisacodyl Dose in Adults

 Use in the treatment of Bowel cleansing (enema only):

• 10 mg Rectal (1 enema) as single dose

Use in the treatment of Constipation:

• 5 to 15 mg orally once daily
• Enema, suppository: 10 mg Rectal (1 enema or suppository) once daily

Bisacodyl Dose in children:

Use in the treatment of Constipation: Oral:

• 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: Limited data available (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:

• 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: Limited data available (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 lectation:

• The risk of systemic exposure to bisacodyl after maternal use is very low.
• Plasma concentrations of BHPM, the active metabolite in bisacodyl, are low (median: 61 ng/mL; Range: 20 to 118 ng/mL). The pharmacokinetics of BHPM are variable after oral doses of 10 mg/day given to women within 7 days of giving birth (Friedrich 2011, Friedrich 2011).
• Pregnant women can have constipation treated in a similar manner as nonpregnant women. If diet and lifestyle changes are unsuccessful, medications may be prescribed.
• As an initial treatment, agents other than bisacodyl should be considered.
• Although stimulant laxatives such as bisacodyl are not recommended for long-term use, they can be used when necessary (ACG [Christie 2007,]).

Bisacodyl use during breast feeding:

• It is unknown if Bisacodyl can be found in breast milk.
• The risk of systemic exposure to maternal products is very low.
• After administration of bisacodyl 10mg once daily for seven days to eight breastfeeding mothers (lower limit: 1 ng/mL), neither bisacodyl (or its active metabolite) was detected in breast milk (Friedrich 2011,).

Bisacodyl Dose in Renal Disease:

• No dose adjustments have been recommended by manufacturer in patient with kidney disease.

Bisacodyl Dose in Liver Disease:

No dose adjustments have been recommended by manufacturer in patient with liver disease.

Less Common Side Effects of Bisacodyl Include:

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

Contraindication to Bisacodyl include:

Warnings/Precautions

• Benzyl alcohol, and its derivatives:
  • Some dosage forms may contain sodium benzoate/benzoic acids.
  • Large amounts of benzylalcool (>=99mg/day) have been linked to potentially fatal toxicity in neonates (the "gasping Syndrome").
  • This includes metabolic acidosis and respiratory distress, as well as CNS dysfunction (including hypotension), gasping respirations, and cardiac collapse.
  • Refer to the manufacturer's label.

Bisacodyl: Drug Interaction

How to administer Bisacodyl?

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.

Mechanism of action of Bisacodyl:

• Inhibits peristalsis through direct irritation of the smooth muscle in the intestine (or the colonic intramuralplexus).
• Alters water and electrolyte production, causing net intestinal fluid accumulation and laxation.

Start of actionOral: 6-12 hours; Rectal : 0.25-1 hour (suppository), 5-20 minutes (enema).

Half-lifeBHPM: 8 Hours (Friedrich 2011, p.

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

Metabolism: Bisacodyl can be metabolized in the colon to an active metabolite, BHPM.

BHPM then gets converted in the liver into a glucuronide sodium (Friedrich 2011,).

Absorption: Oral, rectal, Systemic, 5% (Wald, 2003).

Excretion: BHPM: Urine, bile (Friedrich 2011)   

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: