Pharm

Bisacodyl

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Bisacodyl, Dulcolax, Correctol

  • See Also
  1. Stimulant Laxative
  2. Senna
  3. Laxative
  4. Constipation
  5. Functional Constipation
  6. Pediatric Constipation
  • Indications
  1. Functional Constipation
  2. Colonoscopy Bowel Preparation
  3. Constipation Prophylaxis in Chronic Opioid Use
  • Precautions
  1. Avoid chronic use of Stimulant Laxatives (see adverse effects below)
  • Mechanism
  1. Simulant Laxative
  2. Bisacodyl is a Diphenylmethane, a synthetic pyridinylmethylene-diacetate ester derivative
  3. Direct parasympathetic effects at mucosal Sensory Nerves, increasing peristaltic contraction
  • Medications
  1. Various trade names including Dulcolax and Correctol
    1. Correctol was previously formulated with Phenolphthalein (off U.S. market as of 2009)
  2. Tablets: 5 mg
  3. Suppository: 10 mg
  • Dosing
  • Oral
  1. See Colonoscopy Bowel Preparation
  2. See Constipation Prophylaxis in Chronic Opioid Use
  3. General
    1. Swallow tablets whole (do not chew)
    2. Avoid within 1 hour of milk or Antacids
    3. Onset in 6 to 10 hours
  4. Adult (and age >10 years)
    1. Take 5 to 15 mg orally daily after breakfast as needed
    2. Dose may be be titrated from 1 to 3 tablets orally (5 to 15 mg)
    3. Constipation Prophylaxis in Chronic Opioid Use uses doses as high as 3 tabs twice daily
  5. Child (3 to 10 years old)
    1. Give 5 mg orally after breakfast as needed
    2. May increase to 10 mg orally per day
  • Dosing
  • Rectal
  1. Onset in 60 minutes
  2. Adult (and age >10 years)
    1. Take 10 mg per Rectum once daily or up to 3 times per week
  3. Child (2 to 10 years)
    1. Give 5 mg per Rectum daily as needed
    2. May increase to 10 mg rectally per day
  • Pharmacokinetics
  1. Onset of activity
    1. Oral: 6 to 10 hours
    2. Rectal: 60 minutes
  • Adverse Effects
  • Short-Term
  1. Nausea
  2. Vomiting
  3. Abdominal Cramping
  • Adverse Effects
  • Long-Term (Laxative abuse)
  1. See Stimulant Laxative
  2. Avoid prolonged use (habit forming)!
  3. Colonic denervation and atony (Cathartic colon)
    1. Decreased motility of right colon with secondary worsening Constipation
    2. Associated with Anthraquinone Laxatives
    3. Results from myenteric plexus injury
  4. Electrolyte and nutritional disturbance
    1. Hypokalemia
    2. Sodium overload
    3. Protein-losing Enteropathy
  5. Melanosis coli
    1. Benign darkening of colonic mucosa
    2. Macrophage deposition in lamina propria
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Resources
  1. Bisacodyl Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=71215710-f33d-4e01-a543-fc46b5ce5137
  2. Bisacodyl Suppository (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fc2d299-d699-4176-84f1-02fdaac76df8
  • References
  1. (2023) Management of Constipation, Presc Lett, #390108