Bisacodyl

Bisacodyl is a Stimulant Laxative belonging to Drug for Occasional Constipation.

Bisacodyl is a stimulant laxative used for the temporary relief of occasional constipation and cleansing of the colon as a preparation for colonoscopy in adults.

The Oral formulations of bisacodyl are only 16% bioavailable. Its apparent Volume of distribution is 289 L. It metabolised in the colon to the active metabolite, bis-(-p-hydroxyphenyl)-pydidyl-2-methane (BHPM); further metabolised in the liver to a glucuronide salt. It is Excreted mainly via urine, and bile (as BHPM).

Bisacodyl shows side effects like Stomach cramps, faintness, and stomach discomfort.

Bisacodyl is available in the form of Oral Tablets, Rectal suppositories, and rectal enema.

Bisacodyl is available in India, US, UK, Singapore, Malaysia, Italy, Spain, Canada, France, Japan, China, Indonesia, Switzerland, and Russia.

Bisacodyl belongs to the Drug for Occasional Constipation acts as a Stimulant Laxative.

Bisacodyl stimulates peristalsis by directly irritating the smooth muscle of the intestine, possibly the colonic intramural plexus; alters water and electrolyte secretion producing net intestinal fluid accumulation and laxation.

The amount of time required for Bisacodyl to show its action (onset of action) is about 6-10 hours after oral administration and 15-60 minutes after rectal administration.

The time until which Bisacodyl remains active (Duration of action) in the body is not clinically established.

Bisacodyl is available in the form of Oral Tablets, Rectal suppositories, and rectal enema.

Bisacodyl tablet is taken orally, usually once daily. Bisacodyl suppository and enema given via rectal route, usually once daily.

Bisacodyl is a stool softener, which is used in the treatment of constipation (difficulty in passing stool). It is also used before certain medical procedures or surgery to empty the bowels. This medicine works by increasing the activity of the intestines to cause a bowel movement.

Bisacodyl is a Stimulant Laxative belonging to Drug for Occasional Constipation.

Bisacodyl stimulates peristalsis by directly irritating the smooth muscle of the intestine, possibly the colonic intramural plexus; alters water and electrolyte secretion producing net intestinal fluid accumulation and laxation.

Bisacodyl is approved for use in the following clinical indications

• Bowel cleansing

• Constipation

• Bowel cleansing

Rectal: 10 mg (1 enema) as single dose.

• Constipation

Adult Dose:

Oral: 5 to 15 mg once daily.

Rectal: Enema, suppository: 10 mg (1 enema or suppository) once daily.

Pediatric Dose:

Oral:

Children 3 to <10 years: Limited data available in ages <6 years: Oral: 5 mg once daily.

Children 10 to <12 years: Oral: 5 to 10 mg once daily.

Children ≥12 years and Adolescents: Oral: 5 to 15 mg once daily.

Rectal:

Suppository:

Children 2 to ≤10 years: Limited data available in ages <6 years: Rectal: 5 mg.

Children >10 years and Adolescents: Rectal: 5 to 10 mg.

Enema:

Children 2 to ≤10 years: Limited data available: Rectal: 5 mg (15 mL) once daily.

Children >10 years and Adolescents: <12 years: Rectal: 5 to 10 mg (15 to 30 mL) once daily.

Bisacodyl is available in various strengths as 5 mg and 10 mg.

Bisacodyl is available in the form of Oral Tablets, Rectal suppositories, and rectal enema.

Do not administer Tablet within 1 hour of milk, dairy products, or an antacid.

Bisacodyl is contraindicated in patients with

• Patients who are hypersensitive to this drug or to any ingredient in the formulation or component of the container.

• Patients with ileus, intestinal obstruction, acute abdominal conditions like acute appendicitis, acute inflammatory bowel diseases, severe abdominal pain associated with nausea and vomiting which may be indicative of more severe conditions.

• Severe dehydration.

• In case of rare hereditary conditions that may be incompatible with an excipient of the product (lactose or sucrose).

• As with all laxatives, Bisacodyl should not be taken on a continuous daily basis or for extended periods without investigating the cause of constipation. Prolonged excessive use may lead to fluid and electrolyte imbalance and hypokalaemia.

• Do not use Bisacodyl in the presence of abdominal pain, nausea, fever or vomiting, or within two hours of another medicine since the desired effect of the other medicine may be reduced.

• Intestinal loss of fluids can promote dehydration. Symptoms may include thirst and oliguria. In patients suffering from fluid loss where dehydration may be harmful (e.g. renal insufficiency, elderly patients) Bisacodyl should be discontinued and only be restarted under medical supervision.

• Patients may experience haematochezia (blood in stool) that is generally mild and self-limiting.

• Dizziness and/or syncope have been reported in patients who have taken Bisacodyl. The details available for these cases suggest that the events would be consistent with defecation syncope (or syncope attributable to straining at stool), or with a vasovagal response to abdominal pain related to constipation and not necessarily to the administration of Bisacodyl itself.

• The use of suppositories may lead to painful sensations and local irritation, especially in patients with anal fissures and ulcerative proctitis, and should be used in these conditions under medical advice or as directed by a physician.

• Bisacodyl coated tablets contain lactose and sucrose. One coated tablet contains 34.9 mg lactose and 21.4 mg sucrose (saccharose), resulting in 69.8 mg lactose and 42.8 mg sucrose per maximum recommended daily dose for the treatment of constipation. For the preparation of the diagnostic procedure, this will result in 139.6 mg of lactose and 85.6 mg sucrose per maximum recommended daily dose in adults. Patients with rare hereditary conditions of galactose intolerance, e.g. galactosaemia, or fructose intolerance should not take Bisacodyl tablets.

• Stimulant laxatives including Bisacodyl do not help with weight loss.

Clinical data show that neither the active moiety of bisacodyl, BHPM (bis-(p-hydroxyphenyl)-pyridyl-2-methane), nor its glucuronides are excreted into the milk of healthy lactating human females. Thus, Bisacodyl can be used during breast-feeding.

There are no adequate and well-controlled studies in pregnant women. For use during pregnancy, it is recommended that medical advice from a physician first be obtained. As with all medications, Bisacodyl should only be taken during pregnancy on medical advice.

Do not administer Tablet within 1 hour of milk, dairy products, or an antacid.

Common

• Fluid and electrolyte imbalance, hypokalaemia (prolonged use), Abdominal pain, abdominal cramps, nausea, diarrhea, vomiting, haematochezia, abdominal discomfort, anorectal discomfort, rectal burning (suppository).

• Antacids

May diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Management: Antacids should not be used within 1 hour before bisacodyl administration.

• Dichlorphenamide

Laxatives may enhance the hypokalemic effect of Dichlorphenamide.

• Polyethylene Glycol-Electrolyte Solution

Bisacodyl may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution.

• Sodium Sulfate

Laxatives (Stimulant) may enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased.

The common side effects of Bisacodyl include the following

Common side effects

• Stomach cramps, faintness, stomach discomfort.

Rare side effects

• Rectal bleeding.

• Pregnancy

Pregnancy Category C

There are no adequate and well-controlled studies in pregnant women. For use during pregnancy, it is recommended that medical advice from a physician first be obtained. As with all medications, Bisacodyl should only be taken during pregnancy on medical advice.

• Nursing Mothers

Clinical data show that neither the active moiety of bisacodyl, BHPM (bis-(p-hydroxyphenyl)-pyridyl-2-methane), nor its glucuronides are excreted into the milk of healthy lactating human females. Thus, Bisacodyl can be used during breast-feeding.

• Pediatric Use

Children should not be given Bisacodyl without medical advice.

• Geriatric Use

Information not available.

Symptoms: Watery stools, abdominal cramps, fluid, and electrolytes loss. Chronic case: Chronic diarrhea, abdominal pain, hypokalemia, secondary hyperaldosteronism, renal calculi, renal tubular damage, metabolic alkalosis, and muscle weakness.

Management: Perform gastric lavage or induce vomiting to minimize absorption. Fluid replacement and correction of electrolyte imbalance may be required.

• Pharmacodynamic

Information not available.

• Pharmacokinetics

Absorption

Oral formulations of bisacodyl are only 16% bioavailable.

Distribution

Its apparent Volume of distribution is 289 L.

Metabolism and Excretion

Metabolised in the colon to the active metabolite, bis-(-p-hydroxyphenyl)-pydidyl-2-methane (BHPM); further metabolised in the liver to a glucuronide salt. Excreted mainly via urine, and bile (as BHPM).

Corsetti M, Landes S, Lange R. Bisacodyl: A review of pharmacology and clinical evidence to guide use in clinical practice in patients with constipation. Neurogastroenterology & Motility. 2021 Oct;33(10):e14123.

Parente F, Vailati C, Bargiggia S, Manes G, Fontana P, Masci E, Arena M, Spinzi G, Baccarin A, Mazzoleni G, Testoni PA. 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-litre polyethylene glycol as preparation for colonoscopy in chronic constipation. Digestive and liver disease. 2015 Oct 1;47(10):857-63.

Noergaard M, Traerup Andersen J, Jimenez-Solem E, Bring Christensen M. Long-term treatment with stimulant laxatives–clinical evidence for effectiveness and safety? Scandinavian Journal of Gastroenterology. 2019 Jan 2;54(1):27-34.

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