bisacodyl

Therapeutic Classification: laxatives

Pharmacologic Classification: stimulant laxatives

Indications ⬆ ⬇

REMS

Constipation.
Evacuation of the bowel before radiologic studies or surgery.
Part of a bowel regimen in spinal cord injury patients.

Action ⬆ ⬇

Stimulates peristalsis.
Alters fluid and electrolyte transport, producing fluid accumulation in the colon.

Therapeutic effects:

Evacuation of the colon.

Pharmacokinetics ⬆ ⬇

Absorption: Variable absorption follows oral administration; rectal absorption is minimal; action is local in the colon.

Distribution: Small amounts of metabolites excreted in breast milk.

Metabolism/Excretion: Small amounts absorbed are metabolized by the liver.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(evacuation of bowel)

ROUTE	ONSET	PEAK	DURATION
PO	6–12 hr	unknown	unknown
Rectal	15–60 min	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Abdominal pain;
Obstruction;
Nausea or vomiting (especially with fever or other signs of an acute abdomen).

Use Cautiously in:

Severe cardiovascular disease;
Anal or rectal fissures;
Excess or prolonged use (may result in dependence).

Adv. Reactions/Side Effects ⬆ ⬇

F and E: hypokalemia (with chronic use)

GI: abdominal cramps, nausea, diarrhea, rectal burning

MS: muscle weakness (with chronic use)

Misc: protein-losing enteropathy, tetany (with chronic use)

Interactions ⬆ ⬇

Drug-drug:

Antacids, histamine H2-receptor antagonists, and proton pump inhibitors may remove enteric coating of tablets resulting in gastric irritation/dyspepsia.
May ↓ the absorption of other orally administered drugs because of ↑ motility and ↓ transit time.

Drug-Food:

Milk may remove enteric coating of tablets, resulting in gastric irritation/dyspepsia.

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥12 yr): 5–15 mg/day (up to 30 mg/day) as a single dose.
PO (Children 3–11 yr): 5–10 mg/day (0.3 mg/kg) as a single dose.
Rect (Adults and Children ≥12 yr): 10 mg/day single dose.
Rect (Children 2–11 yr): 5–10 mg/day single dose.
Rect (Children <2 yr): 5 mg/day single dose.

Availability ⬆ ⬇

(Generic available)

Enteric-coated tablets: 5 mg^OTC
Rectal suppositories: 10 mg^OTC
Rectal enema: 10 mg/30 mL^OTC

Assessment ⬆ ⬇

Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
- Assess color, consistency, and amount of stool produced.

Implementation ⬆ ⬇

Do not confuse Dulcolax (bisacodyl) with Dulcolax (docusate sodium).
May be administered at bedtime for morning results.
PO: Taking on an empty stomach will produce more rapid results.
- DNC: Do not crush or chew enteric-coated tablets. Take with a full glass of water or juice.
- Do not administer oral doses within 1 hr of milk or antacids; this may lead to premature dissolution of tablet and gastric or duodenal irritation.
Rectal suppository or enema can be given at the time a bowel movement is desired. Lubricate suppositories with water or water-soluble lubricant before insertion. Encourage patient to retain the suppository or enema 15–30 min before expelling.

Patient/Family Teaching ⬆ ⬇

Advise patients, other than those with spinal cord injuries, that laxatives should be used only for short-term therapy. Prolonged therapy may cause electrolyte imbalance and dependence.
Advise patient to increase fluid intake to at least 1500–2000 mL/day during therapy to prevent dehydration.
Encourage patients to use other forms of bowel regulation (increasing bulk in the diet, increasing fluid intake, or increasing mobility). Normal bowel habits may vary from 3 times/day to 3 times/wk.
Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
Advise patient that bisacodyl should not be used when constipation is accompanied by abdominal pain, fever, nausea, or vomiting.

Evaluation/Desired Outcomes ⬆ ⬇

Soft, formed bowel movement when used for constipation.
Evacuation of colon before surgery or radiologic studies, or for patients with spinal cord injuries.

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Pronunciation ⬇

Classifications ⬆ ⬇