Drugs List

Therapeutic Indications

Uses

Constipation

Unlicensed Uses

Bowel evacuation - prior to investigative procedure
Bowel evacuation - prior to surgical procedure

Contraindications

Children under 4 years
Acute surgical abdomen
Appendicitis
Galactosaemia
Gastrointestinal obstruction
Hereditary fructose intolerance
Inflammatory bowel disease
Paralytic ileus
Severe dehydration

Precautions and Warnings

Children aged 4 to 12 years
Breastfeeding
Glucose-galactose malabsorption syndrome
Lactose intolerance
Pregnancy

Not all available brands/formulations are licensed for use in children
Contains lactose
Preparation contains sucrose
Indigestion remedies should not be taken at the same time
If daily use is required, investigate the cause of constipation
Prolonged use may cause fluid/electrolyte imbalance and hypokalaemia
Discontinue if severe abdominal symptoms develop
Advise patient not to take with milk
Advise patient to seek medical advice if symptoms persist for > 5 days

Prolonged excessive use may lead to fluid and electrolyte imbalance, diarrhoea, hypokalaemia, and may precipitate rebound constipation. Intestinal loss of fluids can promote dehydration. Symptoms may include thirst and oliguria. Bisacodyl must be discontinued in patients suffering from fluid loss where dehydration may be harmful (e.g. renal insufficiency, elderly patients). Prolonged use may also lead to atonic non-functioning colon.

Concurrent use of antacids or milk products may reduce the resistance of the tablet coating. This may lead to dyspepsia and gastric irritation.

Patients may experience blood in stool that is generally mild and self-limiting. There have been reports of abdominal pain and bloody diarrhoea in some cases associated with colonic mucosal ischaemia.

Dizziness or syncope has been reported during use of bisacodyl, consistent with defecation syncope (or syncope attributable to straining at stool), or with vasovagal response to abdominal pain which may be related to the constipation that prompted the use of laxatives.

Bisacodyl should only be used if bulk-forming and osmotic laxatives are ineffective or contraindicated.

Pregnancy and Lactation

Pregnancy

Use bisacodyl with caution during pregnancy.

Manufacturers advise bisacodyl may be used with caution during pregnancy. At the time of writing there are no adequate and well-controlled studies in pregnant women. It is not known if bisacodyl crosses the placenta, however its molecular weight is low enough for passive diffusion to occur. The minimal amounts in systemic circulation (5%) suggest that neither the embryo nor foetus will have clinically significant exposure to the drug (Briggs 2015).

Lactation

Use bisacodyl with caution during breastfeeding.

Manufacturers advise bisacodyl may be used with caution during breastfeeding. At the time of writing, there is no published experience concerning the use of bisacodyl during breastfeeding. Its molecular weight is low enough for excretion into breast milk but minimal amounts (5%) are absorbed into maternal circulation. The effects on the nursing infant are unknown but appear to be negligible (Briggs 2015).

If laxative treatment is considered necessary, and neither bulk or osmotic laxatives are effective, then bisacodyl may be considered the drug of choice during breastfeeding (Schaefer 2015).

Side Effects

Abdominal cramps
Abdominal discomfort
Abdominal pain
Anaphylactic reaction
Angioedema
Blood in stool
Colitis
Dehydration
Diarrhoea
Dizziness
Fluid and electrolyte disturbances
Hypersensitivity reactions
Hypokalaemia
Intestinal colic
Ischaemic colitis
Nausea
Rectal discomfort
Syncope
Vomiting

Presentation

Oral formulations containing bisacodyl.

Drugs List

Therapeutic Indications

Uses

Constipation

Unlicensed Uses

Bowel evacuation - prior to investigative procedure
Bowel evacuation - prior to surgical procedure

Dosage

The onset of action is approximately 6 to 12 hours.

Adults

Children

Contraindications

Children under 4 years
Acute surgical abdomen
Appendicitis
Galactosaemia
Gastrointestinal obstruction
Hereditary fructose intolerance
Inflammatory bowel disease
Paralytic ileus
Severe dehydration

Precautions and Warnings

Children aged 4 to 12 years
Breastfeeding
Glucose-galactose malabsorption syndrome
Lactose intolerance
Pregnancy

Not all available brands/formulations are licensed for use in children
Contains lactose
Preparation contains sucrose
Indigestion remedies should not be taken at the same time
If daily use is required, investigate the cause of constipation
Prolonged use may cause fluid/electrolyte imbalance and hypokalaemia
Discontinue if severe abdominal symptoms develop
Advise patient not to take with milk
Advise patient to seek medical advice if symptoms persist for > 5 days

Prolonged excessive use may lead to fluid and electrolyte imbalance, diarrhoea, hypokalaemia, and may precipitate rebound constipation. Intestinal loss of fluids can promote dehydration. Symptoms may include thirst and oliguria. Bisacodyl must be discontinued in patients suffering from fluid loss where dehydration may be harmful (e.g. renal insufficiency, elderly patients). Prolonged use may also lead to atonic non-functioning colon.

Concurrent use of antacids or milk products may reduce the resistance of the tablet coating. This may lead to dyspepsia and gastric irritation.

Patients may experience blood in stool that is generally mild and self-limiting. There have been reports of abdominal pain and bloody diarrhoea in some cases associated with colonic mucosal ischaemia.

Dizziness or syncope has been reported during use of bisacodyl, consistent with defecation syncope (or syncope attributable to straining at stool), or with vasovagal response to abdominal pain which may be related to the constipation that prompted the use of laxatives.

Bisacodyl should only be used if bulk-forming and osmotic laxatives are ineffective or contraindicated.

Pregnancy and Lactation

Pregnancy

Use bisacodyl with caution during pregnancy.

Manufacturers advise bisacodyl may be used with caution during pregnancy. At the time of writing there are no adequate and well-controlled studies in pregnant women. It is not known if bisacodyl crosses the placenta, however its molecular weight is low enough for passive diffusion to occur. The minimal amounts in systemic circulation (5%) suggest that neither the embryo nor foetus will have clinically significant exposure to the drug (Briggs 2015).

Lactation

Use bisacodyl with caution during breastfeeding.

Manufacturers advise bisacodyl may be used with caution during breastfeeding. At the time of writing, there is no published experience concerning the use of bisacodyl during breastfeeding. Its molecular weight is low enough for excretion into breast milk but minimal amounts (5%) are absorbed into maternal circulation. The effects on the nursing infant are unknown but appear to be negligible (Briggs 2015).

If laxative treatment is considered necessary, and neither bulk or osmotic laxatives are effective, then bisacodyl may be considered the drug of choice during breastfeeding (Schaefer 2015).

Counselling

Advise patient not to take the tablet with milk or antacids.

Advise patient tablets should be swallowed whole and not chewed or crushed with an adequate amount of fluid.

Advise patient that tablets should not be taken on a continuous basis for more than 5 days without investigating the cause of constipation.

Side Effects

Abdominal cramps
Abdominal discomfort
Abdominal pain
Anaphylactic reaction
Angioedema
Blood in stool
Colitis
Dehydration
Diarrhoea
Dizziness
Fluid and electrolyte disturbances
Hypersensitivity reactions
Hypokalaemia
Intestinal colic
Ischaemic colitis
Nausea
Rectal discomfort
Syncope
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: November 2020

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Bisacodyl 5mg Laxative Tablets 12+ years. Dr. Reddy's Laboratories (UK) Ltd. Revised May 2020.

Summary of Product Characteristics: Dulcolax Adult 5mg Gastro-Resistant Tablets (GSL). Sanofi. Revised October 2020.

Summary of Product Characteristics: Dulcolax Twelve Plus 5mg Gastro-Resistant Tablets (P). Sanofi. Revised November 2021.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 08 September 2022.