Version May 2024
Constipation:
Note: Other agents (eg, polyethylene glycol 3350) are preferred for constipation maintenance therapy. Stimulant laxatives (eg, bisacodyl) may be used as additional or second-line therapy (NASPGHAN [Tabbers 2014]).
Oral (NASPGHAN [Tabbers 2014]; manufacturer’s labeling):
Note: Must be able to swallow tablet whole; tablet should not be crushed.
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 (1/2 suppository) once daily (NASPGHAN [Tabbers 2014]; manufacturer's labeling).
Children >10 years and Adolescents: Rectal: 5 to 10 mg (1/2 to 1 suppository) once daily (NASPGHAN [Tabbers 2014]; manufacturer's labeling).
Enema: Note: 30 mL bisacodyl is delivered per 37 mL bottle:
Children 2 to ≤10 years: Limited data available: Rectal: 5 mg (15 mL) once daily (NASPGHAN [Tabbers 2014]).
Children >10 years and Adolescents: Limited data available in children <12 years: Rectal: 5 to 10 mg (15 to 30 mL) once daily (NASPGHAN [Tabbers 2014]; manufacturer's labeling).
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
(For additional information see "Bisacodyl: Drug information")
Bowel cleansing (enema only): Rectal: 10 mg (1 enema) as single dose
Constipation:
Oral: 5 to 15 mg once daily
Rectal: Enema, suppository: 10 mg (1 enema or suppository) once daily
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (limited systemic absorption) (expert opinion).
Hemodialysis, intermittent (thrice weekly): BHPM (active metabolite): Unlikely to be significantly dialyzed (large Vd): No supplemental dose or dosage adjustment necessary (limited systemic absorption) (expert opinion).
Peritoneal dialysis: BHPM (active metabolite): Unlikely to be significantly dialyzed (large Vd): No dosage adjustment necessary (limited systemic absorption) (expert opinion).
CRRT: No dosage adjustment necessary (limited systemic absorption) (expert opinion).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (limited systemic absorption) (expert opinion).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Postmarketing:
Gastrointestinal: Abdominal pain (Rao 2021), diarrhea (Rao 2021), flatulence (Rao 2021), ischemic colitis (Ajani 2012)
Nervous system: Headache (Rao 2021)
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.
Other warnings/precautions:
• Appropriate use: Tablets: Do not chew or crush; do not use if you cannot swallow without chewing. Do not administer within 1 hour after taking an antacid, milk, or any dairy products.
• Appropriate use: Enema/Suppositories: For rectal use only, discontinue use and consult a health care provider if rectal bleeding occurs or if no bowel movement is produced after use.
• Self-medication (OTC use): Consult a health care provider prior to use if stomach pain, nausea, vomiting, or a sudden change in bowel movements lasting >2 weeks occurs, or if you have already used a laxative, including bisacodyl, for >1 week. Use may cause stomach discomfort, faintness, rectal burning, and mild cramps. Discontinue use and consult a health care provider if use >1 week is needed.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Enema, Rectal:
Fleet Bisacodyl: 10 mg/30 mL (37 mL)
Suppository, Rectal:
Dulcolax: 10 mg (4 ea, 8 ea, 16 ea, 28 ea, 50 ea)
FT Gentle Laxative: 10 mg (8 ea)
Gentle Laxative: 10 mg (1 ea, 50 ea)
OneLAX: 10 mg (12 ea, 50 ea)
The Magic Bullet: 10 mg (10 ea, 100 ea)
Generic: 10 mg (12 ea, 30 ea, 50 ea, 100 ea)
Tablet Delayed Release, Oral:
Alophen: 5 mg [contains corn starch, fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10)]
Bisacodyl EC: 5 mg
Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #6(sunset yellow)alumin lake, methylparaben, propylparaben, quinoline (d&c yellow #10) aluminum lake, sodium benzoate]
Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]
Bisacodyl EC: 5 mg [contains fd&c yellow #6(sunset yellow)alumin lake, methylparaben, propylparaben, quinoline (d&c yellow #10) aluminum lake, sodium benzoate]
Bisacodyl EC: 5 mg [contains fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]
Correct: 5 mg [DSC]
Ducodyl: 5 mg [DSC]
Dulcolax: 5 mg [contains methylparaben, propylparaben, quinoline yellow (d&c yellow #10), sodium benzoate]
Ex-Lax Ultra: 5 mg [contains fd&c yellow #6 (sunset yellow), methylparaben]
FT Laxative: 5 mg [contains corn starch, fd&c yellow #6(sunset yellow)alumin lake, methylparaben, propylparaben, quinoline (d&c yellow #10) aluminum lake, sodium benzoate]
GoodSense Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]
GoodSense Bisacodyl Laxative: 5 mg [contains fd&c yellow #6(sunset yellow)alumin lake, methylparaben, propylparaben, quinoline (d&c yellow #10) aluminum lake, sodium benzoate]
GoodSense Womens Laxative: 5 mg [DSC] [gluten free; contains corn starch]
Womens Laxative: 5 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #5 (tartrazine), sodium benzoate]
Generic: 5 mg
May be product dependent
Enema (Fleet Bisacodyl Rectal)
10 mg/30 mL (per mL): $0.11
Suppository (Bisacodyl Rectal)
10 mg (per each): $0.26 - $0.52
Suppository (OneLAX Rectal)
10 mg (per each): $0.17
Suppository (The Magic Bullet Rectal)
10 mg (per each): $1.19
Tablet, EC (Bisacodyl Oral)
5 mg (per each): $0.03
Tablet, EC (Ex-Lax Ultra Oral)
5 mg (per each): $0.22
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Administer with water; patient should swallow tablet whole; do not break or chew enteric-coated tablet; do not administer within 1 hour of ingesting antacids, milk, or dairy products.
Rectal:
Suppository: Remove foil, insert into rectum with pointed end first. Retain in rectum for ~15 to 20 minutes. If suppository needs to be cut to obtain appropriate dose, cut suppository lengthwise with a sharp knife/blade prior to administration (Bowden 2010).
Enema: Administer with patient lying on left side and knees bent or with patient kneeling and head and chest leaning forward until left side of face is resting comfortably. Shake well; remove protective shield and gently insert enema tip into rectum with slight side to side movement with tip pointing toward navel; have patient bear down if possible. Do not force the enema tip into the rectum as this may cause injury. Squeeze the bottle until nearly all liquid is expelled; some liquid will remain in unit after use. Gently remove enema tip from rectum; patient should maintain position until urge to evacuate is strong (usually 5 to 20 minutes).
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.
Bariatric surgery: Tablet, delayed release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Do not cut or crush in order to avoid gastric irritation.
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. Maintain position until urge to evacuate is strong (usually 5 to 20 minutes).
Suppository: Remove foil, insert into rectum with pointed end first. Retain in rectum for 15 to 20 minutes.
Oral: Store at 20°C to 25°C (68°F to 77°F); protect from humidity.
Rectal: Store at <30°C (86°F).
Treatment of constipation (OTC products: Tablets, Suppositories: FDA approved in ages ≥6 years and adults; Enema: FDA approved in ages ≥12 years and adults); bowel cleansing prior to procedures or examination (OTC products: Enema: FDA approved in children ≥12 years and adults).
Note: Approved ages and uses for products may vary; consult labeling for specific information.
Doxidan may be confused with doxepin
Dulcolax (bisacodyl) may be confused with Dulcolax (docusate)
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
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. Risk D: Consider therapy modification
Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy
Polyethylene Glycol-Electrolyte Solution: Laxatives (Stimulant) may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of colonic mucosal aphthous ulcerations may be increased. Management: Consider avoiding this combination due to a potential for increased risk of colonic mucosal aphthous ulcerations. Risk D: Consider therapy modification
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. Risk X: Avoid combination
Tablet: Do not administer within 1 hour of milk, dairy products, or an antacid.
Systemic exposure following maternal use of bisacodyl is limited. Plasma concentrations of BHPM (the active metabolite of bisacodyl) are low (median: 61 ng/mL; range: 20 to 118 ng/mL) and the pharmacokinetics are highly variable following oral doses of 10 mg/day for 7 days to women immediately postpartum (Friedrich 2011).
Use of bisacodyl should be limited during pregnancy due to an increased risk of adverse events, such as electrolyte abnormalities. When dietary changes and lifestyle modifications are insufficient, agents other than bisacodyl are recommended for the treatment of constipation in pregnant women (Body 2016; Gomes 2018).
Stool frequency and consistency, fluid status; serum electrolytes (as clinically appropriate or with prolonged use).
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
Onset of action: Oral: 6 to 12 hours; Rectal: 0.25 to 1 hour (suppository), 5 to 20 minutes (enema)
Half-life: BHPM: ~8 hours (Friedrich 2011)
Distribution: Vd: BHPM: 289 L (after multiple doses) (Friedrich 2011)
Metabolism: Bisacodyl is metabolized to an active metabolite (BHPM) in the colon; BHPM is then converted in the liver to a glucuronide salt (Friedrich 2011)
Absorption: Oral, rectal: Systemic, <5% (Wald 2003)
Excretion: BHPM: Urine, bile (Friedrich 2011)
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