Mode of action
Act by direct stimulation of nerve endings in colonic mucosa to increase intestinal motility. May cause accumulation of water and electrolytes in the colonic lumen.
Indications
Constipation; Bowel preparation before diagnostic or surgical procedures requiring bowel emptying.
Contraindications
Intestinal obstruction, partial or complete; Acute abdominal conditions, e.g. appendicitis; Inflammatory bowel condition.
Specific considerations
Elderly: increased risk of faecal incontinence.
Pregnancy: avoid direct stimulants except for occasional doses; ADEC category A.
Lactation: may be used.
Adverse effects
Infrequent: rectal irritation, proctitis (with rectal administration), abdominal cramps, fluid and electrolyte imbalance (especially hypokalaemia).
Dosage
Constipation
Adult: Oral, 5–15 mg as a single dose at night. Rectal, 10 mg once daily when required.
Child: >3 years, oral 5–10 mg as a single dose at night; rectal 5–10 mg once daily as required. <3 years, rectal 5 mg once daily as required.
Bowel preparation: Adult, up to 30 mg orally on the night before the procedure (or 10 mg on each of the 2 nights before the procedure), usually followed by 10 mg rectally on the morning of the procedure.
Practice points
- onset of action is 6–12 hours (oral); 15–60 minutes (suppository); 5–15 minutes (enema)
- may be used long term for constipation in spinal damage, chronic neuromuscular disease and in people
- taking opioids; often used with other laxatives
- stimlants are the laxative group most often associated with laxative misuse.
Products
BISACODYL SUPP. 10 MG (DULCOLAX®, LAXADYL®, SACOLUX®)
BISACODYL TABS 5 MG (BICODYL®, DULCOLAX®, LAXADYL®)