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Uses

Constipation

Used as a stimulant laxative to relieve occasional constipation.

Has a more pronounced laxative effect than mild laxatives (e.g., anthraquinones such as cascara sagrada [no longer commercially available in the US]) but less pronounced than the violent purgation produced by castor oil.

Use of stimulant laxatives for simple constipation is seldom necessary or desirable.

If a stimulant laxative is used, senna derivatives may be preferred.

Used to treat constipation that occurs following prolonged bed rest or hospitalization.

Used to treat chronic constipation assopciated with opiate therapy.

Because bisacodyl may be distributed into milk, other laxatives usually are preferred for postpartum constipation.

Stimulant laxatives have been used to treat constipation resulting from diminished colonic motor response in geriatric patients but, because this type of constipation is frequently due to psychological or physical laxative dependence, the bulk-forming laxatives are preferred.

Stimulant laxatives are used to treat constipation occurring secondary to idiopathic slowing of transit time, to constipating drugs, or to irritable bowel or spastic colon syndrome.

Stimulant laxatives have been used to treat constipation in patients with neurologic constipation.

Colonic Evacuation

Used orally and/or rectally (as suppositories or enemas) to empty the bowel prior to surgery or radiologic, proctoscopic, or endoscopic (e.g., sigmoidoscopic, proctoscopic) procedures, when thorough evacuation is essential. Oral therapy often is supplemented with rectal evacuants.

Used orally or rectally as a laxative for postoperative, antepartum, or postpartum care.

Enemas are used to cleanse the colon postoperatively.

Suppositories may be used to cleanse the colon in pregnant women prior to delivery if they are given at least 2 hours before onset of the second stage of labor.

Usually supplemented with administration of rectal evacuants, such as saline, stimulant, or soapsuds enemas, immediately before radiologic procedures.

Bisacodyl tannex is added to barium sulfate enemas to aid in coating the intestinal mucosa and enhance colonic evacuation prior to radiologic examination of the colon.

Colostomy Flushing

Has been used to facilitate flushing of colostomies†; may reduce or eliminate the need for irrigations.

Dosage and Administration

Administration

Administer orally as delayed-release (enteric-coated) tablets.

Adminster rectally as suspension enemas or as suppositories.

Administered as a flush suspension† for colostomies.

Oral Administration

Bisacodyl is administered orally.

For occasional use as an oral laxative, administer the evening before a morning bowel movement is desired.

To avoid gastric irritation and the possibility of vomiting, delayed-release (enteric-coated) tablets must be swallowed whole and not crushed, chewed, or taken within 1 hour of antacids or milk.

Rectal Administration

Bisacodyl also is administered rectally as a suppository or enema.

Remove the foil wrapper and insert the suppository well into the rectum, pointed end first, and retain for at least 15–20 minutes if possible.

Shake bisacodyl enemas well and remove the protective shield from the tip before inserting rectally. Lie on left side with left knee slightly bent and the right leg drawn up or be in the knee-chest position and insert the enema tip into the rectum. Squeeze the contents of the enema container into the rectum.

Bisacodyl tannex is administered rectally as an enema.

Rectal suppositories and enemas may be administered at the time a bowel movement is desired.

Dosage

Pediatric Patients

Constipation

Stimulant laxatives generally avoided in children <6 years of age for occasional constipation, unless otherwise directed by a clinician.

Oral

Children 3–11 Years of Age: A single 5- to 10-mg (usually 5-mg) or 0.3-mg/kg dose daily.

Children ≥12 Years of Age: A single 5- to 15-mg (usually 10-mg) dose daily.

Rectal (enema)

Children ≥12 Years of Age: A single 10-mg (30-mL) dose daily.

Rectal (suppositories)

Children <2 Years of Age: A single 5-mg (½ suppository) dose daily.

Children 2–11 Years of Age: A single 5- or 10-mg (½ or 1 suppository, respectively) dose daily.

Children ≥12 Years of Age: A single 10-mg (1 suppository) dose daily.

Adults

Constipation

Oral

Usually, 5–15 mg daily given as a single dose; some patients may require single daily doses up to 30 mg.

Rectal (enema)

A single 10-mg (30-mL) dose daily.

Rectal (suppositories)

A single 10-mg (1 suppository) dose daily.

Colonic Evacuation

Up to 30 mg may be given orally when complete evacuation of the colon is required for special procedures.

One of the following regimens can be used to clear the bowel prior to surgical, radiologic, or endoscopic procedures. When available, provide patients with a copy of the manufacturers' instructions, which detail the specific regimen to be employed.

Bisacodyl Preparation for Barium Sulfate Enemas

Oral and Rectal

Give up to 30 mg of bisacodyl orally the night before the procedure, followed by a 10-mg bisacodyl rectal suppository 1–2 hours before the procedure. Do not eat following administration of the tablets.

Bisacodyl and Magnesium Citrate Preparatory Regimens

Oral and Rectal

Preparatory regimens using magnesium citrate, which acts mainly on the small intestine, in addition to administration of the usual oral (up to 30 mg) and rectal (10 mg) dose of bisacodyl also have been used.

Bisacodyl Antepatum Preparation

Rectal (suppositories)

To cleanse the colon prior to delivery, a single 10-mg bisacodyl rectal suppository is administered at least 2 hours before onset of the second stage of labor.

Bisacodyl Tannex Preparatory Enema

Enema

Bisacodyl tannex may be used prior to radiologic examinations or sigmoidoscopic or proctoscopic procedures.

Give a residue-free diet the day before the prcedure, followed by 30–60 mL of castor oil orally 16 hours before the examination or procedure.

Prepare a cleansing enema by dissolving bisacodyl tannex equivalent to 1.5 mg of bisacodyl and 2.5 g of tannic acid (one packet of the commercially available bisacodyl tannex product) in 1 L of lukewarm water.

When used as a radiopaque enema adjuvant, bisacodyl tannex equivalent to 1.5–3 mg of bisacodyl (1–2 packets of the commercially available product) is dissolved in 1 L of barium sulfate suspension. The concentration of bisacodyl tannex should not exceed 0.5% (2 packets of the commercially available product per L).

Administer the cleansing enema containing bisacodyl tannex the day of the procedure.

If necessary, repeat the cleansing enema, but total dosage for one entire colonic examination (including the cleansing enema) should not exceed 4.5 mg of bisacodyl and 7.5 g of tannic acid (3 packets of the commercially available preparation), and no more than 6 mg of bisacodyl and 10 g of tannic acid (4 packets of the commercially available product) should be administered during a 72-hour period.

Dulcolax^® Prep Kit

Oral and Rectal

The regimen begins with a liquid meal at a prescribed time, followed by periodic clear liquid intake throughout the day and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.

In the usual regimen, 300 mL of magnesium citrate is administered orally at 4 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 6 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 5:30 a.m. the morning of the procedure.

Evac-Q-Kwik^® Kit

Oral and Rectal

Each regimen begins with a liquid meal at a prescribed time, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.

In the usual regimen, 300 mL of magnesium citrate is administered orally at 4 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at 7 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 10 p.m. the day before the procedure.

In the alternative regimen, 300 mL of magnesium citrate is administered orally at 7 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at 10 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 6 a.m. the morning of the procedure.

E-Z-EM^® LoSo Prep Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.

In the usual regimen, one packet of magnesium citrate is dissolved in 240 mL cold water (yeilding a 16.4-g magnesium citrate solution) and administered orally at 5:30 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 7:30 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at least 2 hours before the procedure.

Fleet^® Prep Kits

Oral and Rectal

Available in 3 kit combinations containing bisacodyl tablets, sodium phosphate oral solution, and either a bisacodyl suppository (kit #1), a large-volume cleansing enema (kit #2), or a bisacodyl enema (kit #3).

Each kit can be administered in regimens beginning 18, 24, or 48 hours before the procedure; in most cases, the 24-hour regimen is followed.

Each regimen begins with a light meal at a prescribed time, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of either a bisacodyl suppository, bisacodyl enema, or cleansing (“bag”) enema 1 hour before leaving for the procedure.

In the 24-hour regimen, 45 mL of sodium phosphate is mixed with ½ glass of cold clear liquid and administered orally at 4 p.m. the day before the procedure, followed by 20 mg (or alternative dose per clinician) of bisacodyl orally at 9 p.m. the day before the procedure, and then by either a 10-mg bisacodyl rectal suppository (kit #1), a cleansing enema (kit #2), or a 10-mg (30-mL) bisacodyl enema administered 1 hour before leaving for the procedure.

LiquiPrep^® Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.

In the usual regimen, 300 mL of magnesium citrate is administered orally at 5:30 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 9:30 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository 1 hour before leaving for the procedure.

Tridate^® Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.

In the usual regimen, 300 mL of magnesium citrate is administered orally at 8 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at 10 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 7 a.m. the morning of the procedure.

Tridate^® Dry Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.

In the usual regimen, one packet of magnesium citrate is dissolved in 240 mL room-temperature water (yielding a 19-g magnesium citrate solution; allow to dissolve for 20 minutes before drinking) and is administered orally in 2 divided doses at 6 p.m. and 6:15 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at bedtime (between 9 p.m. and midnight) the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 7 a.m. the morning of (at least 2 hours before) the procedure.

X-Prep^® Kit-1

Oral and Rectal

There are 3 recommended regimens, depending on the time of day the procedure is scheduled and whether the patients is to be admitted; the sequence of laxative administration is the same for all 3 regimens, with only the scheduled times changing. The sequence of liquid meals and clear liquid intake differs, and the manufacturer's instructions should be consulted for details.

The regimen begins with an oral laxative, followed by an additional oral laxative, and concluding with rectal administration of a bisacodyl suppository.

For morning procedures, 2 tablets (Senokot^® S) containing standardized senna concentrate (sennosides 8.6 mg) and docusate sodium (50 mg) are administered orally at 7:30 a.m. the day before the procedure, followed by 74 mL (X-Prep^® Liquid) containing standardized senna concentrate (sennosides 130 mg) orally at 3 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at least 1 hour before leaving for the procedure.

For afternoon procedures, 2 tablets (Senokot^® S) containing standardized senna concentrate (sennosides 8.6 mg) and docusate sodium (50 mg) are administered orally at noon with a liquid lunch the day before the procedure, followed by 74 mL (X-Prep^® Liquid) containing standardized senna concentrate (sennosides 130 mg) orally at 11 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at least 1 hour before leaving for the procedure.

For hospitalized patients admitted the afternoon before the procedure and for late admissions, 2 tablets (Senokot^® S) containing standardized senna concentrate (sennosides 8.6 mg) and docusate sodium (50 mg) upon admission the day before the procedure, followed by 74 mL (X-Prep^® Liquid) containing standardized senna concentrate (sennosides 130 mg) orally at 6–7 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at least 1 hour before leaving for the procedure.

Special Populations

Dosage in Hepatic Impairment

No specific dosage recommendations for hepatic impairment. Minimally absorbed systemically following oral or rectal administration.

Dosage in Renal Impairment

No specific dosage recommendations for renal impairment. Minimally absorbed systemically following oral or rectal administration.

Geriatric Patients

No specific geriatric dosage recommendations.