What is bisacodyl

Bisacodyl is a stimulant laxative used to relieve constipation and also to prepare the bowel for diagnostic or surgical procedures requiring the bowel to be empty. Bisacodyl is a diphenylmethane laxative that acts by directly stimulating the nerve endings in the mucosa of the colon, increasing the movement of the intestines. Bisacodyl can help you empty your bowels if you have constipation (difficulty pooing).

Bisacodyl is used in hospitals to help you empty your bowels before surgery or some examinations or treatments. Your hospital will explain how to use it.

Bisacodyl comes as a tablet and a suppository (a medicine that you push gently into your back passage).

Bisacodyl tablets and suppositories are available on prescription and to buy from pharmacies.

Key facts

• Bisacodyl tablets take 6 to 12 hours to work.
• Bisacodyl suppositories take 10 to 45 minutes to work, so it’s best to stay close to a toilet.
• The most common side effects are feeling sick (nausea), diarrhea, stomach pain or cramps.
• Only give bisacodyl to children if their doctor recommends it.
• Do not take bisacodyl tablets or use bisacodyl suppositories every day for more than 5 days.
• Bisacodyl is also called by the brand name Alophen Pills, Bisac-Evac, Carter’s Little Pills, Correctol, Dulcolax, Feen-A-Mint, Fleet Bisacodyl, Bisacodyl Uniserts, Fleet Bisacodyl Enema, Dulcolax Bowel Prep Kit, Bisco-Lax, Doxidan Tablet, Ducodyl, Dulcolax Laxative, Evac-U-Gen, Ex-lax Ultra, Feen-A-Mint, Fleet Bisacodyl, Gen Lax, Magic Bullet, Veracolate, Dulcogen, Bisa-Plex, Bisolax, Gentle Laxative, Laxative Gentle Suppositories, Correct (New Formula), Modane, Colax, Gentlax Tablet and Fematrol.

Who can and can’t take bisacodyl

Bisacodyl can be used by adults.

Bisacodyl can also be used by children, if their doctor recommends it. Doctors normally only recommend it for children aged 4 years and older. Occasionally, they recommend it for children aged 2 years and older.

Bisacodyl enteric-coated tablets are not recommenced for children up to 6 years of age since patients in this age group may have difficulty swallowing the tablet without chewing it ¹⁾. Gastric irritation may develop if the enteric coating is destroyed by chewing ²⁾.

Furthermore, laxatives should not be given to young children unless prescribed by a physician. Since children are not usually able to describe their symptoms precisely, proper diagnosis should precede the use of laxatives ³⁾. This will avoid the complication of an existing condition (e.g., appendicitis) or the appearance of more severe side effects ⁴⁾.

Bisacodyl isn’t suitable for some people. To make sure it’s safe for you, tell your doctor or pharmacist if you have:

• ever had an allergic reaction to bisacodyl or any other medicines in the past
• signs of dehydration
• severe stomach pain and you are feeling sick or being sick (nausea or vomiting)
• a serious problem in your tummy (abdomen), such as appendicitis, a blockage in your bowel (intestinal obstruction), ulcerative colitis or Crohn’s disease, or a problem with the muscles in your bowel not being able to move food and liquid along

For bisacodyl tablets, also tell your doctor or pharmacist if you:

• can’t digest some sugars – the tablets contain a small amount of lactose and sucrose

For bisacodyl suppositories, also tell your doctor or pharmacist if you have:

• ever had an allergic reaction to suppositories
• tears or open sores (anal fissures) or cracked skin around your back passage (anus)

Before taking bisacodyl – Precautions

• tell your doctor and pharmacist if you are allergic to bisacodyl, any other medications, or any of the ingredients in these products. Check the label or ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• if you are taking antacids, wait at least 1 hour before taking bisacodyl.
• tell your doctor if you have stomach pain, nausea, vomiting, or a sudden change in bowel movements lasting more than 2 weeks.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking bisacodyl, call your doctor.
• talk to your doctor about the risks and benefits of taking this medication if you are 65 years of age or older. Older adults should not usually take bisacodyl because it is not as safe or effective as other medications that can be used to treat the same condition.
• Stimulant laxatives are habit forming and long term use of these drugs may result in laxative dependence and loss of normal bowel function ⁵⁾.

Pediatric use

Safety and effectiveness in pediatric patients has not been established

Geriatric use

Of the 222 patients who received HalfLytely HalfLytely (PEG-3350, sodium chloride, sodium bicarbonate and potassium chloride for oral solution) and 10 mg bisacodyl tablets bowel prep kit in clinical trials, 73 (33%) were 65 years of age or older, while 18 (8%) were 75 years of age or older. No overall differences in safety or effectiveness were observed between geriatric patients and younger patients, and other reported clinical experience has not identified differences in responses between geriatric patients and younger patients but greater sensitivity of some older individuals cannot be ruled out.

Note: HalfLytely is a white powder for reconstitution containing 210 grams of PEG-3350, 2.86 grams of sodium bicarbonate, 5.6 grams of sodium chloride, 0.74 grams of potassium chloride and 1 gram of flavoring ingredient (if applicable). This preparation can be used without the addition of a flavor pack. When dissolved in water to a volume of 2 liters, the HalfLytely solution is isosmotic (having the same osmotic pressure of intracellular fluid), clear, and colorless. The HalfLytely solution is administered orally after taking the two bisacodyl delayed release tablets.

Cautions with other medicines

Some medicines – and some foods – interfere with the way bisacodyl works.

For safety, tell your doctor or pharmacist if you are taking any other medicines, including herbal remedies, vitamins or supplements.

They include:

• water tablets (diuretics), steroids (like prednisolone) or digoxin (a heart medicine) – these can upset the balance of salts and minerals in your body if you have too much bisacodyl by accident. If you are taking digoxin, this imbalance makes it more likely you will have the serious side effects of digoxin. It’s important not to take too much bisacodyl if you are taking any of these medicines.
• indigestion remedies (antacids) and dairy products like milk, cheese and yogurt – these interact with bisacodyl tablets and stop them working properly. They can also make the bisacodyl irritate your stomach and give you indigestion. Do not take bisacodyl at the same time – leave a gap of 1 hour before or after taking bisacodyl if you are having indigestion remedies or dairy products. The small amount of milk in coffee and tea is unlikely to affect it, but it’s best to take bisacodyl tablets with a glass of water.

Mixing bisacodyl with herbal remedies or supplements

There is not enough research to know if complementary medicines and herbal remedies are safe to take with bisacodyl.

Bisacodyl in Pregnancy and Breastfeeding

Tell your pharmacist or doctor if you are trying to get pregnant, already pregnant, or breastfeeding.

FDA Pregnancy Risk Category B: NO EVIDENCE OF RISK IN HUMANS. Adequate, well controlled studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals, or, in the absence of adequate human studies, animal studies show no fetal risk. The chance of fetal harm is remote but remains a possibility ⁶⁾.

Bisacodyl tablets or suppositories are not generally recommended if you are pregnant, especially in the first 3 months and while you are breastfeeding. Talk to your doctor about the benefits and risks of taking bisacodyl.

If you are pregnant or breastfeeding, it’s always better to try to treat constipation without taking a medicine. Your doctor or midwife will first advise you to eat more fiber and drink plenty of fluids. It may also help to do gentle exercise.

If diet and lifestyle changes do not work, your doctor or midwife may recommend another laxative, such as lactulose or Fybogel. These are safer laxatives to take during pregnancy and while breastfeeding.

I just found out I am pregnant. Should I stop taking bisacodyl?

Always talk with your healthcare provider before making any changes in your medications. It is important to consider the benefits of treating constipation symptoms during pregnancy.

Constipation may cause pain and other health problems in pregnancy such as cramps, hemorrhoids, and breakdown of the anal tissue. Treating constipation will help reduce the risk of these problems. Dietary changes such as increasing fluids, eating high fiber foods such as whole grains and fresh fruits and vegetables can help prevent constipation. Regular exercise can also help. Although occasional constipation is common in pregnancy, talk with your healthcare provider if constipation becomes an ongoing problem. Your healthcare provider may also want to confirm the diagnosis of constipation and see how dietary and exercise changes can help before discussing medical treatment.

Can the use of laxatives during pregnancy cause birth defects?

Few studies have been done to look at the possible risks from using laxatives during pregnancy. However, the available studies show that when used in recommended doses, laxatives are not expected to increase the risk of birth defects or pregnancy problems.

Are there other concerns when using laxatives?

Yes. Laxatives may reduce the amount of nutrition and medicines that get into the blood since laxatives can make food go through the intestines faster than usual. Nutritional problems are only seen when these agents are used more than recommended.

When more than the recommended amounts of laxatives are used, some can also lower the levels of salts, such as magnesium, in a person’s blood. There is one reported case of low magnesium levels in a newborn that was linked to the mother using too much docusate sodium. The baby’s main symptom was jitteriness, which went away by the second day of life.

Castor oil has been used at the end of pregnancy to bring on labor. It can cause severe diarrhea and cramping of the bowel and uterus. However, if the lower part of the uterus (cervix) is not ready, these contractions will not bring on labor. If you are at the end of your pregnancy, your health care provider can discuss other ways to begin labor.

Bisacodyl and Breastfeeding

Bisacodyl is not absorbed from the gastrointestinal tract, and its active metabolite, which is absorbed, is not detectable in breastmilk ⁷⁾. Bisacodyl can be taken during breastfeeding and no special precautions are required ⁸⁾. Sixteen postpartum women who were not breastfeeding, but were producing at least 200 mL of milk daily by breast pump were given either oral enteric-coated bisacodyl tablets 10 mg daily or oral liquid sodium picosulfate (Laxoberal) 10 mg daily for 7 days ⁹⁾. Both drugs are prodrugs metabolized to the active drug, bis-(p-hydroxyphenyl)-2-pyridyl-2-methane. All breastmilk was collected daily from the day before drug administration to 2 days after the last dose. Free and conjugated bis-(p-hydroxyphenyl)-2-pyridyl-2-methane were undetectable (<1 mcg/L) in all milk samples ¹⁰⁾.

Bisacodyl contraindications

Bisacodyl tablets bowel prep kit is contraindicated in the following conditions:

• Known allergies to polyethylene glycol or other components of the kit
• Gastrointestinal (GI) obstruction
• Bowel perforation
• Toxic colitis
• Toxic megacolon

Warnings and Precautions

There have been reports of generalized tonic-clonic seizures in patients with use of large volume (4 liter) PEG-based colon preparation products in patients with no prior history of seizures. The seizure cases were associated with severe vomiting, excessive beverage consumption and electrolyte abnormalities (for example, hyponatremia, hypokalemia). The neurologic abnormalities resolved with correction of fluid and electrolyte abnormalities. Therefore, bisacodyl tablets bowel prep kit should be used with caution in patients using concomitant medications (such as diuretics) that increase the risk of electrolyte abnormalities or patients with known or suspected hyponatremia. Monitor baseline and post-colonoscopy laboratory tests (sodium, potassium, calcium, creatinine, and BUN) in these patients.

Warnings

There have been reports of generalized tonic-clonic seizures in patients with use of large volume (4 liter) PEG-based colon preparation products in patients with no prior history of seizures. The seizure cases were associated with severe vomiting, excessive beverage consumption and electrolyte abnormalities (for example, hyponatremia, hypokalemia). The neurologic abnormalities resolved with correction of fluid and electrolyte abnormalities. Therefore, bisacodyl tablets bowel prep kit should be used with caution in patients using concomitant medications (such as diuretics) that increase the risk of electrolyte abnormalities or patients with known or suspected hyponatremia. Monitor baseline and post-colonoscopy laboratory tests (sodium, potassium, calcium, creatinine, and BUN) in these patients.

Precautions

Use with caution in patient with severe ulcerative colitis, ileus or gastric retention. Observe patients with impaired gag reflex and patients prone to regurgitation or aspiration during administration of HalfLytely solution. If GI obstruction or perforation is suspected, appropriate studies should be performed to rule out these conditions before administration. There have been reports of ischemic colitis in patients with use of HalfLytely and 20 mg bisacodyl tablets bowel prep kit. If patients develop severe abdominal pain or rectal bleeding, patients should be evaluated as soon as possible.

Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes (sodium, potassium, calcium, BUN and creatinine). Hives and skin rashes have been reported with PEG-3350 based products which are suggestive of an allergic reaction.

How does bisacodyl work

Bisacodyl is in a class of medications called stimulant laxatives. It works by increasing activity of the intestines to cause a bowel movement.

Bisacodyl is hydrolyzed by intestinal brush border enzymes and colonic bacteria to form an active metabolite [bis-(p-hydroxyphenyl) pyridyl-2 methane; (BHPM)] that acts directly on the colonic mucosa to produce colonic peristalsis.

Bisacodyl is used on a short-term basis to treat constipation. It also is used to empty the bowels before surgery and certain medical procedures.

Bisacodyl has been used to facilitate flushing of colostomies and may reduce or eliminate the need for irrigations.

What is bisacodyl used for

Bisacodyl is used for treatment of occasional constipation, or to prepare patients for radiological examinations of the colon, sigmoidoscopy, and proctologic examinations, and for pre-operative bowel preparation.

Bisacodyl is used:

• to treat constipation that occurs following prolonged bed rest or hospitalization.
• to treat chronic constipation associated with opiate therapy.
• to treat constipation occurring secondary to idiopathic slowing of transit time, to constipating drugs, or to irritable bowel or spastic colon syndrome.
• to treat constipation in patients with neurologic constipation.

How should bisacodyl be used?

Bisacodyl comes as a tablet to take by mouth. Swallow the tablets whole with a glass of water; do not split, chew, or crush them. Do not take bisacodyl within 1 hour after drinking or eating dairy products. Bisacodyl is usually taken the evening before a bowel movement is desired. Do not take bisacodyl more than once a day or for more than 1 week without talking to your doctor. Follow the directions on the package or on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take bisacodyl exactly as directed. Frequent or continued use of bisacodyl may make you dependent on laxatives and cause your bowels to lose their normal activity.

What special dietary instructions should I follow?

A regular diet and exercise program is important for regular bowel function. Eat a high-fiber diet and drink plenty of liquids (eight glasses) each day as recommended by your doctor.

How long does it take for bisacodyl to work?

Bisacodyl tablet taken by mouth normally causes a bowel movement within 6 to 12 hours. If you do not have a regular bowel movement after taking bisacodyl, do not take any more medication and talk to your doctor.

Bisacodyl suppositories take 10 to 45 minutes to work, so it’s best to stay close to a toilet.

How long should I take bisacodyl for?

Do not take bisacodyl every day for more than 5 days. If you are still constipated after that, talk to your doctor.

Is it safe to take bisacodyl for a long time?

Ideally, you should only use bisacodyl occasionally and for a few days at a time.

Using laxatives like bisacodyl for longer can lead to a fluid and salt imbalance in your body and you may become dehydrated.

If you need to use laxatives every day for a longer time, talk to your doctor.

With long term use or overdosage of stimulant laxatives, electrolyte disturbances including hypokalemia, hypocalcemia, metabolic acidosis or alkalosis, abdominal pain, diarrhea, malabsorption, weight loss, and protein-losing enteropathy may occur ¹¹⁾. Electrolyte disturbances may produce vomiting and muscle weakness; rarely osteomalacia, secondary aldosteronism, and tetany may occur. Pathologic changes in including structural damage to the myenteric plexus, severe and permanent interference with colonic motility, and hypertrophy of the muscularis mucosae may occur with chronic use ¹²⁾.

Can I take different laxatives together?

For most people, 1 laxative will be enough to make your constipation better.

Occasionally, you may need to take 2 different types of laxatives at the same time to get your bowels moving again. Only take 2 laxatives together if your doctor or pharmacist tell you to as this increases the risk of side effects.

Are other laxatives any better?

There are other types of laxative. They work in a different way from bisacodyl, but are equally good at treating constipation.

• Bulk-forming laxatives, for example Fybogel and methylcellulose. These increase the “bulk” or weight of poo, which in turn stimulates bowel movement. They take 2 or 3 days to work.
• Osmotic laxatives, for example lactulose. These draw water from the rest of the body into your bowel to soften your poo and make it easier to pass. They take at least 2 days to work.
• Stimulant laxatives, for example senna. These stimulate the muscles that line your gut, helping them to move poo along your gut to your back passage. Senna takes about 8 hours to work.

Can I use bisacodyl after surgery?

It’s quite common to have constipation after surgery. Using a laxative may help.

If you have constipation after an operation, it’s better to use lactulose because it is gentler than bisacodyl. You can get it on prescription or buy it from pharmacies.

Can lifestyle changes help constipation?

It’s often possible to improve constipation without having to use laxatives. Before trying bisacodyl – or to stop constipation coming back – it may help to:

• eat more fiber – aim for about 30-35 g of fiber a day. High-fiber foods include fruit, vegetables and cereals. If you’re not used to a high-fiber diet, increase the amount of fiber you eat gradually.
• add bulking agents, such as wheat bran, to your diet. These will help make your poo softer and easier to pass (although bran and fiber can sometimes make bloating worse).
• drink plenty of water – to keep poo soft.
• exercise regularly – keeping your body active will help to keep your gut moving.
• go to the toilet when you need to, rather than holding it in.

Bisacodyl dosage

Alleviation of constipation can be expected within 8 to 12 hours if taken at bedtime or within 6 hours if taken during waking hours. You may find that it is most convenient to take bisacodyl about 30 to 60 minutes before your normal bedtime in order to produce a bowel movement in the morning.

Usual Adult Dose for Bowel Preparation

• 5 to 15 mg (1 to 3 tablets) orally once a day as needed or
• 10 mg (1 suppository) rectally once a day as needed or
• 10 mg rectal liquid once a day as needed.

Usual Adult Dose for Constipation

• 5 to 15 mg (1 to 3 tablets) orally once a day as needed or
• 10 mg (1 suppository) rectally once a day as needed or
• 10 mg rectal liquid once a day as needed.

Renal Dose Adjustments

• No adjustment recommended.
• Caution is recommended when using bisacodyl enemas containing monobasic or dibasic sodium phosphate in patients with impaired renal function or where colostomy exists as hypocalcemia, hyperphosphatemia, hypernatremia, and acidosis may occur.

Liver Dose Adjustments

No adjustment recommended

Dialysis

No adjustment recommended

How and when to take bisacodyl

Before using rectal bisacodyl

• tell your doctor and pharmacist if you are allergic to bisacodyl, any other medications, or any of the ingredients in these products. Check the label or ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have stomach pain, nausea, vomiting, a sudden change in bowel movements lasting more than 2 weeks, anal fissures, or hemorrhoids.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using rectal bisacodyl, call your doctor.
• talk to your doctor about the risks and benefits of using this medication if you are 65 years of age or older. Older adults should not usually use rectal bisacodyl because it is not as safe or effective as other medications that can be used to treat the same condition.

How to take bisacodyl

Bisacodyl Tablets

• Take the medicine once a day just before bedtime.
• You can take it with or without food. Swallow the tablet whole with water.
• Do not have milk, indigestion remedies (antacids) or medicines to reduce stomach acid (for example, proton pump inhibitors) at the same time as bisacodyl. This is because they will stop the medicine working properly. Leave a gap of 1 hour between taking any of these and taking your bisacodyl tablets.

Bisacodyl Suppositories

• Take the wrapping off and push a suppository gently into your back passage (anus).
• Suppositories work quickly (usually between 10 and 45 minutes), so use it when you know you will be near a toilet.
• Read the instructions in the leaflet inside the package. They will explain how to use the suppository.

Rectal bisacodyl comes as a suppository and enema to use rectally. It is usually used at the time that a bowel movement is desired. The suppositories usually cause a bowel movement within 15 to 60 minutes and the enema within 5 to 20 minutes. Do not use bisacodyl more than once a day or for more than 1 week without talking to your doctor. Follow the directions on the package or on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use rectal bisacodyl exactly as directed. Frequent or continued use of bisacodyl may make you dependent on laxatives and cause your bowels to lose their normal activity. If you do not have a regular bowel movement after using bisacodyl, do not use this medication again and talk to your doctor.

If using a bisacodyl suppository, follow these steps:

1. If the suppository is soft, hold it under cool water or place it in the refrigerator for a few minutes to harden it before removing the wrapper.
2. Remove the wrapper.
3. If you were told to use half of the suppository, cut it lengthwise with a clean, sharp knife or blade.
4. Lie down on your left side and raise your right knee to your chest.
5. Using your finger, insert the suppository, pointed end first, into your rectum until it passes the muscular sphincter of the rectum, about 1 inch (2.5 centimeters) in adults. If not inserted past this sphincter, the suppository may pop out.
6. Hold it in place for as long as possible.
7. Wash your hands thoroughly.

If using a bisacodyl enema, follow these steps:

1. Shake the enema bottle well.
2. Remove the protective shield from the tip.
3. Lie down on your left side and raise your right knee to your chest or kneel and lean forward so that your head and chest are resting comfortably.
4. Gently insert the enema bottle into the rectum with the tip pointing toward the navel.
5. Squeeze the bottle gently until the bottle is nearly empty.
6. Remove the enema bottle from the rectum. Hold the enema contents in place as long as possible, for up to 10 minutes.
7. Wash your hands thoroughly.

How much bisacodyl to take

Bisacodyl Tablets

The usual dose in:

• adults and children aged 12 years and over is 5—15 mg/day (1 to 3 tablets) once a day before bedtime
• children aged 6 to 11 years old is 5 mg (1 tablet) a day before bedtime, if their doctor recommends it

If you are an adult or child aged 10 and over and you have not taken bisacodyl before, start with 1 tablet. If that doesn’t work well enough for you, you can take 2 tablets.

Bisacodyl Suppositories

The usual dose for:

• adults and children aged 12 years and over is 1 suppository (10mg) a day
• children 6 to 12 years old is 1 suppository (5mg) a day, if their doctor recommends it

What if I forget to take it?

If you forget a dose of bisacodyl, don’t worry. Just take the next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

What if I take too much?

Taking an extra dose of bisacodyl by accident is unlikely to harm you. You may get diarrhea and stomach pain, but this should get better within a day or two.

If you’re worried, talk to your doctor or pharmacist for advice.

Is there any food and drink I need to avoid?

Do not take bisacodyl at the same time as dairy products like milk, cheese or yogurt. Leave a gap of 1 hour between taking any of these and taking your bisacodyl tablets. The small amount of milk in coffee and tea should not affect the bisacodyl tablet.

It’s a good idea to stop eating pastries, cakes, puddings and cheese for a while as these can make constipation worse.

Can I drink alcohol with bisacodyl?

Yes, you can drink alcohol with bisacodyl.

Bisacodyl side effects

Like all medicines, bisacodyl may cause side effects in some people, but many people have no side effects or only minor ones.

Common side effects

Common side effects, which happen in more than 1 in 100 people, are:

• feeling sick (nausea)
• diarrhea
• stomach pain or cramps
• stomach cramps
• faintness
• rectal administration of bisacodyl suspensions or suppositories may cause irritation and a sensation of burning of the rectal mucosa and mild proctitis (for rectal bisacodyl)

These side effects are mild and usually go away after a couple of days. Talk to your doctor or pharmacist if the side effects bother you or don’t go away.

Gastrointestinal

Bisacodyl causes acute nonspecific inflammatory injury to the rectal mucosa, which can confound the assessment of patients with suspected inflammatory bowel disease.

The surreptitious abuse of laxatives is a common cause of severe chronic diarrhea. In some cases, the stool contains fecal leukocytes, which, in this case, is indicative of the irritant effect of bisacodyl (nonspecific colonic mucosal inflammation), and not necessarily of infection. Surreptitious abuse of laxatives due to bisacodyl can be determined by urinalysis for a metabolite, bisacodyl diphenol. In some cases, stool analysis for bisacodyl could be considered in the diagnostic assessment.

Abdominal cramping has been described as a mild, colicky discomfort. This can be a problem since cramping my indicate not only a side effect of bisacodyl, but underlying gastrointestinal pathology.

Abdominal distension and vomiting are less common gastrointestinal side effects.

Gastrointestinal side effects have been reported the most frequently. These have included abdominal cramping, diarrhea, abdominal distention, and vomiting. Severe diarrhea has been reported as a possible result of surreptitious laxative abuse. The sensation of rectal “burning” with administration of bisacodyl enema has been reported.

Metabolic

The metabolic consequences of some Fleet bisacodyl enema preparation kits that contain monobasic or dibasic sodium phosphate in patients with renal insufficiency can be profound. Due to the sodium and phosphate absorption, severe hypernatremia, hypophosphatemia, and hypocalcemia may occur.

Metabolic side effects have included severe hypernatremia, hypophosphatemia, and hypocalcemia. These effects have been reported primarily with Fleet bisacodyl enema preparation kits that contain monobasic or dibasic sodium phosphate and administered to patients with renal insufficiency. Fleet bisacodyl enemas without these ingredients may be used safely in such patients.

Serious side effects

Call your doctor straight away if these rare side effects happen to you:

• feeling dizzy
• blood in your poo
• rectal bleeding
• being sick (vomiting)

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to bisacodyl.

• A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

• getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
• wheezing
• tightness in the chest or throat
• having trouble breathing or talking
• swelling of the mouth, face, lips, tongue or throat

These are not all the side effects of bisacodyl. For a full list, see the leaflet inside your medicines packet.

How to cope with side effects

What to do about:

• feeling sick – try taking bisacodyl with some food.
• diarrhea – stop taking bisacodyl and drink plenty of water or other fluids. Speak to a pharmacist if you have signs of dehydration, such as
• peeing less than usual or having dark, strong-smelling pee. Don’t take any other medicines to treat diarrhea without speaking to a pharmacist or doctor.
• stomach pain or cramps – reduce your dose of bisacodyl or stop taking it until these side effects go away.

Human Toxicity Reports

Mild to moderate toxicity

• Nausea, vomiting, abdominal pain, and diarrhea have been reported.

Severe toxicity

• Fluid and electrolyte depletion, hypotension from extensive fluid losses, blisters, and skin sloughing of the buttocks and perineum with diarrhea.

Chronic toxicity

• Electrolyte abnormalities (e.g., hypochloremia, hypokalemia, hypocalcemia, hypomagnesemia), reflex bowel hypofunction, permanent colonic dysfunction (cathartic colon, causing chronic constipation, bloating, and abdominal pain), frank/occult gastrointestinal bleeding and associated anemia, steatorrhea, protein-loss gastroenteropathy, pancreatic dysfunction. Toxic hepatitis and jaundice have been reported following the chronic use of very large doses of senna.

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in clinical studies of another drug and may not reflect the rates observed in practice. In a clinical study of HalfLytely and (10 mg vs. 20 mg) bisacodyl tablets bowel prep kit multicentered, controlled clinical trials, abdominal pain/cramping, nausea, vomiting and headache were the most common adverse reactions ( 3%) after the administration of HalfLytely and (10 mg or 20 mg) bisacodyl tablets bowel prep kit. Less than 1% of patients exposed to HalfLytely and 10 mg bisacodyl tablets bowel prep kit reported vomiting and abdominal pain/cramping. The data in reflects exposure in 222 patients to HalfLytely and 10 mg bisacodyl tablets vs. 223 patients exposed to HalfLytely and 20 mg bisacodyl tablets. The HalfLytely and 10 mg bisacodyl tablets bowel prep kit population was 20-85 years of age, 46% male, 54% female, 10% African American, 85% Caucasian, 8% Hispanic requiring a colonoscopy. The demographics of the comparator group were similar.

In therapeutic oral doses, all stimulant laxatives may produce some degree of abdominal discomfort, nausea, mild cramps, griping, and/or faintness. Rectal administration of bisacodyl suspensions may cause irritation and a sensation of burning of the rectal mucosa and mild proctitis ¹³⁾.

Weakness, incoordination, and orthostatic hypotension may be exacerbated in elderly patients as a result of significant electrolyte loss when stimulant laxatives are used repeatedly to evacuate the colon ¹⁴⁾.

Suppository may produce mild feeling of a sharp stinging pain or tenesmus, and with continued rectal administration may cause proctitis ¹⁵⁾. Sloughing of surface of epithelium of rectum has been observed. Inflammatory changes that occur after short-term use of bisacodyl suppositories may resemble those seen in mild idiopathic ulcerative proctitis.

Bisacodyl should not be given to patients with intestinal obstruction or acute abdominal conditions such as appendicitis; care should be taken in patients with inflammatory bowel disease. It should not be used in patients with severe dehydration. The suppositories should preferably be avoided in patients with anal fissures, proctitis, or ulcerated hemorrhoids ¹⁶⁾.

A case report on a female patient with frequent, repetitive formation of kidney stones and rapid double J stent encrustation, which were related to the chronic abuse of bisacodyl. Although these stones can be fragmented successfully by extracorporeal shockwave lithotripsy, it seems that the better treatment for this type of stone formation is to avoid the abuse of laxatives ¹⁷⁾.

A case report a case of ammonium acid urate stone due to laxative abuse ¹⁸⁾. A 27-year-old female complained of left flank pain. Computed tomography revealed bilateral ureter stones (right 16.5 x 9.0 mm; left 4 mm), while left ureter stone was radiolucent on the plain X ray film. Bilateral hydronephrosis was seen, but no therapy was performed for the right stone, because 99mTc-MAG3 scintigraphy revealed that right kidney had no function. The left stone was successfully removed by transurethral approach. The stone was revealed to be an ammonium acid urate by infrared spectrophotometry. She had been taking many laxatives (bisacodyl, sennoside, aloe extract) for 12 years to control her body weight ¹⁹⁾. Ammonium acid urate stones are rarely seen in developed countries. We have reviewed 9 cases in Japan, describing ammonium acid urate stones due to laxative abuse. Among these patients, 24-hour urine volume and excretion in urinary sodium were decreased, and serum aldosterone was increased. The involvement of laxative abuse should be considered when ammonium acid urate is formed in a woman with a low body mass index ²⁰⁾.