Bisacodyl, a derivative of diphenylmethane, is a stimulant laxative used to treat constipation. Bisacodyl often is used to prepare patients for radiological examinations of the colon, sigmoidoscopy, and proctologic examinations. Bisacodyl was approved by the FDA in October 1957. In 1998, the FDA proposed to amend the final monograph for OTC laxative products to reclassify certain stimulant laxative ingredients, including aloe, bisacodyl, casanthranol, cascara sagrada, and senna, from Category I (generally recognized as safe and effective) to Category III (further testing is required), until more data regarding safety and efficacy were available. The final OTC laxative monograph rule, effective November 5, 2002, stated that data were submitted to the FDA regarding bisacodyl's safety and efficacy as an OTC laxative, and that future publications would address the drug's role as an acceptable OTC laxative. In 1999, bisacodyl tannex formulations were withdrawn from the US market.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
-Oral preparations should be administered the evening before a morning bowel movement is desired. Administering on an empty stomach will produce more rapid results.
-To avoid gastric irritation and the possibility of vomiting, enteric-coated preparations must be swallowed whole and not crushed or taken within 1 hour of antacids or milk.
Rectal Administration
-Suppositories or enemas may be administered at the time a bowel movement is desired.
-Instruct patient on proper use of suppository or enemas (see Patient Information).
-Unwrap and moisten the suppository with water prior to insertion. If suppository is too soft because of storage in a warm place, chill in the refrigerator for 30 minutes or run cold water over it before removing the wrapper.
-Encourage patient to retain suppository or enema for 15-30 minutes before expelling.
Short-term usage of bisacodyl (at normal dosages) typically results in abdominal pain or cramps, faintness, nausea, vomiting, or mild abdominal discomfort. Rectal suppositories of bisacodyl may cause rectal burning and mild proctitis.
Stimulant laxatives, such as bisacodyl, are the laxatives most likely to cause gastrointestinal (GI) irritation, fluid and electrolyte loss (e.g., hypokalemia), or diarrhea, particularly with prolonged use. Prolonged use of stimulant laxatives can result in physiological dependence on the laxative ('cathartic colon'), leading to constipation when use is interrupted.
Bisacodyl tannex formulations are no longer available in the US. Bisacodyl tannex was not to be used for multiple dosages because of the risk of increased absorption of tannic acid, leading to hepatotoxicity and possibly death; recommended dosages were not to be exceeded. Bisacodyl tannex was also contraindicated in patients < 10 years of age because the risk of absorbing tannic acid had not been studied in this population.
Bisacodyl should not be used in patients with known or suspected GI obstruction or ileus; GI perforation; toxic colitis or toxic megacolon. Patients with symptoms suggestive of bowel obstruction (e.g., acute abdomen or symptoms of appendicitis, abdominal pain, distension, nausea, or vomiting) should be evaluated prior to initiating laxative therapy. Use bisacodyl with caution in the presence of severe ulcerative colitis or other conditions where there may be compromised integrity of the bowel wall (e.g., diverticulitis, rectal fissures). Stimulant laxatives may aggravate these conditions, and may rarely result in bowel perforation in such patients. In a patient with fecal impaction, the administration of a stimulant laxative is not likely to produce disimpaction, and other known effective methods should be employed. Bisacodyl tablets should not be used in patients with dysphagia or those who cannot swallow a tablet without chewing it first.
Patients should be advised to discontinue use and consult their health care professional if they notice a sudden change in bowel habits that persists for two weeks. Bisacodyl is contraindicated in patients with rectal GI bleeding; if rectal GI bleeding or failure to produce a bowel movement within 12 hours occurs after the use of this laxative, patients should discontinue use and consult their health care professional. For self-treatment, patients should not use this product for a period of 1 week or more without provider consultation; chronic use is not recommended. Patients with rectal bleeding (undiagnosed) should stop using the laxative and consult prescriber for evaluation. Stimulant laxatives, such as bisacodyl, are the laxatives most likely to cause GI irritation or fluid and electrolyte loss. Elderly patients may be more susceptible to hypokalemia or other electrolyte imbalance. If diarrhea occurs, the stimulant laxative should be discontinued. Laxative dependence ('cathartic colon') may occur with long-term continuous stimulant laxative therapy. However, when used no more than 2 to 3 times per week, most stimulant laxatives currently available can be used without risk of laxative dependence.
Pregnant individuals should consult a qualified health care prescriber prior to using bisacodyl as controlled studies in pregnancy have not been performed; however no evidence of teratogenic effects has been reported with use and systemic absorption is low after either oral or rectal administration. Use at recommended doses for occasional constipation during pregnancy, when needed, is not expected to produce harm to the fetus. The safest first-line treatments to use during pregnancy are those that have more data regarding their use in pregnancy and are not absorbed systemically (e.g., fiber, bulk-forming laxatives, stool softeners). When needed, psyllium, docusate sodium, or polyethylene glycol 3350 have minimal systemic absorption and can be considered for chronic constipation during pregnancy.
Clinical data show that neither the active moiety of bisacodyl (BHPM or bis-(p-hydroxyphenyl)-pyridyl-2-methane) nor its glucuronides are excreted into the milk of healthy lactating females. Thus, clinical risk to the infant is negligible and the drug may be used if needed during breast-feeding; no special precautions exist. Other agents may also be considered for treating constipation during lactation; alternate drugs to consider include docusate products, magnesium hydroxide, and psyllium. Senna (standardized sennosides) has also been commonly used post-partum and is considered compatible with breast-feeding.
Oral administration of bisacodyl is not recommended for neonates, infants, or children younger than 6 years old. Use is limited by the child's ability to swallow tablets without chewing. Suppositories of bisacodyl, at an appropriate dosage, may be used for younger children (1 year of age and older) if under the advice of their health care prescriber. Bisacodyl enemas are not recommended in children younger than 12 years of age. The use of bisacodyl (any formulation) in infants is not recommended.
Stimulant laxatives, such as bisacodyl, are the laxatives most likely to cause GI irritation or fluid and electrolyte loss. Geriatric patients may be more susceptible to hypokalemia or other electrolyte imbalance. If diarrhea occurs, the stimulant laxative should be discontinued. The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of medications in residents of long-term care facilities. The OBRA guidelines caution that laxatives may cause flatulence, bloating, and abdominal pain.
For the treatment of occasional constipation:
Oral dosage:
Adults: 5 to 15 mg PO as a single dose or once daily as needed. Either a suppository or oral tablet/capsule(s) may be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.
Children and Adolescents 12 to 17 years: 5 to 15 mg PO as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.
Children 6 to 11 years: 5 mg PO as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation).
Rectal dosage (suppository):
Adults: 10 mg (1 suppository) rectally as a single dose or once daily as needed. Either a suppository or oral tablet/capsule(s) may be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.
Children and Adolescents 12 to 17 years: 10 mg (1 suppository) rectally as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.
Children 6 to 11 years: 5 mg (0.5 suppository) rectally as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.
Rectal dosage (enema):
Adults: 10 mg (1 retention enema) rectally as a single dose or once daily as needed.
Children and Adolescents 12 to 17 years: 10 mg (1 retention enema) rectally as a single dose or once daily as needed.
Maximum Dosage Limits:
-Adults
15 mg/day PO or 10 mg/day PR.
-Geriatric
15 mg/day PO or 10 mg/day PR.
-Adolescents
15 mg/day PO or 10 mg/day PR.
-Children
12 years: 10 mg/day PR (suppository or enema) or 15 mg/day PO.
6 to 11 years: 5 mg/day PR or PO; do not use enema.
Less than 6 years: Safety and efficacy have not been established. Off-label use has been reported.
-Infants
Safety and efficacy have not been established.
-Neonates
Not indicated.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
*non-FDA-approved indication
Acetaminophen; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Aluminum Hydroxide: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Carbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Hydroxide: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Trisilicate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Amoxicillin; Clarithromycin; Omeprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Antacids: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aspirin, ASA; Omeprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Atropine; Difenoxin: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Bumetanide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Calcium Carbonate: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour. (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Calcium Carbonate; Magnesium Hydroxide: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Carbonate; Simethicone: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Phosphate, Supersaturated: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery.
Calcium; Vitamin D: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Chlorpheniramine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Cimetidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Dexlansoprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Dichlorphenamide: (Moderate) Use dichlorphenamide and bisacodyl together with caution. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Measure potassium concentrations at baseline and periodically during dichlorphenamide treatment. If hypokalemia occurs or persists, consider reducing the dichlorphenamide dose or discontinuing dichlorphenamide therapy.
Diphenoxylate; Atropine: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Esomeprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Ethacrynic Acid: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Famotidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Food: (Minor) The concomitant use of bisacodyl oral tablets with milk-containing products can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid ingesting milk products within 1 hour before or after the bisacodyl dosage.
Furosemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
H2-blockers: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone; Ibuprofen: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Ibuprofen; Famotidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Lactulose: (Major) In general, other laxatives, such as bisacodyl, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved.
Lansoprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Lansoprazole; Amoxicillin; Clarithromycin: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Loop diuretics: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Magnesium Hydroxide: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Magnesium Salts: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
Naproxen; Esomeprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Nizatidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Omeprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Omeprazole; Amoxicillin; Rifabutin: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Omeprazole; Sodium Bicarbonate: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage. (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Pantoprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Polyethylene Glycol: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis. (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes; Ascorbic Acid: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis. (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes; Bisacodyl: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Proton pump inhibitors: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Rabeprazole: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Ranitidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Sodium Bicarbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery.
Torsemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Stimulant laxatives are believed to produce laxation by directly stimulating peristaltic movement of the intestine via local mucosal irritation, thus increasing motility. More recent studies suggest that bisacodyl promotes evacuation of the colon by altering intestinal fluid and electrolyte absorption. This causes a net intestinal fluid accumulation and produces laxation.
Bisacodyl is administered either orally or rectally. Bisacodyl distributes locally, and the circulating drug undergoes hepatic metabolism and is then excreted in the urine.
-Route-Specific Pharmacokinetics
Oral Route
Bisacodyl is minimally absorbed (15%), and the onset of action of the drug begins 6-8 hours after an oral dose.
Other Route(s)
Rectal Route
Bisacodyl is minimally absorbed (15%), and the onset of action of the drug begins 15-60 minutes after rectal administration.