Can senna and bisacodyl be taken concurrently?

From the Guidelines

It is not recommended to take senna and bisacodyl at the same time, as both are stimulant laxatives that can cause excessive stimulation of the bowel, leading to severe cramping, abdominal pain, diarrhea, and potentially dangerous electrolyte imbalances. According to the most recent and highest quality study, the 2018 ESMO clinical practice guidelines for the diagnosis, assessment, and management of constipation in advanced cancer 1, the preferred options for laxatives include osmotic laxatives, such as polyethylene glycol (PEG), lactulose, or magnesium and sulfate salts, or stimulant laxatives, such as senna, cascara, bisacodyl, and sodium picosulfate. However, the guidelines do not recommend combining stimulant laxatives, as this can increase the risk of adverse effects.

Some key points to consider when using laxatives include:

• Using one laxative at a time at the recommended dosage
• Starting with a low dose and gradually increasing as needed
• Using laxatives for short-term relief only (less than 7 days) to avoid dependence and decreased bowel function
• Consulting a healthcare provider before combining laxatives or changing the regimen
• Considering alternative approaches, such as increasing fiber intake, staying hydrated, or using a different class of laxative that works through a different mechanism.

It's also important to note that the 2018 ESMO guidelines provide a comprehensive overview of the management of constipation in advanced cancer, including the use of laxatives, suppositories, and enemas, as well as the importance of assessing and addressing the underlying cause of constipation 1. Additionally, the guidelines highlight the need for careful consideration of the potential risks and benefits of different laxatives, particularly in patients with advanced disease or underlying medical conditions 1.

In terms of specific dosing recommendations, bisacodyl is typically taken as 5-10 mg once daily, while senna is usually taken as 8.6-17.2 mg once or twice daily 1. However, the optimal dosing regimen may vary depending on individual patient needs and circumstances, and should be determined in consultation with a healthcare provider.

Overall, the key takeaway is that combining senna and bisacodyl is not recommended, and patients should instead work with their healthcare provider to develop a personalized plan for managing constipation that takes into account their individual needs and medical history.

From the Research

Combination of Senna and Bisacodyl

• The use of senna and bisacodyl in combination for the treatment of constipation is mentioned in several studies 2, 3, 4, 5.
• A study from 2004 discusses the medical management of chronic constipation, including the use of stimulants like senna or bisacodyl as subsequent treatments if fiber is not successful or tolerated 2.
• Another study from 2022 provides evidence-based recommendations for the over-the-counter management of chronic constipation, supporting the use of polyethylene glycol-based preparations and senna as first-line laxatives, and modest evidence for the use of bisacodyl as a stimulant 3.
• A prospective randomized trial from 1992 compared the effects of senna and bisacodyl in addition to Golytely lavage for colonoscopy preparation, finding both regimens to be safe, well-tolerated, and effective 4.
• A pilot study from 2014 evaluated the efficacy of same-day bowel preparation with senna alkaloids combined with bisacodyl tablets, finding the protocol to be safe and effective for colonoscopy procedures 5.

Safety and Efficacy

• The combination of senna and bisacodyl has been shown to be safe and effective in several studies 4, 5.
• However, a study from 2018 highlights the potential risk of perineal blistering in children taking senna-based laxatives, particularly with high doses or prolonged exposure to stool 6.
• The same study found that senna is a safe treatment option for constipation in children, with no evidence of tolerance or major side effects besides abdominal cramping or diarrhea during the first weeks of administration 6.

Clinical Use

• The use of senna and bisacodyl in combination may be considered for the treatment of constipation, particularly in cases where fiber is not successful or tolerated 2.
• However, it is essential to follow the recommended dosages and administration guidelines to minimize the risk of adverse effects 4, 5, 6.
• Patients should be monitored for potential side effects, and the treatment regimen should be adjusted as needed to ensure safe and effective management of constipation 3, 6.