From the Guidelines
Bisacodyl should not be prescribed for daily use beyond 1-2 weeks due to the risk of dependence, electrolyte imbalances, and decreased bowel function over time, as recommended by the American Gastroenterological Association-American College of Gastroenterology clinical practice guideline 1. When considering the management of chronic idiopathic constipation, it's crucial to prioritize treatments that are safer for long-term use. The guideline suggests the following options:
- Fiber supplementation with adequate hydration
- Osmotic laxatives like polyethylene glycol, which has been shown to have a durable response over 6 months 1
- Other osmotic laxatives such as magnesium oxide and lactulose, which can be used with caution in specific patient populations 1 Bisacodyl, a stimulant laxative, is recommended for short-term use or rescue therapy only, with a maximum dose of 10 mg orally daily 1. Prolonged or excessive use can lead to diarrhea and electrolyte imbalance, and its long-term safety and efficacy are unknown 1. If constipation persists beyond two weeks, it's essential to investigate potential underlying conditions and consider alternative approaches, rather than continuing or increasing the dose of bisacodyl.
From the Research
Bisacodyl Prescription for Longer than Two Weeks
- The evidence base does not support the use of stimulant laxatives, including bisacodyl, for more than four weeks 2.
- A study found that oral bisacodyl is effective and well-tolerated in patients with chronic constipation for a treatment period of four weeks 3.
- Another study reported that bisacodyl is effective and well tolerated in the long-term treatment of pediatric functional constipation refractory to conventional therapy, with a median duration of treatment of 14 months 4.
- A review of the pharmacology and clinical evidence of bisacodyl found that it has a dual prokinetic and secretory action and is effective in increasing the number of complete spontaneous bowel movements per week in patients with chronic constipation 5.
- However, the use of bisacodyl for longer than two weeks should be approached with caution, as stimulant laxatives are associated with harmful long-term colonic effects and possible carcinogenic risk 2.
- There is a lack of high-quality trials to assess the efficacy and safety of bisacodyl for longer than four weeks, and longer term RCTs and epidemiological studies are warranted to investigate the effects and safety of bisacodyl on the longer term 2, 6.