How long does Dulcolax (bisacodyl) take to work and how long does its effect last?

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Koliko brzo djeluje Dulcolax i koliko dugo traje njegov učinak

Dulcolax (bisacodyl) u obliku oralnih tableta počinje djelovati nakon 6-12 sati, dok rektalni čepići djeluju znatno brže, unutar 30-60 minuta 1.

Vrijeme djelovanja prema formulaciji

Oralne tablete s enteričkim oblogom

  • Početak djelovanja: 6-12 sati nakon uzimanja 1
  • Tablete su dizajnirane s kiselootpornom oblogom koja se otapa u crijevima, ne u želucu
  • Ovo odgođeno djelovanje omogućava uzimanje navečer radi jutarnjeg pražnjenja crijeva
  • Većina nuspojava (proljev, abdominalna bol) javlja se u prvom tjednu liječenja 1

Rektalni čepići

  • Početak djelovanja: 30-60 minuta 1
  • Znatno brže djelovanje jer lijek djeluje lokalno u rektumu
  • Istraživanja pokazuju da čepići izazivaju laksativni učinak u prosjeku za 56.6 ± 10.8 minuta 2
  • Minimalna sistemska apsorpcija - djelovanje je gotovo isključivo lokalno 2

Dulcolax prah (polietilen glikol 3350)

  • Početak djelovanja: 1-3 dana 3
  • Ovo je osmotski laksativ, različit od stimulativnog bisacodyla
  • Sporije ali blaže djelovanje

Trajanje učinka

Bisacodyl ima biološki poluživot od približno 16.5 ± 4.2 sati za njegov aktivni metabolit (BHPM-glukuronid) 4. Međutim, klinički učinak (pražnjenje crijeva) obično se javlja kao jednokratni događaj unutar navedenih vremenskih okvira, a ne kao kontinuirani učinak.

Mehanizam djelovanja

Bisacodyl se u crijevima pretvara u aktivni metabolit bis-(p-hidroksifenyl)-piridil-2-metan (BHPM) koji:

  • Direktno stimulira peristaltiku debelog crijeva 1, 5
  • Povećava sekreciju vode u lumen crijeva 5
  • Djeluje lokalno na sluznicu kolona 1

Klinički savjeti za doziranje

Preporučena početna doza je 5 mg oralno, iako su klinička ispitivanja koristila 10 mg 1:

  • Doza od 10 mg povezana je s visokom stopom proljeva (53.4%) i abdominalne boli (24.7%) 1
  • Započnite s 5 mg i povećajte ako nema odgovora
  • Američka gastroenterološka udruga preporučuje bisacodyl za kratkotrajnu ili hitnu terapiju, ne za dugotrajnu upotrebu 1

Važna upozorenja

Kontraindikacije - ne koristiti kod 1:

  • Ileusa ili crijevne opstrukcije
  • Teške dehidracije
  • Akutnih upalnih stanja crijeva

Interakcije: Antibiotici mogu smanjiti učinkovitost jer utječu na crijevne bakterije koje proizvode aktivni metabolit 1.

Dugotrajna upotreba: Iako su studije pokazale da većina pacijenata (94%) ostaje na stabilnoj dozi bez znakova habituacije 6, smjernice preporučuju kratkotrajnu upotrebu zbog čestih nuspojava 1.

References

2
Research

Is bisacodyl absorbed at all from suppositories in man?

International journal of pharmaceutics, 2000

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