From the Guidelines
Dulcolax (bisacodyl) is generally safe for short-term use in most adults when taken as directed, according to the most recent guidelines from the American Gastroenterological Association and the American College of Gastroenterology 1.
Key Points to Consider
- It's an over-the-counter stimulant laxative that typically works within 6-12 hours to relieve occasional constipation.
- The standard dose for adults is 5-10 mg taken orally once daily, preferably at bedtime, or a 10 mg suppository used once daily.
- However, Dulcolax should not be used for more than 7 consecutive days without medical supervision, as prolonged use can lead to dependence, electrolyte imbalances, and weakened bowel function, as noted in the clinical practice guideline on pharmacological management of chronic idiopathic constipation 1.
- Side effects may include stomach cramps, diarrhea, nausea, and rectal irritation.
- Certain people should avoid Dulcolax or use it with caution, including those with intestinal blockage, severe abdominal pain, inflammatory bowel disease, rectal bleeding, or kidney disease.
- Pregnant or breastfeeding women should consult their healthcare provider before use.
- The certainty of evidence for the use of bisacodyl is rated as moderate for several outcomes, including CSBM and SBM frequency, responder rate, global relief, and stool consistency 1.
Important Considerations
- Dulcolax works by stimulating the intestinal muscles and increasing water in the stool, which helps promote bowel movements, but this mechanism also explains why some people experience cramping as a side effect.
- The guideline recommends the use of bisacodyl or sodium picosulphate short term or as rescue therapy over management without bisacodyl or sodium picosulphate, with a strong recommendation and moderate certainty of evidence 1.
- Short-term use is defined as daily use for 4 weeks or less, and while long-term use is probably appropriate, data are needed to better understand tolerance and side effects 1.
From the Research
Safety of Dulcolax (Bisacodyl)
- The safety of Dulcolax (bisacodyl) has been evaluated in several studies, although the evidence is not as extensive as for some other laxatives 2, 3, 4, 5.
- A 2005 systematic review found a paucity of quality data regarding bisacodyl, making it difficult to assess its safety and efficacy 2.
- A 2021 systematic review found moderate evidence (grade B) to support the use of bisacodyl, with common adverse events including diarrhea, nausea, bloating, and abdominal pain 3.
- A 2015 study compared the use of 2-L polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-L polyethylene glycol as preparation for colonoscopy in patients with chronic constipation, and found that bisacodyl was well tolerated and effective 4.
- A 2014 systematic review found that stimulant laxatives, including bisacodyl, provided better relief of constipation symptoms than placebo, with minor side effects reported 5.
Adverse Events
- Common adverse events associated with bisacodyl use include:
- Serious adverse events were not reported in the studies reviewed 3, 5.
Efficacy
- Bisacodyl has been found to be effective in relieving constipation symptoms, although the evidence is not as strong as for some other laxatives 3, 4, 5.
- A 2021 systematic review found moderate evidence (grade B) to support the use of bisacodyl for chronic constipation 3.
- A 2015 study found that bisacodyl was effective in preparing patients for colonoscopy, although it was not superior to polyethylene glycol 4.