From the Guidelines
Bisacodyl (Bicolax) should be dosed at 10 to 15 mg, 2 to 3 times daily, in the Intensive Care Unit (ICU) to manage constipation, with a goal of one nonforced bowel movement every 1 to 2 days. This dosing recommendation is based on the guidelines from the National Comprehensive Cancer Network (NCCN) for palliative care, which emphasizes the importance of assessing and treating constipation in patients, including those in the ICU 1. The NCCN guidelines suggest that bisacodyl can be used to treat persistent constipation, and the recommended dose is consistent with this goal.
When managing constipation in ICU patients, it is essential to consider the underlying causes, such as impaction, obstruction, or other treatable conditions, and rule them out before initiating treatment with bisacodyl 1. Additionally, the use of other laxatives, such as rectal bisacodyl, oral polyethylene glycol, lactulose, magnesium hydroxide, or magnesium citrate, may be considered if constipation persists.
Key considerations for bisacodyl use in the ICU include:
- Monitoring for adverse effects, such as abdominal cramping, electrolyte disturbances, and dehydration, especially in critically ill patients with compromised fluid status or electrolyte imbalances
- Adjusting the dose based on patient response and the goal of achieving one nonforced bowel movement every 1 to 2 days
- Considering alternative routes of administration, such as rectal suppositories, for faster action in patients who need prompt relief
- Evaluating the need for scheduled dosing rather than as-needed dosing, especially for patients on prolonged immobilization, opioid therapy, or enteral nutrition.
From the FDA Drug Label
Adults and children 12 years and over 1 suppository once daily Children 6 to under 12 years 1/2 suppository once daily Children under 6 years Ask a doctor
The dose of Bisacodyl (Bicolax) is 1 suppository once daily for adults and children 12 years and over, and 1/2 suppository once daily for children 6 to under 12 years. However, there is no specific information provided for the dose in the Intensive Care Unit (ICU). 2
From the Research
Dose of Bisacodyl in the Intensive Care Unit (ICU)
There are no research papers to assist in answering this question, as the provided studies do not mention the dose of Bisacodyl in the ICU setting.
Available Information on Bisacodyl Dosage
- The study 3 mentions that patients received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam, or bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam.
- The study 4 states that children received a 5-mg bisacodyl tablet at noon and started a clear fluid diet, with an additional bisacodyl tablet taken in the evening by patients more than 5 years old.
- The study 5 investigated the effect of chronic administration of bisacodyl on net water and electrolyte flux in the rat colon, with doses of 3 mg and 10 mg kg-1 day-1.
- The study 6 provides an overview of the pharmacology and clinical evidence of bisacodyl, but does not specifically mention the dose in the ICU setting.
Other Medications and Dosage
- The study 7 discusses the dosing recommendations for oseltamivir, which is not relevant to the question about bisacodyl dosage in the ICU.