What is the recommended dose of Dulcolax (bisacodyl) for an 80-year-old man with constipation?

Recommended Dosage of Bisacodyl (Dulcolax) for an 80-Year-Old Man with Constipation

For an 80-year-old man with constipation, the recommended dose of bisacodyl (Dulcolax) is 10 mg once daily, which can be titrated up to 15 mg daily if needed, with a goal of achieving one non-forced bowel movement every 1-2 days. 1

Dosing Algorithm for Elderly Patients

1. Initial Dosing:

   • Start with 10 mg oral bisacodyl once daily
   • Administer preferably in the morning to avoid nighttime bowel movements
   • Allow 6-12 hours for onset of action

2. Dose Titration:

   • If inadequate response after 2-3 days, increase to 15 mg daily
   • Maximum recommended dose: 15 mg daily (for elderly patients)
   • Do not exceed three times daily dosing in elderly patients due to increased risk of dehydration and electrolyte disturbances

3. Duration:

   • Use for shortest duration necessary to establish regular bowel movements
   • Reassess need for continued therapy after 1-2 weeks

Special Considerations for Elderly Patients

• Start Low, Go Slow: Elderly patients may be more sensitive to stimulant laxatives and should start at the lower end of the dosing range 1
• Monitor for Dehydration: Ensure adequate fluid intake when using bisacodyl in elderly patients
• Drug Interactions: Be cautious if the patient is taking digoxin, as bisacodyl may reduce serum digoxin concentration when taken simultaneously 2
• Timing: If the patient is taking other medications, administer bisacodyl at least 2 hours apart from other oral medications to avoid potential interference with absorption

Complementary Approaches

Before or alongside bisacodyl therapy, implement:

• Lifestyle Modifications:

  • Increase fluid intake
  • Increase dietary fiber if adequate fluid intake and physical activity are present
  • Encourage appropriate physical activity

• Medication Review:

  • Discontinue non-essential constipating medications
  • Rule out other causes of constipation (e.g., hypercalcemia, hypothyroidism, medications)

When to Consider Alternative or Additional Therapies

If bisacodyl alone is insufficient:

1. Add polyethylene glycol (PEG) 17g daily, which is recommended as first-line treatment by the American Gastroenterological Association 1

2. Consider adding other laxatives such as:

   • Bisacodyl suppository (one rectally daily-BID)
   • Lactulose, 30-60 mL BID-QID
   • Magnesium hydroxide, 30-60 mL daily-BID
   • Magnesium citrate, 8 oz daily

Monitoring and Follow-up

• Assess response after 1-2 days of treatment
• Monitor for adverse effects such as abdominal cramping or diarrhea
• Ensure adequate fluid intake to prevent electrolyte imbalances
• Goal of therapy: One non-forced bowel movement every 1-2 days 3, 1

Caution

• Bisacodyl is a stimulant laxative and should not be used long-term without medical supervision
• Prolonged use may lead to dependence and decreased bowel function
• If constipation persists despite appropriate therapy, further evaluation for underlying causes is warranted