What medication is used in a suppository for constipation?

Medications Used in Suppositories for Constipation

Bisacodyl 10 mg is the primary medication used in rectal suppositories for constipation, providing rapid relief within 30-60 minutes of insertion. 1, 2

Mechanism of Action and Efficacy

Bisacodyl is a stimulant laxative that works by:

• Converting to its active metabolite bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) in the colon
• Directly stimulating colonic peristalsis and secretion
• Providing faster onset of action (30-60 minutes) compared to oral formulations (6-12 hours) 1

Bisacodyl suppositories are particularly useful for:

• Acute constipation requiring rapid relief
• Patients who need predictable timing of bowel movements
• Situations where oral medications are not feasible or effective

Dosing and Administration

• Standard dose: 10 mg per suppository 2
• Frequency: Once daily as needed for constipation
• Administration: Insert the suppository into the rectum with the pointed end first
• Timing: Best administered when a bowel movement is desired within the next hour

Clinical Considerations

Advantages

• Rapid onset of action (30-60 minutes)
• Bypasses the digestive system, making it useful when oral intake is limited
• Predictable timing of effect, allowing for planned bowel movements
• Effective for acute constipation relief

Potential Adverse Effects

• Abdominal cramping or discomfort
• Local rectal irritation
• Diarrhea (if overused)
• Contraindicated in patients with ileus, intestinal obstruction, severe dehydration, or acute inflammatory bowel conditions 1

Alternative Suppository Options

While bisacodyl is the most common medication in suppositories for constipation, other options include:

• Glycerin suppositories: Work as lubricants and mild osmotic agents
• Sodium phosphate enemas: Provide osmotic effect but should be used cautiously due to potential electrolyte disturbances 1

Place in Treatment Algorithm

Suppositories are typically used:

1. After failure of oral laxatives
2. When rapid relief is needed
3. As rescue therapy for acute constipation
4. For patients who cannot tolerate oral medications

The National Comprehensive Cancer Network recommends that persistent constipation may be treated with bisacodyl suppositories when oral treatments are insufficient, with a goal of one non-forced bowel movement every 1-2 days 1.

Cautions and Contraindications

Rectal suppositories should be avoided in patients with:

• Neutropenia or thrombocytopenia
• Recent colorectal or gynecological surgery
• Recent anal or rectal trauma
• Severe colitis or intestinal inflammation
• Undiagnosed abdominal pain 1

For long-term management of constipation, oral laxatives like polyethylene glycol (PEG) are generally preferred, with suppositories reserved for acute relief or as rescue therapy 1, 3.