What is the dose and frequency of bisacodyl (laxative)?

From the Guidelines

Bisacodyl should be dosed at 5-10 mg orally once daily, typically taken at bedtime, for short-term use or as rescue therapy in adults with chronic idiopathic constipation (CIC) 1.

Key Considerations

• The medication should be swallowed whole without crushing or chewing, and should not be taken within one hour of antacids or milk.
• For acute constipation, a single dose is often sufficient, while for chronic constipation, it may be used intermittently as needed but not daily for extended periods.
• Alternatively, bisacodyl can be administered as a 10 mg suppository rectally once daily.

Mechanism of Action and Side Effects

• Bisacodyl works as a stimulant laxative by increasing intestinal motility and water secretion into the bowel, typically producing a bowel movement within 6-12 hours after oral administration or 15-60 minutes after rectal use.
• Side effects may include abdominal cramping, diarrhea, and nausea.

Important Precautions

• Bisacodyl should not be used long-term as this can lead to dependence, electrolyte imbalances, and decreased bowel function.
• Patients should increase fluid intake, dietary fiber, and physical activity as first-line approaches to constipation before relying on laxatives like bisacodyl.

Clinical Guidelines

• The American Gastroenterological Association-American College of Gastroenterology clinical practice guideline recommends the use of bisacodyl or sodium picosulphate short-term or as rescue therapy in adults with CIC 1.

From the Research

Dose and Frequency of Bisacodyl

• The dose of bisacodyl varies depending on the patient population and the specific study, with reported doses including 5 mg/day 2, 7.5 mg, and 10 mg 3, 4, 5, 6.
• In pediatric patients, the median dose of bisacodyl was 5 mg/day 2.
• In adult patients, the initial dose of bisacodyl was 5 mg in 76.1% of patients, 7.5 mg in 17% of patients, and 10 mg in 6.9% of patients 3.
• The frequency of bisacodyl administration is typically once daily, with some studies administering the medication for 4 weeks 5 or longer 2, 3.

Treatment Duration

• The treatment duration of bisacodyl varies depending on the study, with some patients receiving the medication for 4 weeks 5 and others for longer periods, up to 77 months 2.
• In one study, 90% of patients took bisacodyl for less than 36 months 2.
• Another study found that most patients (94%) remained on the same dose of bisacodyl during the follow-up period of 12 months 3.

Efficacy and Safety

• Bisacodyl has been shown to be effective in increasing bowel movement frequency and improving stool consistency in patients with constipation 2, 3, 5, 6.
• The medication is generally well-tolerated, with few reported side effects 2, 3, 5, 6.