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

From the Guidelines

The recommended dose of rectal bisacodyl is one 10 mg suppository inserted rectally once daily, with the goal of achieving one non-forced bowel movement every 1-2 days. This recommendation is based on the most recent and highest quality study available, which is the 2019 NCCN clinical practice guidelines in oncology 1.

Key Considerations

• Bisacodyl suppositories typically produce a bowel movement within 15-60 minutes after insertion.
• The medication should be unwrapped completely before insertion, and patients should try to retain the suppository for at least 15-20 minutes to allow it to dissolve and work effectively.
• Bisacodyl is a stimulant laxative that works by increasing intestinal motility and fluid secretion in the colon, which stimulates bowel movements.
• It should not be used for more than 7 consecutive days without medical supervision, as prolonged use can lead to dependence, electrolyte imbalances, or dehydration.
• Patients should maintain adequate fluid intake while using bisacodyl.
• If constipation persists despite treatment, medical evaluation is recommended to identify underlying causes.

Additional Guidance

• The use of rectal suppositories or enemas should be avoided in patients with neutropenia or thrombocytopenia 1.
• Other laxatives, such as polyethylene glycol, lactulose, magnesium hydroxide, or magnesium citrate, may be considered if constipation persists 1.
• Peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, may be used to relieve opioid-induced constipation while maintaining pain management 1.

From the Research

Dose and Frequency of Rectal Bisacodyl

The provided studies do not specifically mention the dose and frequency of rectal bisacodyl. However, the following information is available for oral bisacodyl:

• The dose of bisacodyl used in the studies ranged from 5 mg to 10 mg once daily 2, 3.
• A study found that most patients (94%) remained on the same dose of bisacodyl as initially prescribed for the first year, with only 3.2% of patients having their dose increased and 2.8% having their dose decreased 2.
• Another study used a dose of 10 mg bisacodyl once daily for 4 weeks and found it to be effective and well-tolerated in patients with chronic constipation 3.

Efficacy and Safety of Bisacodyl

Some key points about the efficacy and safety of bisacodyl include:

• Bisacodyl was found to be effective in improving stool frequency and consistency in patients with idiopathic constipation 4, 3.
• Bisacodyl was also found to be effective in improving bowel function, constipation-related symptoms, and disease-related quality of life in patients with chronic constipation 3.
• The safety of bisacodyl was evaluated in several studies, with most adverse events being mild and frequent, mostly diarrhea and abdominal pain 5.
• However, the evidence base does not support the use of stimulant laxatives, including bisacodyl, for more than four weeks due to potential harmful long-term colonic effects and possible carcinogenic risk 5.

Key Findings

Some key findings from the studies include:

• Bisacodyl was ranked first in terms of efficacy at 4 weeks, but ranked last in terms of safety for total number of adverse events and abdominal pain 6.
• Prucalopride ranked first at 12 weeks and may be the most efficacious treatment for patients with chronic idiopathic constipation 6.
• Bisacodyl can be prescribed at a stable dose for more than 28 days, with most patients remaining on their initial prescribed dose during the follow-up period 2.