Bisacodyl Suppository Dosing Recommendations
For adults and children 12 years and older, the recommended dose for a bisacodyl suppository is 1 suppository (10 mg) in a single daily dose. 1
Administration Guidelines
- Insert the suppository well into the rectum, pointed end first, after peeling open the plastic wrapper 1
- Patient should retain the suppository for about 15-20 minutes for optimal effect 1
- For children 6 to under 12 years of age, use half a suppository in a single daily dose 1
- Bisacodyl suppositories are not recommended for children under 6 years of age 1
Mechanism and Onset of Action
- Bisacodyl suppositories have a rapid onset of action, typically within 30-60 minutes 2
- The medication works by being converted in the gut to its active metabolite (BHPM), which directly stimulates colonic peristalsis 2, 3
- The prompt laxative effect typically appears within approximately 20-60 minutes after rectal administration 3, 4
Clinical Applications
- Bisacodyl suppositories are particularly useful when digital rectal examination identifies a full rectum or fecal impaction 2
- In palliative care settings, bisacodyl may be used at doses of 10-15 mg daily to three times daily for severe constipation 5, 2
- For patients with constipation in palliative care, the goal is to achieve one non-forced bowel movement every 1-2 days 5
Special Considerations
- Bisacodyl is contraindicated in patients with ileus, intestinal obstruction, severe dehydration, or acute inflammatory conditions of the bowel 2, 6
- Common adverse effects include diarrhea and abdominal pain 2, 6, 7
- Prolonged or excessive use can lead to electrolyte imbalances and dependence 2
- For hospitalized patients with constipation, bisacodyl has shown greater efficacy in increasing defecation frequency compared to some other laxatives 8
Dosing in Specific Scenarios
- For opioid-induced constipation in palliative care, bisacodyl suppositories can be used once or twice daily 5
- If impaction occurs, consider adding other laxatives in addition to bisacodyl suppositories 5
- In cases of persistent constipation, the suppository can be used alongside oral bisacodyl, with oral dosing typically starting at 5 mg and not exceeding 10 mg daily for adults 6, 7