From the FDA Drug Label
Directions adults and children 12 years of age and over 1 suppository in a single daily dose. The best evidence for a suppository PRN for elderly constipation secondary to opioid use and sedentary nature is 1 suppository of bisacodyl 10mg in a single daily dose, as needed 1.
- The dosage is for adults and children 12 years of age and over.
- Bisacodyl is a stimulant laxative that provides gentle, predictable, and fast relief 1.
- The active ingredient in each suppository is Bisacodyl USP, 10 mg 1.
From the Research
For elderly patients experiencing constipation due to opioid use and sedentary lifestyle, bisacodyl suppositories (10 mg) are the recommended first-line PRN suppository option, as supported by the most recent and highest quality study available 2. These can be used as needed when oral laxatives have failed to produce a bowel movement within 2-3 days. Some key points to consider when using bisacodyl suppositories include:
- Glycerin suppositories (2-3 g) offer a gentler alternative for milder constipation.
- When administering, insert the suppository into the rectum and have the patient retain it for 15-30 minutes if possible.
- For optimal management, combine suppositories with a preventive regimen including a stimulant laxative (senna 8.6-17.2 mg daily) plus an osmotic agent (polyethylene glycol 17 g daily), adequate hydration (6-8 glasses of water daily), increased dietary fiber, and physical activity as tolerated.
- Suppositories work by directly stimulating the rectal mucosa and promoting evacuation through local irritation, making them effective for immediate relief when oral medications haven't worked.
- Regular reassessment of the bowel regimen is important, as needs may change with alterations in opioid dosing or mobility status, as noted in studies on opioid-induced constipation management 3, 4. It's also worth noting that while other studies discuss various treatment options for constipation in the elderly 5, 6, the most recent and relevant evidence supports the use of bisacodyl suppositories as a first-line PRN option 2.