Dulcolax (Bisacodyl) Suppository Dosing
For adults and children 12 years and older, use one 10 mg suppository as a single daily dose; for children 6 to under 12 years, use half a suppository (5 mg) as a single daily dose; bisacodyl suppositories should not be used in children under 6 years of age. 1
Administration Technique
- Insert the suppository well into the rectum, pointed end first, after peeling open the plastic wrapper 1
- Retain the suppository for approximately 15-20 minutes 1
- Expect onset of action within 30-60 minutes after insertion 2, 3
Duration of Use
- Bisacodyl suppositories are recommended for short-term use (4 weeks or less) or as rescue therapy rather than continuous daily treatment 4, 2, 5
- The American Gastroenterological Association defines short-term use as daily use for 4 weeks or less based on high-quality trial data 2, 5
- While longer-term use may be appropriate in refractory cases, more data are needed to understand tolerance and side effects with extended use 2
Clinical Context for Use
- Bisacodyl suppositories are preferred when digital rectal examination identifies a full rectum or fecal impaction 3
- They work faster than oral formulations and osmotic laxatives, providing relief within 30-60 minutes 2, 3
- Consider as rescue therapy after failure of fiber and over-the-counter osmotic laxatives 5
Contraindications
Do not use bisacodyl suppositories in patients with: 2, 3
- Ileus or intestinal obstruction
- Severe dehydration
- Acute inflammatory bowel conditions
- Recent colorectal or gynecological surgery
- Recent anal or rectal trauma
- Children under 6 years of age 1
Common Adverse Effects
- Diarrhea occurs in 53.4% of patients (vs 1.7% with placebo) 2
- Abdominal pain/cramping occurs in 24.7% of patients (vs 2.5% with placebo) 2
- Risk of electrolyte imbalances with excessive use 4, 2, 3
- Risk of dehydration secondary to diarrhea 2
Monitoring Parameters
Monitor closely for: 2
- Signs of dehydration (decreased urine output, dry mucous membranes, lethargy)
- Abdominal pain or distress
- Electrolyte disturbances, particularly in elderly patients 5
Seek immediate medical attention for: 2
- Severe or persistent abdominal pain
- Signs of severe dehydration
Special Populations
Elderly Patients
- Elderly patients are particularly vulnerable to fluid and electrolyte disturbances and require close monitoring 5
- Consider starting with lower doses when possible 5
Pediatric Patients
- Glycerin suppositories are typically safer alternatives for infants and toddlers when rectal intervention is needed 2
- For children 6-12 years, use half a suppository (5 mg) 1
- Long-term use in pediatric functional constipation refractory to conventional therapy has shown effectiveness, though this should be reserved for specialized care settings 6