Disclaimer: This information is intended to supplement, not substitute for or replace, the judgment of healthcare professionals.

Users are solely responsible for use of

the information and any risks arising from or related to such use. Wolters Kluwer Clinical Drug Information assumes no responsibility or liability for errors or omissions
of any kind or the use of this information in any application or patient care setting. The content is not intended to be a stand-alone reference, and may not include all
information or instructions relevant to a particular medication or patient, including possible therapeutic differences between drugs, interactions, contraindications, side
effects, warnings, precautions, allergic reactions, adverse reactions, FDA-approved or off-label indications, dosing regimens or duration of therapy. The information is
reported from sources that are believed to be reliable. Because of the dynamic nature of this information, users must ensure that this information is current and they
are aware of the most recent available manufacturer product information, literature, and medical practices. The information is not intended to independently endorse
any particular drug as being therapeutically equivalent to any other drug or to identify any particular drug as being either safe or effective for the treatment of any
individual patient or group of patients or any particular health condition. Wolters Kluwer Clinical Drug Information does not engage in any independent review, testing or
study of any medication, related medical literature or formal or informal adverse event reporting, in connection with providing this information. Any pricing information
is not a quotation or offer to sell or purchase and does not necessarily represent the actual prices charged or paid in a single transaction or group of transactions.

Bisacodyl
Brand Names: International

Abilaxine (EG)

Alaxa (IT)
Alsylax (CL)

Anan (JP)

Anulax (EC)

Atzirut X (IL)

Bekunis B (LU)
Bilaxine (SY)

Bioyl (TW)

Bisacod (TH)

Bisadyl (BH, EG)

Bisakodils (EE)

Bisalax (AU, BG)

Bisco (HK, PH)

Bislax (LK)

Bolax (ET)

Buscolax (PH)

Camvolax (LK)
Conlax-10 (HK)

Contalax (FR, IL)

Corlex-5 (LK)

Cosadin (PH)

Custodiol (ID)

Danalax (VN)

Dissilax (AE, CY, IQ, IR, JO, KW, LY, OM, SA, SY, YE)

Ducodil (BR)

Dulco Laxo (ES)

Dulco-lax perles (GB)

Dulcobis (PL)

Dulcolan (VE)

Dulcolax (AE, AR, AT, BB, BE, BF, BG, BH, BJ, BM, BR, BS, BZ, CH, CI, CN, CO, CR, CU, CY, CZ, DE, DK, DO, EG, ET, FR, GB, GH, GM,
GN, GR, GT, GY, HK, HN, HR, HU, IE, IQ, IR, IS, IT, JM, JO, KE, KR, KW, LB, LR, LU, LY, MA, ML, MR, MT, MU, MW, MX, MY, NE, NG, NI,
NL, NO, NZ, OM, PA, PE, PH, PK, PT, QA, RO, RU, SA, SC, SD, SE, SI, SK, SL, SN, SR, SV, SY, TH, TN, TR, TT, TW, TZ, UG, UY, VN, YE,
ZM, ZW)

Dulcorax (KR)

Dulxative (PH)
Duralax (BD)

Entrolax (MT)

Fenolax (CZ)

Gencolax (TH)

Isilax (BR)

Johnlax (TW)

Lax-Tab (AU, NZ)

Laxabixal (ES)

Laxacod (ID)

Laxadin (IL)

Laxadyl (AE, BF, BJ, CI, CY, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN,
SY, TN, TZ, UG, YE, ZM, ZW)

Laxamag (RO)

Laxamin (AR)

Laxana (ID)
Laxans-ratiopharm (LU)

Laxatin (TW)
Laxbene (AT)

Laxcodyl (TH)
Laxet (BD)

Laxin (EG)
Laxocodyl (AE, BH, JO, KW, SA)

Longshutong (CN)
Megalax (ZA)

Metalax (FI)
Moderlax (PT)

Mucinum (BE)
Oralax (ZW)

Perilax (DK, ZA)

Prolaxan (ID)

Purgo-Pil (BE, LU)

Pyrilax (PL)

Relaxium (BD)
Satolax-10 (JP)

Stadalax (CZ, RO)

Stolax (ID)

Suben (TW)
Tirgon N (LU)

Toilax (DK, FI, IE, NO, SE)

Ultralax (AR)

Vesilac (PH)
Zu Zu Ton (TW)

Zycolax (LK)
 International Nonproprietary Names (INN)

Bisacodilo [Spanish]
Bisacodyl [English]

Bisacodyl [French]
Bisacodylum [Latin]

Бисакодил [Russian]

‫[ ﺑﻴﺴﺎﻛﻮدﻳﻞ‬Arabic]

⽐沙可啶 [Chinese]
Brazilian Nonproprietary Names (DCB)

Bisacodil

Anatomic Therapeutic Chemical (ATC) Classification

A06AB02

Pharmacologic Category

Laxative, Stimulant

Dosing: Adult
Bowel cleansing (enema only): Rectal: 10 mg (1 enema) as single dose

Constipation:

Oral: 5 to 15 mg once daily

Rectal: Enema, suppository: 10 mg (1 enema or suppository) once daily

Dosing: Geriatric
Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric
Constipation:

Oral: Limited data available in patients <6 years:

Children ≥3 years to <10 years: 5 mg once daily (NASPGHAN/ESPGHAN [Tabbers 2014]).

Children 10 to <12 years: 5 to 10 mg once daily (NASPGHAN/ESPGHAN [Tabbers 2014]).

Children ≥12 years and Adolescents: 5 to 15 mg once daily (NASPGHAN/ESPGHAN [Tabbers 2014]; manufacturer's
labeling).

Rectal:

Suppository: Limited data available in children <6 years:

Children 2 to ≤10 years: 5 mg (1/2 suppository) once daily (NASPGHAN/ESPGHAN [Tabbers 2014]).

Children >10 years and Adolescents: 5 to 10 mg once daily (NASPGHAN/ESPGHAN [Tabbers 2014]).
 Enema: Limited data available in children <12 years:

Children ≥2 to 10 years: 5 mg once daily (NASPGHAN/ESPGHAN [Tabbers 2014]).

Children >10 years and Adolescents: 5 to 10 mg once daily (NASPGHAN/ESPGHAN [Tabbers 2014]).

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Use: Labeled Indications

Bowel cleansing (enema only): Bowel cleansing prior to rectal examination.

Constipation: Temporary relief of occasional constipation and irregularity.

Clinical Practice Guidelines

Constipation:

AGA, “Guideline on the Medical Management of Opioid-Induced Constipation,” October 2018

The American Society of Colon and Rectal Surgeons, “Clinical Practice Guideline for the Evaluation and Management of
Constipation,” 2017

Administration: Oral
Administer with water. Swallow tablet whole; do not break, chew, or crush; do not administer within 1 hour of antacids, milk, or dairy
products.

Bariatric surgery: Tablet, delayed release: Some institutions may have specific protocols that conflict with these recommendations;
refer to institutional protocols as appropriate. Do not cut or crush in order to avoid gastric irritation.

Administration: Rectal
Enema: Shake well; remove protective shield, insert tip into rectum with slight side to side movement; squeeze the bottle until
nearly all liquid expelled (some liquid will remain in unit after use). Gently remove the unit, a small amount of liquid will remain
in unit after use.

Suppository: Remove foil, insert into rectum with pointed end first. Retain in rectum for 15 to 20 minutes.

Administration: Pediatric
Oral: Administer on an empty stomach with water; patient should swallow tablet whole; do not break or chew enteric-coated tablet;
do not administer within 1 hour of ingesting antacids, alkaline material, milk, or dairy products

Rectal:

Suppository: Remove foil, insert into rectum with pointed end first. Retain in rectum for 15 to 20 minutes.

Enema: Shake well; remove protective shield, insert tip into rectum with slight side to side movement; squeeze the bottle until
nearly all liquid expelled (some liquid will remain in unit after use). Gently remove the unit, a small amount of liquid will
remain in unit after use.

Dietary Considerations
Tablet: Do not administer within 1 hour of milk, dairy products, or an antacid.

Storage/Stability
Oral: Store at 20°C to 25°C (68°F to 77°F); protect from humidity.

Rectal: Store at <30°C (86°F).

Medication Safety Issues

Sound-alike/look-alike issues:
Warnings/Precautions
Dosage form specific issues:
 • Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a
metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially
fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory
distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and
cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from
protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in
neonates. See manufacturer’s labeling.

Other warnings/precautions:

• Appropriate use: Tablets: Do not chew or crush; do not use if you cannot swallow without chewing. Do not administer within 1
hour after taking an antacid, milk, or any dairy products.

• Appropriate use: Enema/Suppositories: For rectal use only, discontinue use and consult a health care provider if rectal
bleeding occurs or if no bowel movement is produced after use.

• Self-medication (OTC use): Consult a health care provider prior to use if stomach pain, nausea, vomiting, or a sudden change
in bowel movements lasting >2 weeks occurs, or if you have already used a laxative, including bisacodyl, for >1 week. Use
may cause stomach discomfort, faintness, rectal burning, and mild cramps. Discontinue use and consult a health care
provider if use >1 week is needed.

Geriatric Considerations
The chronic use of stimulant cathartics is inappropriate and should be avoided; although constipation is a common complaint from
elderly, such complaints require evaluation; elderly are often predisposed to constipation due to disease, drugs, immobility, and a
decreased fluid intake, partially because they have a blunted “thirst reflex” with aging; short-term use of stimulants is best; if
prophylaxis is desired, this can be accomplished with bulk agents (psyllium), stool softeners, and hyperosmotic agents (sorbitol
70%); stool softeners are unnecessary if stools are well hydrated, soft, or “mushy”.

Pregnancy Considerations
Systemic exposure following maternal use of bisacodyl is limited. Plasma concentrations of BHPM (the active metabolite of
bisacodyl) are low (median: 61 ng/mL; range: 20 to 118 ng/mL) and the pharmacokinetics are highly variable following oral doses
of 10 mg/day for 7 days to women immediately postpartum (Friedrich 2011).

Use of bisacodyl should be limited during pregnancy due to an increased risk of adverse events, such as electrolyte abnormalities.
When dietary changes and lifestyle modifications are insufficient, agents other than bisacodyl are recommended for the treatment
of constipation in pregnant women (Body 2016; Gomes 2018).

Breast-Feeding Considerations
It is not known if bisacodyl is present in breast milk.

Systemic exposure following maternal use is limited. Neither bisacodyl nor its active metabolite (BHPM) were detectable in breast
milk following administration of bisacodyl 10 mg once daily for 7 days to eight breastfeeding women (lower limit of detection:
1 ng/mL) (Friedrich 2011).

Adverse Reactions
<1%: Abdominal cramps (mild), electrolyte disturbance (metabolic acidosis or alkalosis, hypocalcemia), nausea, rectal irritation
(burning), vertigo, vomiting

Allergy and Idiosyncratic Reactions

Aniline Dye Allergy

Diphenylmethane Laxative Allergy

Drug Interactions: Avoid Concomitant Use

There are no known interactions where it is recommended to avoid concomitant use.

Drug Interactions: Decreased Effect

The levels/effects of Bisacodyl may be decreased by: Antacids

Drug Interactions: Increased Effect/Toxicity

Bisacodyl may increase the levels/effects of: Dichlorphenamide; Polyethylene Glycol-Electrolyte Solution

Drug Interactions: Metabolism/Transport Effects

None known.

Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] =
Discontinued product

Enema, Rectal:

Fleet Bisacodyl: 10 mg/30 mL (37 mL)

Suppository, Rectal:

Bisac-Evac: 10 mg (1 ea [DSC], 8 ea [DSC], 12 ea [DSC], 50 ea [DSC], 100 ea [DSC], 500 ea [DSC], 1000 ea [DSC])

Biscolax: 10 mg (12 ea [DSC], 100 ea)

Dulcolax: 10 mg (4 ea, 8 ea, 16 ea, 28 ea, 50 ea)

Gentle Laxative: 10 mg (50 ea)

The Magic Bullet: 10 mg (10 ea, 100 ea)

Generic: 10 mg (12 ea, 50 ea, 100 ea)

Tablet Delayed Release, Oral:

Bisacodyl EC: 5 mg

Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, methylparaben,
propylparaben]

Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, methylparaben,
propylparaben, sodium benzoate]

Bisacodyl EC: 5 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Bisacodyl EC: 5 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, methylparaben, propylparaben,
sodium benzoate]

Correct: 5 mg

Ducodyl: 5 mg

Dulcolax: 5 mg [contains fd&c yellow #10 (quinoline yellow), methylparaben, propylparaben, sodium benzoate]

Ex-Lax Ultra: 5 mg [contains fd&c yellow #6 (sunset yellow), methylparaben]

Fleet Laxative: 5 mg [DSC]

GoodSense Bisacodyl EC: 5 mg [contains corn starch, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

GoodSense Womens Laxative: 5 mg [gluten free; contains corn starch]

Womens Laxative: 5 mg [contains fd&c blue #1 aluminum lake, sodium benzoate, tartrazine (fd&c yellow #5)]

Generic Available (US)

May be product dependent

Pricing: US
Enema (Fleet Bisacodyl Rectal)

10 mg/30 mL (per mL): $0.07

Suppository (Bisacodyl Rectal)

10 mg (per each): $0.09 - $0.31

Suppository (The Magic Bullet Rectal)

10 mg (per each): $1.19

Tablet, EC (Ex-Lax Ultra Oral)

 5 mg (per each): $0.22

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is
provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the
manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not
be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a
single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or
implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall
Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing
data is updated monthly.

Mechanism of Action
Stimulates peristalsis by directly irritating the smooth muscle of the intestine, possibly the colonic intramural plexus; alters water
and electrolyte secretion producing net intestinal fluid accumulation and laxation

Pharmacodynamics/Kinetics
Onset of action: Oral: 6 to 12 hours; Rectal: 0.25 to 1 hour (suppository), 5 to 20 minutes (enema)

Half-life: BHPM: ~8 hours (Friedrich 2011)

Distribution: Vd: BHPM: 289 L (after multiple doses) (Friedrich 2011)

Metabolism: Bisacodyl is metabolized to an active metabolite (BHPM) in the colon; BHPM is then converted in the liver to a
glucuronide salt (Friedrich 2011)

Absorption: Oral, rectal: Systemic, <5% (Wald 2003)

Excretion: BHPM: Urine, bile (Friedrich 2011)

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding
No information available to require special precautions

Related Information

Laxatives, Classification and Properties

Oral Medications That Should Not Be Crushed or Altered

Index Terms

Doxidan

References
Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319.[PubMed 11487763]

Bisacodyl suppository [prescribing information]. Allegan, MI: Perrigo; November 2011.

Body C, Christie JA. Gastrointestinal diseases in pregnancy: nausea, vomiting, hyperemesis gravidarum, gastroesophageal reflux
disease, constipation, and diarrhea. Gastroenterol Clin North Am. 2016;45(2):267‐283. doi:10.1016/j.gtc.2016.02.005[PubMed
27261898]

Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal
Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm[PubMed 6810084]

Correctol tablet (bisacodyl) [prescribing information]. Memphis: TN: MSD Consumer Care, Inc; June 2014.

Cullen G and O'Donoghue D, "Constipation and Pregnancy," Best Pract Res Clin Gastroenterol, 2007, 21(5):807-18.[PubMed
17889809]

Dahshan A, Lin CH, Peters J, et al, “A Randomized, Prospective Study to Evaluate the Efficacy and Acceptance of Three Bowel
Preparations for Colonoscopy in Children,” Am J Gastroenterol, 1999, 94(12):3497-501.[PubMed 10606310]
Ducodyl (bisacodyl) [prescribing information]. Troy, MI: Prime Marketing; received January 2019.

Dulcolax tablets (bisacodyl) [prescribing information]. Chattanooga, TN: Chattem, Inc; received February 2020.

Fleet enema (bisacodyl) (prescribing information). Lynchburg, VA: C.B.Fleet Company, Inc.

Friedrich C, Richter E, Trommeshauser D, et al, "Absence of Excretion of the Active Moiety of Bisacodyl and Sodium Picosulfate Into
Human Breast Milk: An Open-Label, Parallel-Group, Multiple-Dose Study in Healthy Lactating Women," Drug Metab Pharmacokinet,
2011, 26(5):458-64.[PubMed 21697613]

Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist
need to know? Ann Gastroenterol. 2018;31(4):385‐394. doi:10.20524/aog.2018.0264[PubMed 29991883]

Lo So Prep (bisacodyl) [prescribing information]. Lake Success, NY: Tower Laboratories Ltd, October 2010.

Prather CM, "Pregnancy-Related Constipation," Curr Gastroenterol Rep, 2004, 6(5):402-4.[PubMed 15341717]

"Inactive" ingredients in pharmaceutical products: update (subject review). Pediatrics.1997;99(2):268-278.[PubMed 9024461]

Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-
based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274.[PubMed 24345831]

Brand Names: US

Bisac-Evac [OTC] [DSC]

Bisacodyl EC [OTC]
Biscolax [OTC]
Correct [OTC]
Ducodyl [OTC]
Dulcolax [OTC]

Ex-Lax Ultra [OTC]

Fleet Bisacodyl [OTC]
Fleet Laxative [OTC] [DSC]
Gentle Laxative [OTC]
GoodSense Bisacodyl EC [OTC]
GoodSense Womens Laxative [OTC]
The Magic Bullet [OTC]
Womens Laxative [OTC]

User Note
[Edit Note]