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Pharmacologic class: Stimulant laxative
Therapeutic class: Laxative
Pregnancy risk category B
Unclear. Thought to stimulate colonic mucosa, producing parasympathetic reflexes that enhance peristalsis and increase water and electrolyte secretion, thereby causing evacuation of colon.
Enema: 0.33 mg/ml, 10 mg/ml
Powder for rectal solution: 1.5 mg bisacodyl and 2.5 g tannic acid
Suppositories (rectal): 5 mg, 10 mg
Tablets (enteric-coated): 5 mg
Indications and dosages
➣ Constipation; bowel cleansing for childbirth, surgery, and endoscopic examination
Adults and children ages 12 and older: 5 to 15 mg P.O. or 10 mg P.R. as a single dose
Children older than age 3: 5 to 10 mg or 0.3 mg/kg P.O. as a single dose
Children ages 2 and older: 5 to 10 mg P.R. as a single dose
Children younger than age 2: 5 mg P.R. as a single dose
• Hypersensitivity to drug
• Intestinal obstruction
Use cautiously in:
• hypersensitivity to tannic acid
• severe cardiovascular disease, anal or rectal fissures
• pregnant or breastfeeding patients.
• Make sure patient swallows tablets whole without chewing.
• Don't give tablets within 1 hour of dairy products or antacids (may break down enteric coating).
• Know that drug should be used only for short periods.
CNS: dizziness, syncope
GI: nausea, vomiting, diarrhea (with high doses), abdominal pain, burning sensation in rectum (with suppositories), laxative dependence, protein-losing enteropathy
Metabolic: hypokalemia, fluid and electrolyte imbalances, tetany, alkalosis
Musculoskeletal: muscle weakness (with excessive use)
Drug-drug. Antacids: gastric irritation, dyspepsia
Drug-diagnostic tests. Calcium, magnesium, potassium: decreased levels
Phosphate, sodium: increased levels
Drug-food. Dairy products: gastric irritation
• Assess stools for frequency and consistency.
• Monitor patient for electrolyte imbalances and dehydration.
• Instruct patient to swallow (not chew) enteric-coated tablets no sooner than 1 hour before or after ingesting antacids or dairy products. Tell him not to chew tablets.
• Advise patient not to use bisacodyl or other laxatives habitually because this may lead to laxative dependence.
• Suggest other ways to prevent constipation, such as by eating more fruits, vegetables, and whole grains to increase dietary bulk and by drinking 8 to 10 glasses of water daily.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.