How Bisacodyl works
Bisacodyl is a “prodrug”, i.e. a precursor of the actual active substance. It is converted by the bacteria in the large intestine into the active form BHPM.
This inhibits the absorption of sodium and water from the stool into the blood and promotes the release of water and electrolytes into the intestine. This makes the stool softer. BHPM also stimulates intestinal peristalsis so that food residues are transported faster towards the exit (anus).
A lubricant can be added to the laxative in the event of prolonged or severe symptoms. The lubricant ensures even easier bowel evacuation thanks to the “lubricating effect”.
Absorption, breakdown and excretion
The laxative effect of Bisacodyl occurs after six to twelve hours when taken orally (by mouth) and after 15 to 30 minutes when taken as a suppository. Part of the active ingredient is excreted in the stool, the rest in the urine.
When is Bisacodyl used?
Bisacodyl is mainly used for constipation. It is also used for conditions where easier bowel evacuation is desired (such as haemorrhoids).
Laxatives such as Bisacodyl are also used to prepare a patient for an X-ray examination of the digestive tract and for therapeutic intestinal surgery.
How Bisacodyl is used
In the treatment of acute constipation, the laxative is taken orally as a gastric acid-stable coated tablet or tablet (together with plenty of water and preferably in the evening) or inserted rectally as a suppository.
The usual dosage in Germany and Austria for adults and children over the age of ten is between five and ten milligrams of active ingredient when taken orally or ten milligrams when taken as a suppository. Children from two to ten years of age can take five milligrams of bisacodyl or receive a suppository containing five milligrams of active ingredient as prescribed by a doctor.
Slightly different recommendations apply in Switzerland. Here, children are only given the dose for adults from the age of twelve. Doctors can also only prescribe the laxative from the age of four.
What are the side effects of Bisacodyl?
Possible side effects of Bisacodyl for short-term use are belching, flatulence, diarrhea, nausea, abdominal cramps and pain in the abdomen and/or rectum.
Prolonged use of Bisacodyl can lead to water and electrolyte disorders, particularly a lack of potassium and magnesium, which can result in muscle weakness. A loss of calcium with subsequent osteoporosis can also occur.
What should be considered when using Bisacodyl?
Contraindications
Bisacodyl must not be used in the following cases
- hypersensitivity to the active substance or any of the other ingredients of the medicine
- acute gastrointestinal disorders
- intestinal obstruction
- severe abdominal pain together with nausea and/or vomiting (signs of serious illness)
Patients with renal dysfunction, electrolyte disturbances or dehydration should only use the product under the supervision of a doctor who can assess the risks of increased fluid loss. This applies particularly to elderly patients.
Interactions
The use of bisacodyl is associated with a loss of potassium. This can impair the tolerability of cardiac glycosides – especially when used concurrently with diuretics or corticosteroids (“cortisone”), both of which also affect the water and electrolyte balance. If the electrolyte balance becomes too unbalanced, cardiac arrhythmia may result.
The laxative effect of bisacodyl can impair the absorption of other active substances, such as digoxin (heart medication).
Age restriction
Bisacodyl may not be used in children under two years of age in Germany and Austria, and in children under four years of age in Switzerland.
Preparations for self-medication are available over-the-counter in pharmacies in Germany and Austria from the age of ten, in Switzerland from the age of twelve.
Pregnancy and breastfeeding
Since its market launch in the 1950s, no harmful effects of the laxative have been reported during pregnancy. Bisacodyl can therefore be used in pregnancy in the short term on medical advice.
Clinical data show that neither bisacodyl nor its metabolite pass into breast milk. Women can therefore continue breastfeeding without restriction during use.
How to obtain medication with bisacodyl
Bisacodyl is available in oral form (e.g. tablet) and in the form of suppositories in pharmacies in Germany, Austria and Switzerland without a prescription.
