bisacodyl rectal

Action and Spectrum

Actions and spectrum: 

bisacodyl rectal is a medication that belongs to the class of laxatives. Its primary action is to stimulate bowel movements by directly irritating the intestinal lining and increasing the muscular contractions of the colon.

It is commonly used for the relief of constipation and to prepare the bowels for certain medical procedures. bisacodyl rectal has a local effect in the rectum and lower part of the colon, and its systemic absorption is minimal. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Excessive diarrhea 

Rectal burning 

Vomiting 

Abdominal cramping 

Fluid and electrolyte imbalance 

Vertigo 

Black Box Warning

Black Box Warning:  

There is no specific black box warning associated with the use of bisacodyl rectal. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Known hypersensitivity or allergy to bisacodyl or any of the other ingredients in the formulation. 
• Bowel obstruction or intestinal blockage. 
• Acute surgical abdomen, such as appendicitis or acute inflammatory conditions of the gastrointestinal tract. 
• Severe dehydration. 
• Severe abdominal pain, nausea, or vomiting of unknown cause. 
• Rectal bleeding or undiagnosed rectal conditions. 
• Inflammatory bowel disease like Crohn’s disease or ulcerative colitis. 
• Severe inflammatory conditions of the intestines, such as toxic megacolon. 

Caution: 

• Abdominal pain: If there is severe or persistent abdominal pain before using bisacodyl rectal, as it may indicate a more serious underlying condition. 
• Rectal bleeding: If there is rectal bleeding or suspect a gastrointestinal condition, it is advised to seek medical advice before using bisacodyl rectal. 
• Dehydration: bisacodyl rectal can cause fluid loss from the body, so it is important to maintain adequate hydration during and after its use, especially in cases of severe dehydration or underlying conditions that may increase the risk of dehydration. 
• Pregnancy and lactation: The use of bisacodyl rectal during pregnancy and lactation should be discussed with a healthcare professional. It is important to weigh the potential benefits against the potential risks to the fetus or infant. 
• Children and elderly: Special caution should be exercised when using bisacodyl rectal in children and elderly individuals, as they may be more susceptible to its effects and adverse reactions. 
• Other medications: It is important to inform healthcare professional about all the medications you are taking, including prescription, over the counter, and herbal products, as some medications may interact with bisacodyl rectal.

Comorbidities: 

• Gastrointestinal obstruction: bisacodyl rectal may not be suitable for individuals with a known or suspected gastrointestinal obstruction, as it can worsen the condition. 
• Inflammatory bowel disease (IBD): In individuals with IBD like Crohn’s disease or ulcerative colitis, the use of bisacodyl rectal should be approached with caution. It is important to consult a healthcare professional for appropriate guidance. 
• Appendicitis symptoms: bisacodyl rectal is contraindicated in individuals with symptoms of appendicitis, such as abdominal pain, nausea, vomiting, or fever, as it may mask the underlying condition. 
• Intestinal perforation: bisacodyl rectal should not be used in individuals with suspected or known intestinal perforation, as it can exacerbate the condition. 
• Severe electrolyte imbalance: Individuals with severe electrolyte imbalances, such as low potassium levels (hypokalemia), should exercise caution when using bisacodyl rectal, as it may further disturb electrolyte balance. 

Pregnancy / Lactation

Pregnancy consideration: not assigned 

Lactation: Excreted into human milk: Yes  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• <b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

bisacodyl is a stimulant laxative that acts directly on the colon to promote bowel movement. When administered rectally, bisacodyl stimulates the nerve endings in the rectal mucosa, leading to local reflex contractions of the rectum and increased colonic motility. 

Upon administration, bisacodyl is hydrolyzed by intestinal enzymes into its active metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM). BHPM directly stimulates the colonic mucosa and activates the enteric nervous system, resulting in increased fluid secretion into the colon and enhanced intestinal transit. These actions promote the accumulation of water and electrolytes in the colon, softening the stool and facilitating its passage. 

The pharmacological effects of bisacodyl rectal usually occur within 15 to 60 minutes after administration, with the onset of bowel movement occurring within 1 to 6 hours.  

Pharmacodynamics: 

The pharmacodynamics of bisacodyl rectal involves its action as a stimulant laxative. When administered rectally, bisacodyl stimulates the nerve endings in the rectal mucosa. This stimulation leads to local reflex contractions of the rectum and increased colonic motility. 

The active metabolite of bisacodyl, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), directly stimulates the colonic mucosa and activates the enteric nervous system. This results in increased fluid secretion into the colon and enhanced intestinal transit. The increased fluid accumulation and motility promote the softening of stool and facilitate its passage. 

bisacodyl rectal is effective in promoting bowel movement, typically producing results within 15 to 60 minutes after administration. The onset of bowel movement usually occurs within 1 to 6 hours.  

Pharmacokinetics: 

Absorption 

bisacodyl is minimally absorbed after rectal administration. The majority of the drug remains localized in the rectum and colon, exerting its action locally. 

Distribution 

bisacodyl does not have significant systemic distribution since it primarily acts locally in the gastrointestinal tract. Any absorbed bisacodyl is likely to be rapidly metabolized in the liver. 

Metabolism 

bisacodyl undergoes extensive metabolism in the liver. It is converted to its active metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM). BHPM is responsible for the pharmacological effects of bisacodyl. 

Elimination and excretion 

The exact route of excretion of bisacodyl and its metabolites is not well-documented. However, it is believed that the drug and its metabolites gets eliminated primarily in the feces. 

Adminstartion

Administration: 

bisacodyl rectal is typically administered as a suppository. 

• Wash hands thoroughly before handling the suppository. 
• Remove the suppository from its packaging and hold it between your fingers. 
• Lie on one side with one leg bent toward your chest. 
• Gently insert suppository into rectum, pointed end first. It is important to insert it as far as comfortably possible. 
• Remain lying down for a few minutes to allow the suppository to dissolve and absorb. 
• Dispose of the packaging and wash your hands again. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: bisacodyl rectal 

Pronounced: (bis-a-KOH-dil REK-tuhl)  

Why do we use bisacodyl rectal? 

• Constipation relief: Bisacodyl stimulates bowel movements and helps to alleviate constipation by increasing the muscular contractions in the intestines. 
• Bowel preparation: bisacodyl rectal suppositories are also used to empty bowels before medical procedures, such as colonoscopy or surgery. 
• Fecal impaction: In some cases of severe constipation or fecal impaction, bisacodyl rectal suppositories may be used to help soften and facilitate the passage of hardened stool.