Treatment Name: Bisacodyl (Dulcolax®)

Bisacodyl (Dulcolax®) is a Supportive Care Therapy to treat Constipation

How does bisacodyl (Dulcolax®) work?
Bisacodyl is a laxative designed to directly stimulate the movement of the intestines, which produces a bowel movement. It also causes the body to move water into the intestines, which softens the stool and the excess water can also stimulate the intestines and produce a bowel movement.

Goals of therapy:
Bisacodyl (Dulcolax®) is taken to relieve occasional constipation. It is commonly taken on an as needed basis with the goal of treating constipation.

Bisacodyl (Dulcolax®) is available as an over-the-counter medication.

Schedule

Bisacodyl is commonly taken at home on an as needed basis to treat constipation and maintain normal, regular bowel movements daily or every other day.

Onset of action:
When dosed adequately, bisacodyl tablets generally induce a bowel movement in approximately 6 to 12 hours when taken by mouth. If suppositories are used, the effect is often quicker and a bowel movement may occur in as little as 15 minutes to 1 hour.

Dosing:
Bisacodyl (Dulcolax®) tablets:

Bisacodyl 5-15 mg (one to three tablets) by mouth once daily with a glass of water
Do not take bisacodyl tablets within one hour after taking antacids or eating and drinking milk or dairy products
Unless directed by a doctor, bisacodyl should not be used for longer than one week at a time

Bisacodyl (Dulcolax®) suppositories:

Bisacodyl 10 mg suppository inserted into the rectum once daily. Retain in rectum for 15 to 20 minutes. Do not use more than one bisacodyl suppository per day
If you are receiving chemotherapy, do NOT attempt to use a suppository unless you have discussed this with your doctor. Use of suppositories could cause a tear in the rectum and may lead to a serious infection
Unless directed by a doctor, bisacodyl should not be used for longer than one week at a time

Bisacodyl is usually taken at home. Typical duration of therapy is until bisacodyl no longer works in relieving constipation, or constipation is resolved and bisacodyl is no longer needed. Do not take bisacodyl for more than seven days without talking to your doctor.

Store bisacodyl tablets at room temperature (68-77°F). Store bisacodyl suppositories at a temperature that is less than 86°F otherwise the suppository may melt.

Side Effects

In the prescribing label information (bisacodyl package insert), the most commonly reported side effects from bisacodyl (Dulcolax®) are shown here:

Bisacodyl should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby.

Note: The exact percentages of patients that will experience bisacodyl side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials.

Side effect videos
ConstipationPain

Monitoring

How often is monitoring needed?
Labs (blood tests) are usually not necessary to start or continue bisacodyl therapy. If suppositories are used, a complete blood count (CBC) may be ordered to ensure that the white blood cell count is not too low

How often is imaging needed?
Imaging may be checked if there is concern of a small bowel obstruction (SBO) or blockage. Imaging may include: Abdominal X-ray, or CT scan of the abdomen and pelvis.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue bisacodyl as planned, add additional laxatives, place you on “bowel rest” (nothing by mouth until the obstruction clears), or switch to an alternative therapy for constipation.

To prevent constipation from getting worse, call your doctor if bisacodyl does not produce a bowel movement within the time that they have specified.

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

Questions to ask your Doctor Nurse Pharmacist

Questions to ask your Nurse Doctor Pharmacist

Questions to ask your Pharmacist Doctor Nurse

ChemoExperts Tips

Bisacodyl (Dulcolax®) is an inexpensive, yet effective over-the-counter remedy for constipation
Bisacodyl should not be used if you have noticed blood in the stool as this could be a sign of a serious condition
To maintain regular bowel movements, bisacodyl may be combined with other over-the-counter medications. Talk to your doctor or pharmacist if you have trouble maintaining normal bowel movements
If you are receiving chemotherapy, do NOT attempt to use a suppository or enema unless you have discussed this with your doctor. Suppositories and enemas can cause a tear in the rectum and may lead to a serious infection
Walking helps to stimulate the bowels to move stool down the intestinal tract. A diet high in fiber (found in fruits, vegetables, and whole grains) also helps to maintain a healthy colon (large intestine)
It is important to have regular bowel movements, usually once daily or every other day. Otherwise, your small bowel (intestine) may become blocked. Call your doctor if you have not had a bowel movement for 3 days or more, especially if you feel bloated. If you feel pain in your abdomen/belly, feel nauseated, or vomit at any point while constipated, call your doctor immediately
Do not use suppositories if the foil wrapper is ripped or torn
A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately

Patient Assistance & Co-payment Coverage

References

Bisacodyl (Dulcolax®) package insert

Created: January 7, 2018 Updated: January 7, 2018

What is Constipation?

What is constipation?

Constipation means bowel movements happen less often than usual, or the stool becomes hard, dry, or difficult to pass. Constipation does not only mean “not going often,” but can also include straining, feeling like the bowel does not empty fully, or having pain when trying to go.

What does constipation look like?

Constipation may look like fewer bowel movements, hard or lumpy stool, straining, stomach cramps, bloating, or a feeling of fullness. Some patients also feel nauseated or have a decreased appetite because stool is moving too slowly through the intestines. In very severe cases, stool can build up in the intestines and cause a blockage.

Who gets constipation?

Constipation can happen due to low fluid intake, not enough dietary fiber, decreased physical activity, changes in routine, or certain medications. In patients with cancer, constipation is common because cancer treatment can affect diet, activity, and normal bowel function. One common cause of constipation in patients with cancer is the use of opioid pain medications. Opioids slow the movement of the intestines, reduce normal gut secretions, and can make stool drier and harder.

How is constipation prevented?

Prevention usually starts with simple daily habits such as drinking enough fluids, staying as active as possible, and eating fiber when appropriate. Patients who are at high risk of constipation, such as those receiving opioid pain medications, may be started on a bowel regimen with certain laxatives to help prevent constipation. Medications that are commonly used as part of a bowel regimen include sennosides + docusate (Senna-S®) and polyethylene glycol (MiraLAX®).

How is constipation treated?

Treatment depends on the cause and how severe the constipation is. Common medication options include stimulant laxatives, osmotic laxatives, and enemas. Stool softeners help make stool easier to pass, while stimulant laxatives help the bowel contract and move stool along. Osmotic laxatives work by pulling water into the bowel to soften stool and help it move. Some examples of these medications, most of which are available over-the-counter (OTC), include:

Stimulant laxatives
- Sennosides (Senna®)
- Bisacodyl (Dulcolax®)
Osmotic laxatives
- Polyethylene glycol (MiraLAX®)
- Magnesium citrate
- Magnesium hydroxide
- Lactulose
- Sorbitol
Enemas
- Sodium phosphate (Fleet®)
- Mineral oil
- Glycerin
- Tap water

For patients that have low white blood cells (neutrophils) or low platelets, it is not recommended to treat constipation with enemas.

For constipation related to opioids, if regular laxatives do not work well enough, some patients may need additional medications that are specifically used for opioid-induced constipation such as methylnaltrexone (Relistor®), naldemedine (Symproic®), or naloxegol (Movantik®).

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.