Xelcolax

Indications

Bisacodyl is a stimulant laxative used for short-term relief of constipation. It is also used to empty the bowel before X-rays, colonoscopy (camera examination of the bowel) or surgery, as directed by the hospital. It is available as tablets (usually enteric-coated) and as suppositories.

How It Works

Bisacodyl acts directly on the lining of the large bowel. It stimulates the nerves in the bowel wall, which increases the muscle movements that push stool along, and it draws water into the bowel, making stools softer. Tablets usually work in 6 to 12 hours; suppositories usually work in 15 to 60 minutes.

Dosage and Administration

Adults and children over 10 years: tablets 5 to 10 mg once a day, usually taken at bedtime for a bowel movement the next morning. Swallow tablets whole; do not crush or chew them, and do not take them within 1 hour of milk, antacids or acid-reducing medicines. Suppository: 10 mg inserted into the back passage once a day, usually in the morning. For children under 10 years, and for bowel preparation before procedures, use only as prescribed. Do not use for more than 5 days in a row without medical advice.

Interactions

Milk, antacids and acid-reducing medicines (for example Omeprazole or Ranitidine) can make the tablet coating dissolve too early, causing stomach irritation. Using it with diuretics or steroids such as Prednisolone increases the risk of low potassium. Low potassium can increase the side effects of Digoxin.

Contraindications

Do not use bisacodyl if you have a blocked bowel, severe stomach pain of unknown cause, appendicitis, acute inflammatory bowel disease, severe dehydration, or if you are allergic to it. Suppositories should not be used with anal fissures or painful, inflamed piles.

Side Effects

Common side effects include stomach cramps, abdominal pain, nausea and diarrhoea. Suppositories may cause burning or discomfort in the back passage. Long-term or heavy use can cause loss of fluids and salts such as potassium, and dependence on laxatives.

Get urgent medical help if you have severe or continuing abdominal pain, bleeding from the back passage, black or bloody stools, signs of dehydration (dizziness, very little urine, severe thirst), muscle weakness or an irregular heartbeat, or signs of a serious allergic reaction.

Pregnancy and Lactation

For constipation in pregnancy, diet changes and bulk-forming laxatives are tried first. Bisacodyl may be used for a short time on a doctor's or pharmacist's advice. Very little passes into breast milk, and it is generally considered compatible with breastfeeding for short-term use.

Precautions and Warnings

Drink plenty of fluids and eat fibre-rich foods. Do not use laxatives regularly for long periods. See a doctor if constipation lasts more than 2 weeks, keeps coming back, or comes with weight loss or a change in bowel habit. Some people faint from straining or abdominal cramps, so take care.

Overdose

Too much bisacodyl causes diarrhoea, cramps and loss of fluid and salts, which can be serious in older people and children. Drink fluids and seek medical advice; in severe cases hospital treatment may be needed.

Therapeutic Class

Stimulant laxative.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep suppositories below 25°C so they do not melt.