Bisacodyl is a short-term treatment for constipation that is used to empty the bowels before surgery and certain other medical procedures. As a stimulant laxative, bisacodyl increases the activity of the intestines to cause a bowel movement. Bisacodyl is available as a tablet to take by mouth.
Ahmedzai, S.H., & Boland, J. (2010, April). Constipation in people prescribed opioids. Clinical Evidence, 2407.
To answer the following questions: What are the effects of oral laxatives, rectal preparations, and opioid antagonists for constipation in people prescribed opioids?
Databases searched were MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Library, NHS Centre for Reviews and Dissemination (CRD), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment, TRIP, and the National Institute for Health and Clinical Excellence (NICE) up to August 2009. Alerts from the U.S. Food and Drug Administration and the U.K. Medicines and Healthcare Products Regulatory Agency were included to identify any adverse effects.
Search keyword were constipation and opioids, Lactulose, macrogols, senna, bisacodyl, co-danthrusate/co-danthramer, docusate, ispaghula husk, liquid paraffin, magnesium salts, methylcellulose, arachis oil enema, glycerol suppository, phosphate enema, sodium citrate enema, and opioid antagonists.
Studies were included in the review if they
The GRADE System was used to evaluate study quality. Full information is available online with a subscription.
The final sample comprised 23 systematic reviews, RCTs, or observational studies. This was an update of a previous review that added 1 systematic review and 5 RCTs, with no change in overall recommendations provided.
Nurses should be aware of potential implications related to the use of opioid antagonists in controlling constipation for opioid interactions and changes in pain control. In addition, nurses should routinely assess for pain relief, as well as symptoms of constipation, in this patient population.
Kienzle-Horn, S., Vix, J.M., Schuitjt, C., Peil, H., Jordan, C.C., & Kamm, M.A. (2006). Efficacy and safety of bisacodyl in acute treatment of constipation: A double-blind, randomized, placebo-controlled study. Aliment Pharmacology and Therapeutics, 23, 1479–1488.
To determine the effect and safety of oral bisacodyl on stool frequency and consistency.
Patients received bisacodyl 10 mg (two 5-mg tablets) or placebo (two tablets) orally once daily on three successive days following a three-day run-in period. The study had a three-day baseline period and three treatment days. Patients were asked not to drink milk or take antacids at the same time as study medications because they could dissolve the enteric coating. Randomization was 1:1. Unused medication was collected at the end of the treatment period. Primary endpoints during the three-day treatment period were mean number of stools per day and mean stool consistency.
Eight primary care practices in Germany
This was a phase IV, multicenter, double-blind, randomized, placebo-controlled, parallel group design study.
Bisacodyl is effective and safe in improving stool frequency and consistency.
Kienzle-Horn, S., Vix, J.M., Schuitjt, C., Peil, H., Jordan, C.C., & Kamm, M.A. (2007). Comparison of bisacodyl and sodium picosulfate in the treatment of chronic constipation. Current Medical Research and Opinion, 23, 691–699.
To compare the safety and efficacy of bisacodyl and sodium picosulphate.
Patients received 5 to 10 mg of bisacodyl sugar-coated tablets or sodium picosulphate drops daily over four weeks. The study schedule included four visits: an initial screening visit followed by a seven-day baseline period, a randomization visit (1:1 basis) and two follow-up visits on days 15 and 29.
15 centers (outpatient clinics and specialist gastroenterology units) in Germany
This was a phase IV, open-label, randomized, parallel group study.
Bisacodyl and sodium picosulphate are equally tolerated and effective in the treatment of chronic constipation.
Koopmans-Klein, G., Wagemans, M.F., Wartenberg, H.C., Van Megen, Y.J., & Huygen, F.J. (2015). The efficacy of standard laxative use for the prevention and treatment of opioid induced constipation during oxycodone use: A small Dutch observational pilot study. Expert Review of Gastroenterology and Hepatology, 10, 547–553.
To explore the effectiveness of standard laxative treatment in the prevention of oxycodone-induced constipation
From July 2013 to October 2013, standard laxative treatment consisting of polyethylene glycol (PEG) with electrolytes was started at the same time as opioid intake on day 1. Bisacodyl was prescribed, and patients took this as needed. Patients prescribed oxycodone at least 20 mg slow-release tables were started on the standard laxative treatment and followed for 28 days.
The dose of PEG and electrolytes varied between 0-3 sachets, and the bisacodyl dose varied from 5 mg-20 mg. Based on responder analysis criteria, 43% of patients (9 of 21) who were prescribed a standard laxative therapy regimen did not respond.
A standard laxative therapy regimen may not be effective in all patients given the type of opioid they may be prescribed and what their bowel function is at the start of opioid therapy.
Response to prophylactic PEG plus electrolytes is patients taking oxycodone SR is variable.
National Comprehensive Cancer Network. (2011). NCCN Clinical Practice Guidelines in Oncology: Adult cancer pain [v. 2.2011]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf
The guidelines recommend the following for management of opioid-induced constipation.
If Constipation Occurs:
Recommendations were identified as having low-level evidence and uniform consensus.