Bisacodyl

Bisacodyl is an organic compound that is used as a stimulant laxative drug. It works directly on the colon to produce a bowel movement. It is typically prescribed for relief of episodic and chronic constipation and for the management of neurogenic bowel dysfunction, as well as part of bowel preparation before medical examinations, such as for a colonoscopy.^[2][3]

Bisacodyl

Clinical data
Trade names	Fleet, Dulcolax, Brooklax, others
AHFS/Drugs.com	Monograph
MedlinePlus	a601027
License data	US DailyMed: Bisacodyl
Routes of administration	By mouth, rectal
ATC code	A06AB02 (WHO) A06AG02 (WHO)
Legal status
Legal status	AU: S2 (Pharmacy medicine)[1] US: OTC / Rx-only In general: Over-the-counter (OTC)
Pharmacokinetic data
Bioavailability	15%[citation needed]
Metabolism	Liver (CYP450-mediated)
Elimination half-life	16 hours[citation needed]
Excretion	Primarily in the feces, systemically absorbed drug is excreted in the urine[citation needed]
Identifiers
IUPAC name (pyridin-2-ylmethanediyl)dibenzene-4,1-diyl diacetate OR 4,4'-(pyridin-2-ylmethylene)bis(4,1-phenylene) diacetate
CAS Number	603-50-9 Y
PubChem CID	2391
DrugBank	DB09020 N
ChemSpider	2299 Y
UNII	10X0709Y6I
KEGG	D00245 Y
ChEMBL	ChEMBL942 Y
CompTox Dashboard (EPA)	DTXSID1022681
ECHA InfoCard	100.009.132
Chemical and physical data
Formula	C22H19NO4
Molar mass	361.397 g·mol−1
3D model (JSmol)	Interactive image
SMILES O=C(Oc1ccc(cc1)C(c2ccc(OC(=O)C)cc2)c3ncccc3)C
InChI InChI=1S/C22H19NO4/c1-15(24)26-19-10-6-17(7-11-19)22(21-5-3-4-14-23-21)18-8-12-20(13-9-18)27-16(2)25/h3-14,22H,1-2H3 Y Key:KHOITXIGCFIULA-UHFFFAOYSA-N Y
NY (what is this?)  (verify)

Bisacodyl is a derivative of triphenylmethane. It was first used as a laxative in 1953 because of its structural similarity to phenolphthalein.^[4][5]

It is on the World Health Organization's List of Essential Medicines.^[6] In 2023, it was the 293rd most commonly prescribed medication in the United States, with more than 400,000 prescriptions.^[7][8]

Medical uses

Bisacodyl is used to treat both episodic and chronic constipation, manage symptoms of neurogenic bowel dysfunction, as well as for bowel preparation for a colonoscopy.^[2][3]

Available forms

Bisacodyl is marketed under the trade names Dulcolax/Durolax, Muxol, Fleet, Nourilax, Alophen, Correctol, and Carter's Little Pills (formerly Carter's Little Liver Pills),^[9] as well as being available generically. It is usually sold as 5 mg tablets, 10 mg suppositories, or 5 mg pediatric suppositories. It is also available as a 1.25 US fluid ounces (37 ml) pre-packaged enema containing a 10 mg delivered dose of liquid bisacodyl.^[10]

Administration

When administered rectally in suppository form, it is usually effective in 15 to 60 minutes. For optimal use, if used as a suppository, it is recommended that bisacodyl be given after breakfast to synchronize with the gastrocolic reflex.^[3]

As a commercially prepared micro-enema, it is usually effective in 5 to 20 minutes.^[10]

Mechanism of action

Bisacodyl works by stimulating enteric neurons to cause peristalsis (i.e., colonic contractions). It is also a contact laxative; it increases fluid and salt secretion. The action of bisacodyl on the small intestine is negligible; stimulant laxatives mainly promote evacuation of the colon.^[10]