Dulcolax (Bisacodyl)
Also sold as: Dulcolax, Laxoberon (sodium picosulfate), Bicol, Dulcoflex, Evac-Q
Pregnancy
Cat C
Lactation
Safe
Schedule
OTC
Forms
Enteric-coated tablet 5mg, 10mg +2
Indications
- Constipation (short-term treatment)
- Bowel preparation before colonoscopy, endoscopy, or surgery
- Opiate-induced constipation (adjunct)
- Evacuation for radiological/surgical procedures
Adult Dosing
Constipation (oral)
5–10 mg PO at bedtime
Acts in 8–12 hours. Do not take within 1 hour of antacids/milk (dissolves enteric coat). Short-term use only (< 2 weeks).
Constipation / bowel preparation (suppository)
10 mg rectally
Acts in 15–60 minutes. For rapid, local effect.
Bowel prep (colonoscopy)
2 tablets (10 mg) + macrogol/PEG or phosphate enema — per colonoscopy protocol
Regimen varies; follow endoscopy unit protocol
Pediatric Dosing
Not for infants < 2 years. Short-term use only in children.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No dose adjustment required |
Hepatic Adjustment
No dose adjustment required
Pregnancy & Lactation
Pregnancy: Category C
Avoid in 1st trimester — may stimulate uterine contractions. In 2nd/3rd trimester: bulk-forming laxatives and lactulose preferred. Short-term suppository use generally accepted in pregnancy if essential.
Lactation: Safe
Very poorly absorbed systemically; negligible transfer to breast milk — generally considered safe for breastfeeding
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Antacids, milk, H2 blockers | Dissolve enteric coating if taken within 1 hour of bisacodyl tablet — premature drug release causing gastric irritation | Moderate |
| Corticosteroids, carbenoxolone | Additive risk of hypokalaemia with excessive bisacodyl use | Moderate |
| Digoxin | Hypokalaemia from excessive laxative use increases digoxin toxicity | Moderate |
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Side Effects
Common
- Abdominal cramps and colic (very common — dose-related)
- Nausea
- Diarrhoea (excessive effect — reduce dose)
- Rectal irritation (suppository)
- Hypokalaemia (chronic overuse)
Serious / Discontinue If
- Severe hypokalaemia (chronic misuse — associated with laxative abuse)
- Melanosis coli (harmless brown discolouration of colon with long-term use — resolves on stopping)
- Cathartic colon (extremely rare — with severe long-term abuse)
- Electrolyte disturbances
Contraindications
- Acute surgical abdomen (appendicitis, perforation, obstruction)
- Ileus
- Severe dehydration
- Inflammatory bowel disease (acute flare)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Dulcolax 5mg | Boehringer Ingelheim | 10 tab ₹55 |
| Dulcoflex 5mg | Wockhardt | 10 tab ₹45 |
| Bicol 5mg suppository | Sun Pharma | 5 supp ₹85 |
Monitoring Required
- Stool consistency and frequency
- Serum potassium (if frequent/long-term use)
- Signs of dependence or laxative abuse
Patient Counseling Points
- Take at bedtime — will work 8–12 hours later (morning)
- Do not take within 1 hour of drinking milk or taking antacids — damages the tablet coating
- Swallow tablet whole — do not crush or chew
- Not for long-term daily use — treat the cause of constipation (diet, water, exercise)
- Suppository: lie on left side, insert blunt end first, retain as long as possible (15–60 minutes for effect)
- Increase water and fibre intake to prevent constipation from recurring
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Clinically reviewed by: Dr. Pradeep Nair, DM (Gastroenterology), Consultant Gastroenterologist
Last reviewed: 2026-04-01
References
- NICE Constipation Guidelines CG 99
- BNF — Bisacodyl
- ACG Constipation Guidelines 2021
- Indian Society of Gastroenterology — Constipation Management