Prevention of constipation in patients taking opioid analgesics (codeine, morphine, etc.)
Short-term, symptomatic treatment of constipation
Forms and strengths
5 mg enteric-coated tablet
Dosage
Child over 3 years: 5 to10 mg once daily
Adult:10 to 15 mg once daily
Duration
Prevention of constipation in patients taking opioids: start bisacodyl when analgesic treatment continues more than 48 hours. Tablets must be taken daily, at night (onset of effect within 6 to 12 hours after administration), until the end of the opioid treatment. Regular follow up (frequency/consistency of stools) is essential in order to adjust dosage correctly.
Treatment of constipation: until the patient passes stools, maximum7 days.
Contra-indications, adverse effects, precautions
Do not administer to patients with Crohn's disease, ulcerative colitis, intestinal obstruction, undiagnosed abdominal pain and dehydration.
May cause: diarrhoea, abdominalcramps, hypokalaemia.
In the event of diarrhoea: exclude a faecal impaction or intestinal obstruction, stop treatment for 24 hours and then start again with a halfdose.
In the event of abdominal cramps: reduce or divide the daily dose. Stop treatmentif pain continues. Do not combine with drugs that induce torsades de pointe (halofantrine, erythromycin IV, pentamidine, etc.).
Closely monitor patients taking drugs that induce hypokalaemia (furosemide, amphotericin B, corticosteroids, etc.) or cardiac glycosides.
Pregnancy and breast-feeding: avoid; for routine prevention of constipation due to opioids, use lactulose.
Remarks
To prevent constipation in patients taking opioids,use lactulose if the patient’sstools are solid; use bisacodyl if the patient’sstools are soft.
In children from 6 months to 3 years, do not use the oral route. Use only 5 mg paediatric suppositories (one suppository daily).
Swallow tablets whole; do not crush or chew.
Bisacodyl is equivalent to senna, the representative example of laxative stimulants in the WHO list of essential medicines.
The treatment must be accompanied by dietary measures(plenty of fluids and fibre).