Short term relief of constipation.
Constipation, either chronic or of recent onset, whenever a stimulant laxative is required.
Bowel clearance before surgery or radiological investigation. Replacement
of the evacuant enema in all its indications.

Short-term treatment for constipation
Adults and children over 10 years: 1 to 2 coated tablets (5 - 10 mg) daily before bedtime. Children 4 – 10 years: 1 coated tablet (5 mg) daily before bedtime.
It is recommended to start with the lowest dose. The dose may be adjusted up to the maximum recommended dose to produce regular stools.
The maximum daily dose should not be exceeded.
In the management of constipation, once regularity has been restarted dosage should be reduced and can usually be stopped.

Children aged 10 years or younger with chronic or persistent constipation should only be treated under the guidance of a physician. Bisacodyl should not be used in children aged 4 years or younger. For preparation of diagnostic procedures and preoperatively
For preparation of diagnostic procedures, in pre- and postoperative treatment when defaecation needs to be facilitated, DULCOLAX should be used under medical supervision. The tablets should be combined with suppositories in order to achieve complete evacuation of the intestine. Adults and children over 10 years: 2 coated tablets (10 mg) in the morning and 2 coated tablets (10 mg) in the evening and 1 suppository (10 mg) on the following morning is recommended. Children aged 4 -10 years of age: 1 coated tablet (5 mg) in the evening and
1 suppository (5 mg) on the following morning is recommended.
Instructions for use
It is recommended to take the coated tablets at night to have a bowel movement the following morning. They should be swallowed whole with an adequate amount of fluid.
The coated tablets should not be taken together with products which reduce the acidity of the upper gastrointestinal tract, such as milk, antacids or proton pump inhibitors, in order not to prematurely dissolve the enteric coating.
Suppositories are usually effective in about 20 minutes (usual range 10 to 30 minutes). Rarely the laxative effect has been reported 45 minutes after administration. They should be unwrapped and inserted into the rectum pointed end first.
No specific information on the use of this product in the elderly is available. Clinical trials have included patients over 65 years and no adverse reactions specific to this age group have been reported.

DULCOLAX is contraindicated in patients with ileus, intestinal obstruction, acute abdominal conditions including appendicitis, acute inflammatory bowel diseases, and severe abdominal pain associated with nausea and vomiting which may be indicative of the aforementioned severe conditions. DULCOLAX is also contraindicated in severe dehydration and in patients with Known hypersensitivity to bisacodyl or any other component of the product. In case of hereditary conditions that may be incompatible with an excipient of the product (please refer to “Special warnings and special precautions for use”) the use of the product is contraindicated.

As with all laxatives, DULCOLAX should not be taken on a continuous daily
basis for more than five days without investigating the cause of constipation.
Prolonged excessive use may lead to fluid and electrolyte imbalance and
hypokalaemia.
Intestinal loss of fluids can promote dehydration. Symptoms may include thirst
and oliguria. In patients suffering from fluid loss where dehydration may be
harmful (e.g. renal insufficiency, elderly patients) DULCOLAX should be
discontinued and only be restarted under medical supervision.
Stimulant laxatives including DULCOLAX do not help with weight loss (see
section 5.1 Pharmacodynamic properties).
Patients may experience haematochezia (blood in stool) that is generally mild
and self-limiting.
Dizziness and / or syncope have been reported in patients who have taken DULCOLAX. The details available for these cases suggest that the events would be consistent with defaecation syncope (or syncope attributable to straining at stool), or with a vasovagal response to abdominal pain related to the constipation, and not necessarily to the administration of bisacodyl itself.
There have been isolated reports of abdominal pain and bloody diarrhoea
occurring after taking bisacodyl. Some cases have been shown to be associated
with colonic mucosal ischaemia.
DULCOLAX should not be taken by children under 10 years without medical advice.
DULCOLAX Tablets contain a small amount of lactose (33.2 mg) and sucrose (23.4 mg) in each tablet. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine.

The concomitant use of antacids and milk products may reduce the resistance of the coating of the tablets and result in dyspepsia and gastric irritation.
The concomitant use of diuretics or adreno-corticosteroids may increase the risk of electrolyte imbalance if excessive doses of DULCOLAX are taken.
Electrolyte imbalance may lead to increased sensitivity to cardiac glycosides.
The concomitant use of other laxatives may enhance the gastrointestinal side
effects of DULCOLAX.

Fertility
No studies on the effect on human fertility have been conducted.
Pregnancy
There are no adequate and well-controlled studies in pregnant women. Long
experience has shown no evidence of undesirable or damaging effects during
pregnancy.
Lactation
Clinical data show that neither the active moiety of bisacodyl (BHPM or bis- (p-hydroxyphenyl)-pyridyl-2-methane) nor its glucuronides are excreted into the milk of healthy lactating females.
Nevertheless, as with all medicines, DULCOLAX should not be taken in pregnancy, especially the first trimester, and during breast feeding unless the expected benefit is thought to outweigh any possible risk and only on medical advice.

No studies on the effects of DULCOLAX on the ability to drive and use
machines have been performed.
However, patients should be advised that due to a vasovagal response (e.g. to
abdominal spasm) they may experience dizziness and / or syncope. If patients
experience abdominal spasm they should avoid potentially hazardous tasks such
as driving or operating machinery.

The most commonly reported adverse reactions during treatment are abdominal pain and diarrhoea.
Adverse events have been ranked under headings of frequency using the following convention: Very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, <1/100); rare (≥ 1/10000, <1/1000); very rare (<1/10000). Immune system disorders
Rare: anaphylactic reactions, angioedema, hypersensitivity. Metabolism and nutrition disorders
Rare: dehydration. Nervous system disorders
Uncommon: dizziness.
Rare: Syncope.
Dizziness and syncope occurring after taking bisacodyl appear to be consistent with a vasovagal response (e.g. to abdominal spasm, defaecation).

Gastrointestinal disorders
Uncommon: haematochezia (blood in stool), vomiting, abdominal discomfort, anorectal discomfort.
Common: abdominal cramps, abdominal pain, diarrhoea and nausea.
Rare: colitis including ischaemic colitis.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit / risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the National Pharmacovigilance Center.
• Saudi Arabia:

− The National Pharmacovigilance and Drug Safety Centre (NPC)
o Fax: +966-11-205-7662
o Call NPC at +966-11-2038222, Exts: 2317-2356-2353-2354-2334-2340.
o Toll free phone: 8002490000
o Calling: 19999
o E-mail: npc.drug@sfda.gov.sa

• Other GCC States:

− Please contact the relevant competent authority

Symptoms
If high doses are taken watery stools (diarrhoea), abdominal cramps and a clinically significant loss of fluid, potassium and other electrolytes can occur.
Laxatives when taken in chronic overdose may cause chronic diarrhoea, abdominal pain, hypokalaemia, secondary hyperaldosteronism and renal calculi. Renal tubular damage, metabolic alkalosis and muscle weakness secondary to hypokalaemia have also been described in association with chronic laxative abuse. Therapy
After ingestion of oral forms of DULCOLAX, absorption can be minimised or
prevented by inducing vomiting or gastric lavage. Replacement of fluids and
correction of electrolyte imbalance may be required. This is especially
important in the elderly and the young. Administration of antispasmodics may
be of value.

ATC code: A06AB02
Bisacodyl is a locally acting laxative from the diphenylmethane derivatives group having a dual action. As a contact laxative, for which also antiresorptive hydragogue effects have been described, bisacodyl stimulates after hydrolysis in the large intestine, the mucosa of both the large intestine and of the rectum. Stimulation of the mucosa of the large intestine results in colonic peristalsis with promotion of accumulation of water, and consequently electrolytes, in the colonic lumen. This results in a stimulation of defecation, reduction of transit time and softening of the stool. Stimulation of the rectum causes increased motility and a feeling of rectal fullness. The rectal effect may help to restore the “call to stool” although its clinical relevance remains to be established.
As a laxative that acts on the colon, bisacodyl specifically stimulates the natural
evacuation
process in the lower region of the gastrointestinal tract. Therefore, bisacodyl is
ineffective in altering the digestion or absorption of calories or essential
nutrients in the small intestine.

Following either oral or rectal administration, bisacodyl is rapidly hydrolyzed to
the active principle bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), mainly
by esterases of the enteric mucosa.
Administration as an enteric coated tablet was found to result in maximum BHPM plasma concentrations between 4 – 10 hours post administration whereas the laxative effect occurred between 6 – 12 hours post administration. In contrast, following the administration as a suppository, the laxative effect occurred on average approximately 20 minutes post administration; in some cases it occurred 45 minutes after administration. The maximum BHPM-plasma concentrations were achieved 0.5 – 3 hours following the administration as a suppository. Hence, the laxative effect of bisacodyl does not correlate with the plasma level of BHPM. Instead, BHPM acts locally in the lower part of the intestine and there is no relationship between the laxative effect and plasma levels of the active moiety. For this reason, bisacodyl coated tablets are formulated to be resistant to gastric and small intestinal juice. This results in a main release of the drug in the colon, which is the desired site of action.
After oral and rectal administration, only small amounts of the drug are absorbed and are almost completely conjugated in the intestinal wall and the liver to form the inactive BHPM glucuronide. The plasma elimination half-life of BHPM glucuronide was estimated to be approximately 16.5 hours. Following the administration of bisacodyl coated tablets, an average of 51.8% of the dose was recovered in the faeces as free BHPM and an average of 10.5% of the dose was recovered in the urine as BHPM glucuronide. Following the administration as a suppository, an average of 3.1% of the dose was recovered as BHPM glucuronide in the urine. Stool contained large amounts of BHPM (90% of the total excretion) in addition to small amounts of unchanged bisacodyl.

There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.

Tablet core:
Lactose
Maize starch
Soluble maize starch
Glycerol
Magnesium stearate

Tablet coating:
Magnesium stearate
Sucrose
Talc
Acacia
Titanium dioxide (E171)
Methacrylic acid-methylmethacrylate copolymer (1:1)
Methacrylic acid-methylmethacrylate copolymer (1:2)
Castor oil
Macrogol 6000
Yellow iron oxide (E172)
White beeswax
Carnauba wax
Shellac.

None stated.

3 years

Do not store above 25°C.
Keep container in the outer carton.

Blister packs consisting of opaque white PVC/PVDC blister foil and aluminium
foil (covering foil). Pack sizes 20, 40, 60, 80, 100, and 200
Blister packs consisting of colourless PVC blister foil and aluminium foil (covering foil). Pack sizes 20, 40, 60, 80, 100, and 200
Polypropylene tubs (pack size 1000).
Not all pack sizes may be marketed.

None stated.