Fleet

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Fleet

Classes

Contact/Stimulant Laxatives
Enemas for Constipation

Administration
Oral Administration

Oral preparations should be administered the evening before a morning bowel movement is desired. Administering on an empty stomach will produce more rapid results.
To avoid gastric irritation and the possibility of vomiting, enteric-coated preparations must be swallowed whole and not crushed or taken within 1 hour of antacids or milk.

Rectal Administration

Suppositories or enemas may be administered at the time a bowel movement is desired.
Instruct patient on proper use of suppository or enemas (see Patient Information).
Unwrap and moisten the suppository with water prior to insertion. If suppository is too soft because of storage in a warm place, chill in the refrigerator for 30 minutes or run cold water over it before removing the wrapper.
Encourage patient to retain suppository or enema for 15—30 minutes before expelling.

Adverse Reactions
Moderate

proctitis / Delayed / Incidence not known
hypokalemia / Delayed / Incidence not known
physiological dependence / Delayed / Incidence not known

Mild

nausea / Early / Incidence not known
abdominal pain / Early / Incidence not known
vomiting / Early / Incidence not known
diarrhea / Early / Incidence not known

Common Brand Names

Alophen, Bisac-Evac, Biscolax, Corrective Laxative for Women, Correctol, Dacodyl, Doxidan, Dulcolax, Ex-Lax Ultra, Feen-A-Mint, Fematrol, Femilax, Fleet, Laxative, Reliable Gentle Laxative, Veracolate

Dea Class

OTC

Description

Stimulant laxative often used to prepare patients for radiological GI procedures; administered orally or rectally; reclassified in 1996 as a Category III laxative indicating that more data are needed to determine the safety and efficacy of bisacodyl as a laxative.

Dosage And Indications
For the treatment of occasional constipation. Oral dosage Adults

5 to 15 mg PO as a single dose or once daily as needed. Either a suppository or oral tablet/capsule(s) may be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.

Children and Adolescents 12 to 17 years

5 to 15 mg PO as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.

Children 6 to 11 years

5 mg PO as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation).

Rectal dosage (suppository) Adults

10 mg (1 suppository) rectally as a single dose or once daily as needed. Either a suppository or oral tablet/capsule(s) may be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.

Children and Adolescents 12 to 17 years

10 mg (1 suppository) rectally as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.

Children 6 to 11 years

5 mg (0.5 suppository) rectally as a single dose or once daily as needed. May be used up to 3 times weekly (e.g., every other day) for treatment of routine constipation.

Rectal dosage (enema) Adults

10 mg (1 retention enema) rectally as a single dose or once daily as needed.

Children and Adolescents 12 to 17 years

10 mg (1 retention enema) rectally as a single dose or once daily as needed.

Dosing Considerations
Hepatic Impairment

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Renal Impairment

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

Drug Interactions

Acetaminophen; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Aluminum Hydroxide: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Carbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Hydroxide: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aluminum Hydroxide; Magnesium Trisilicate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Antacids: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Atropine; Difenoxin: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Bumetanide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Calcium Carbonate: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour. (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Calcium Carbonate; Magnesium Hydroxide: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Carbonate; Simethicone: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Calcium Phosphate, Supersaturated: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery.
Calcium; Vitamin D: (Moderate) By increasing intragastric pH, calcium carbonate can affect the dissolution of oral bisacodyl tablets; administration should be separated by 1 hour.
Chlorpheniramine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Cimetidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Dichlorphenamide: (Moderate) Use dichlorphenamide and bisacodyl together with caution. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Measure potassium concentrations at baseline and periodically during dichlorphenamide treatment. If hypokalemia occurs or persists, consider reducing the dichlorphenamide dose or discontinuing dichlorphenamide therapy.
Diphenoxylate; Atropine: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Ethacrynic Acid: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Famotidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Food: (Minor) The concomitant use of bisacodyl oral tablets with milk-containing products can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid ingesting milk products within 1 hour before or after the bisacodyl dosage.
Furosemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Guaifenesin; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
H2-blockers: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone; Ibuprofen: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as bisacodyl, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Ibuprofen; Famotidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Lactulose: (Major) In general, other laxatives, such as bisacodyl, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved.
Loop diuretics: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.
Magnesium Hydroxide: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
Nizatidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Omeprazole; Sodium Bicarbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Polyethylene Glycol: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis. (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes; Ascorbic Acid: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis. (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes; Bisacodyl: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Proton pump inhibitors: (Minor) The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage.
Ranitidine: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage.
Sodium Bicarbonate: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid antacids within 1 hour before or after the bisacodyl dosage.
Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery.
Torsemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy.

How Supplied

Alophen/Bisac-Evac/Bisacodyl/Corrective Laxative for Women/Correctol/Dacodyl/Doxidan/Dulcolax/Feen-A-Mint/Fematrol/Femilax/Reliable Gentle Laxative/Veracolate Oral Tab DR: 5mg
Bisac-Evac/Bisacodyl/Biscolax/Dulcolax/Laxative Rectal Supp: 10mg
Fleet Rectal Enema: 10mg, 30mL

Maximum Dosage
Adults

15 mg/day PO or 10 mg/day PR.

Geriatric

15 mg/day PO or 10 mg/day PR.

Adolescents

15 mg/day PO or 10 mg/day PR.

Children

12 years: 10 mg/day PR (suppository or enema) or 15 mg/day PO.
6 to 11 years: 5 mg/day PR or PO; do not use enema.
Less than 6 years: Safety and efficacy have not been established. Off-label use has been reported.

Infants

Safety and efficacy have not been established.

Neonates

Not indicated.

Mechanism Of Action

Stimulant laxatives are believed to produce laxation by directly stimulating peristaltic movement of the intestine via local mucosal irritation, thus increasing motility. More recent studies suggest that bisacodyl promotes evacuation of the colon by altering intestinal fluid and electrolyte absorption. This causes a net intestinal fluid accumulation and produces laxation.

Pharmacokinetics

Bisacodyl is administered either orally or rectally. Bisacodyl distributes locally, and the circulating drug undergoes hepatic metabolism and is then excreted in the urine.

Oral Route

Bisacodyl is minimally absorbed (15%), and the onset of action of the drug begins 6—8 hours after an oral dose.

Other Route(s)

Rectal Route
Bisacodyl is minimally absorbed (15%), and the onset of action of the drug begins 15—60 minutes after rectal administration.

Pregnancy And Lactation
Pregnancy

Pregnant individuals should consult a qualified health care prescriber prior to using bisacodyl as controlled studies in pregnancy have not been performed; however no evidence of teratogenic effects has been reported with use and systemic absorption is low after either oral or rectal administration. Use at recommended doses for occasional constipation during pregnancy, when needed, is not expected to produce harm to the fetus. The safest first-line treatments to use during pregnancy are those that have more data regarding their use in pregnancy and are not absorbed systemically (e.g., fiber, bulk-forming laxatives, stool softeners). When needed, psyllium, docusate sodium, or polyethylene glycol 3350 have minimal systemic absorption and can be considered for chronic constipation during pregnancy.

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. Thus, clinical risk to the infant is negligible and the drug may be used if needed during breast-feeding; no special precautions exist. Other agents may also be considered for treating constipation during lactation; alternate drugs to consider include docusate products, magnesium hydroxide, and psyllium. Senna (standardized sennosides) has also been commonly used post-partum and is considered compatible with breast-feeding.