MIMS Revision Date: 01 January 2023

1 Name of Medicine

Bisacodyl.

2 Qualitative and Quantitative Composition

Bisalax enema contains 10 mg bisacodyl/5 mL tube.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Enema.
White to grey viscous material.

4 Clinical Particulars

4.1 Therapeutic Indications

Constipation due to confinement to bed, unaccustomed diet or change of environment. Constipation in cases of serious diseases, circulatory disturbances and metabolic disorders; occasional use in chronic constipation; bowel re-training; postoperatively in cases of haemorrhoids and anal fissures; colostomies; preparation for radiography; preparation for sigmoidoscopy or proctoscopy; preoperative preparation; postoperative care; antepartum and postpartum constipation; and preparation for delivery.

4.2 Dose and Method of Administration

The enemas can be used in conjunction with tablets. Taken at bedtime, Bisalax tablets are almost invariably effective by the following morning. When taken before breakfast, they usually produce an effect within 6-8 hours. The effects of the enema occur normally within 5 to 15 minutes.
Adults. Preparation for X-ray examination of abdominal organs. The day prior to the examination, 2 tablets are taken orally at lunchtime and 2 tablets in the evening. One enema is inserted into the rectum in the morning one to two hours prior to examination. No food should be given following the administration of the tablets to prevent re-accumulation of material in the caecum.
After X-ray examination. To treat constipation due to barium contrast medium, use one enema.
Acute constipation. Initially one enema, then 1 or 2 tablets late in the evening and 1 enema in the morning (after breakfast) for about three days.
Constipation in elderly patients. One enema in the morning (after breakfast) on days in which defecation is desired.
Chronic constipation and bowel retraining. By gradually increasing the interval between doses as colonic tone improves, the drug has been found to be effective in redeveloping proper bowel hygiene. There is no tendency to "rebound".
Antepartum use. One enema immediately before delivery is anticipated.
Postpartum or postoperative constipation. One enema to be used immediately after breakfast for two or three days.
Preparation for sigmoidoscopy proctoscopy. For sigmoidoscopy scheduled in advance, administration of tablets the night before and one enema rectally one hour before the examination will almost invariably result in adequate preparation.
Preparation for surgery of the colon. Two tablets at lunchtime and two tablets in the evening on the day before the operation. One enema should be inserted into the rectum on the morning of surgery.
Colostomies. Two tablets the night before inserted into the colostomy opening in the morning will frequently make irrigations unnecessary and in other cases will expedite the procedure.
Children. Preparation for X-ray examination of abdominal organs. Under 1 year. Half an enema the night before the examination and half an enema in the morning on the day of the examination.
1 to 3 years. One enema the night before the examination and one enema in the morning of the day of the examination.
3 to 6 years. One enema in the afternoon of the day before the examination and one enema in the morning of the day of the examination.
6 to 12 years. One tablet at 10 am and one enema in the afternoon of the day before the examination.
Over 12 years. Two tablets at 10 am and two tablets in the evening of the day before the examination and one enema on the morning of the day of the examination.
Constipation. Under 3 years. Half an enema. (Note. Only half the point of the tube should be inserted).
3 to 6 years. One enema as required.
6 to 12 years. One tablet in the evening, and one enema in the morning.
(Note: Bisalax tablets are not recommended for use in children under 6 years of age.)
Advice to patients. If you have noticed a persistent change in bowel habits, consult a physician before using a laxative.
Laxative products should not be used longer than one week unless directed by a physician (see Section 4.4 Special Warnings and Precautions for Use).
Rectal bleeding or failure to have a bowel movement after use of a laxative may indicate a serious condition. Discontinue use and consult a physician.
Bisalax enemas should be administered rectally when required (see Section 4.2 Dose and Method of Administration). Pull off plastic cap from end of nozzle, insert nozzle in rectum and squeeze tube to administer contents. The nozzle of the Bisalax enema may be coated with a lubricant to aid insertion.

4.3 Contraindications

Bisacodyl has the same contraindications as other laxatives.
All laxatives are contraindicated in patients with cramps, colic, nausea, vomiting or other symptoms as in appendicitis, inflammatory bowel disease, acute abdominal situations such as ileus, intestinal obstruction or any other undiagnosed abdominal pain.
Bisalax is also contraindicated in dehydration, hypokalaemia, hypersensitivity to bisacodyl or to any of the excipients.
Bisalax enemas are contraindicated in patients with anal fissure, ulcerative proctitis with mucosal damage and ulcerated haemorrhoids.

4.4 Special Warnings and Precautions for Use

Prolonged use of laxatives may lead to dependence, chronic constipation and loss of bowel function. "Cathartic colon" with atony, dilatation and resemblance of ulcerative colitis or proctitis, is also possible.
In addition, continued use of irritant laxatives may produce serious loss of electrolytes, especially potassium and result in disturbances of cardiac function, diarrhoea, dehydration, malabsorption and protein losing enteropathy.
Syncope has been reported during the use of Bisalax. The event could be related to defecation syncope or to a vasovagal response to abdominal pain.
Use in the elderly. No data available.
Paediatric use. Children should not make frequent use of Bisalax unless medically supervised.
Effects on laboratory tests. No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Concomitant use of diuretics or systemic corticosteroids may increase the risk of electrolyte imbalance. This interaction is significant only if excessive doses of Bisalax are taken.
By increasing the motility of the small intestine and speeding the passage, Bisalax can alter the bioavailability of some drugs absorbed mainly from the small intestine such as digoxin and controlled release formulations.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility. No data available.
Use in pregnancy. (Category A)
Category A of Australian Categorisation of Risk of Drug Use in Pregnancy.
Use in lactation. There is no contraindication to use of Bisalax by nursing mothers, however as bisacodyl is excreted in the breast milk in low quantities, the drug should only be used during lactation when clearly indicated.

4.7 Effects on Ability to Drive and Use Machines

The effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration.

4.8 Adverse Effects (Undesirable Effects)

Bisacodyl is well tolerated and side effects are rare. However, side effects in the form of diarrhoea, local rectal irritation, proctitis, slight indisposition, epigastralgia, tenesmus, nausea, abdominal pain and cramping have been reported. A possible colic should be treated with atropine derivatives.
Rare cases of vomiting, mild transient skin reactions and hypersensitivity reactions including angioedema and anaphylactoid reactions have also been described.
Reporting suspected adverse effects. Reporting suspected adverse reactions after registration 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 at www.tga.gov.au/reporting-problems.

4.9 Overdose

For information on the management of overdose, contact the Poisons Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action. The precise mode of action is unknown. Bisacodyl is a contact laxative. Its action is restricted mainly to the colon; the motility of the small intestine is not appreciably influenced. Bisacodyl acts locally in the gastrointestinal tract, stimulating sensory nerve endings in the colonic mucosa to produce parasympathetic reflexes resulting in increased peristaltic contractions of the colon. Local axon reflexes as well as segmental reflexes are initiated in the region of contact and contribute to the widespread peristaltic activity producing evacuation. For this reason, bisacodyl may be employed satisfactorily in patients with ganglionic blockage or spinal cord damage (paraplegia, poliomyelitis etc).
Clinical trials. No data available.

5.2 Pharmacokinetic Properties

Although previously thought not to be absorbed from the digestive tract, recent studies have shown that up to 5% of an oral dose of bisacodyl may be absorbed in man. Bisacodyl is excreted mainly in faeces, and partly in urine as the glucuronide. When taken on an empty stomach, bisacodyl tablets will exert their effect in 6 to 8 hours. When taken with food, the effect of the tablets will occur in 10 to 12 hours.

5.3 Preclinical Safety Data

Genotoxicity. No data available.
Carcinogenicity. No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Citric acid monohydrate, macrogol 3000, macrogol 400, macrogol 4000 and sodium citrate.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store Bisalax enemas in the original packaging at a temperature at 2°C to 8°C. (Refrigerate. Do not freeze). Before use, allow the enema to reach room temperature.

6.5 Nature and Contents of Container

Yellow LDPE plastic tube with yellow flip off cap. Available in packs of 25 enemas.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Chemical structure.

CAS number. 603-50-9.
Bisacodyl is a white or almost white crystalline powder; odourless, or almost odourless; and tasteless. Chemically, bisacodyl is 4,4'-(2-pyridylmethylene)di(phenylacetate). Its molecular weight is 361.38.

7 Medicine Schedule (Poisons Standard)

Unscheduled.

Date of First Approval

10 August 1999

Date of Revision

07 November 2022

Summary Table of Changes