Gastrointestinal Agent (Laxative)
PREGNANCY RECOMMENDATION: No Human Data—Probably Compatible
BREASTFEEDING RECOMMENDATION: No Human Data—Probably Compatible
PREGNANCY SUMMARY
No reports describing the use of bisacodyl in animal or human pregnancy have been located. A 1984 reference found no reports of adverse effects in pregnancy (1). In addition, a 1985 review considered stimulant laxatives, such as bisacodyl, to be safe in pregnancy, but regular or chronic use should be avoided (2). Because only small amounts are in the systemic circulation, the direct embryo–fetal risk probably is nil.
FETAL RISK SUMMARY
Bisacodyl is a diphenylmethane stimulant laxative that is indicated for the treatment of constipation and for the evacuation of the bowel before diagnostic procedures or surgery (3). It is structurally and pharmacologically related to phenolphthalein (4). (See also Phenolphthalein.) Bisacodyl is available as oral tablets and suppositories. Bisacodyl is converted to its active metabolite in the gastrointestinal tract and acts primarily in the large intestine (3). Only minimal amounts (about 5%) are absorbed into the systemic circulation (3,4).
Animal reproduction studies with bisacodyl have not been located.
It is not known if bisacodyl crosses the human placenta. The molecular weight (about 361) is low enough for passive diffusion across the placenta, but the minimal amounts in the circulation suggest that neither the embryo nor fetus will have clinically significant exposure to the drug.
BREASTFEEDING SUMMARY
No reports describing the use of bisacodyl during human lactation have been located. Although the molecular weight (about 361) is low enough for excretion into milk, only minimal amounts (about 5%) are absorbed into the maternal circulation. The effects of this exposure on a nursing infant are unknown but appear to be negligible. Others have previously arrived at the same conclusion (5,6).
References
1.Onnis A, Grella P. The Biochemical Effects of Drugs in Pregnancy. Volume 2. Chichester, UK: Ellis Horwood Limited, 1984:48–9.
2.Lewis JH, Weingold AB, and The Committee on FDA-Related Matters, American College of Gastroenterology. The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol 1985;80:912–23.
3.Parfitt K, ed. Martindale. The Complete Drug Reference. 32nd ed. London, UK: Pharmaceutical Press, 1999:1179.
4.Gattuso JM, Kamm MA. Adverse effects of drugs used in the management of constipation and diarrhoea. Drug Saf 1994;10:47–65.
5.Vorherr H. Drug excretion in breast milk. Postgrad Med 1974;56:97–104.
6.Anderson PO. Drug use during breast-feeding. Clin Pharm 1991;10:594–624.