Effect of Bisacodyl on Intestinal Electrolyte and Water Net Transport and Transit

Abstract

The effect of bisacodyl on intestinal electrolyte, glucose, and water transport, and transit was studied in 6 healthy volunteers by intestinal perfusion. A 5-lumen tube with an occluding balloon allowed constant perfusion (10 ml/min) of 30 cm of the upper jejunum and a rapid collection of the perfusate free of contaminants. A phenol red bolus was injected into the tube and its passage through the test segment was calculated by dye dilution formula. A 1-hour control period was followed by a test period with 6 mg/h bisacodyl and followed by 2 other 1-hour control periods. Net absorption of Na⁺ (0.35 ± 0.08 mmol/min) and water (1.7 ± 0.6 ml/min) changed to net secretion (Na⁺ -0.93 ± 0.3 ml/min; water -6.6 ± 1.9 ml/min), glucose absorption decreased from 25.4 ± 1.1 to 6.3 ± 0.5 mg/min and K secretion was enhanced. 62 ± 2.1% of bisacodyl was absorbed in the 30-cm jejunal segment. Mean transit time decreased from 8.5 ± 1 to 4.4 ± 0.7 min and mean flow rate increased from 8.4 ± 0.6 to 16.6 ± 1.9 ml/min. There was an inverse linear relationship between mean transit time and mean flow rate. All the effects of bisacodyl were fully or at least partially reversible. Volume and calculated radius of the test segment remained constant and did not change under bisacodyl. It is concluded, that the secretory effect of bisacodyl is mainly responsible for the decreased mean transit time rather than a direct effect on motility.

bis‐(p‐hydroxyphenyl)‐pyridyl‐2‐methane (BHPM)—the active metabolite of the laxatives bisacodyl and sodium picosulfate—enhances contractility and secretion in human intestine in vitro

“…It is difficult to imagine how this mode of action can cause the rather fast onset response in our tissue preparations. Our findings agree with an earlier study performing bisacodyl perfusion in colonic and jejunal loops in healthy volunteers . The authors found an increased K + secretion.…”

Characterization of the Contents of Ascending Colon to Which Drugs are Exposed After Oral Administration to Healthy Adults

“…About 50% of the dose is eliminated in the faeces as BHPM (14). Bisacodyl has been used in the past for similar sampling procedures (15), and its effects on the intralumenal physiology have been shown to be reversible (16,17). Table I shows the exact colon preparation procedures applied in the pilot study, together with food consumption details prior to each colonoscopy.…”

Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

“…Both these diphenyl methane derivatives are prodrugs converted in the gut into the same active metabolite, bis-(p -hydroxyphenyl)-pyridyl-2-methane (BHPM). BHPM has a dual action, namely an antiabsorptive-secretory effect and also a direct prokinetic effect [5] [6]. Only minor amounts are systemically absorbed but are not considered to contribute to the laxative action since the laxative effect of bisacodyl or SPS does not correlate with the plasma level of BHPM.…”