Management of Constipation in ESRD Patients

Safety Profile and Efficacy

Bisacodyl does not contain magnesium or sulfate salts, which are specifically cautioned against in renal impairment due to risk of hypermagnesemia, as recommended by the American Society of Clinical Oncology 1, 2
Oral bisacodyl at 10 mg causes diarrhea in 53.4% vs 1.7% with placebo, and abdominal pain in 24.7% vs 2.5% with placebo, according to the American Gastroenterological Association 3
Starting with lower doses (5 mg) is recommended to minimize adverse effects, as suggested by the American Gastroenterological Association 3

Start with bisacodyl 5 mg orally once daily rather than the 10 mg dose used in trials, to minimize diarrhea and abdominal cramping, as recommended by the American Gastroenterological Association 3
Rule out ileus, intestinal obstruction, or severe dehydration before initiating bisacodyl, as advised by the American Gastroenterological Association 3
Avoid bisacodyl in patients with recent colorectal surgery, anal/rectal trauma, or acute inflammatory bowel conditions, as cautioned by the American College of Gastroenterology 5