Provider Briefing: Bisac-Evac (Bisacodyl) Supply Disruption

If your patients have been reporting difficulty finding Bisac-Evac or other Bisacodyl products — particularly suppositories — you're hearing a real and documented supply issue. This briefing provides an overview of the current Bisacodyl availability landscape, prescribing considerations, and resources to help your patients navigate the disruption.

Timeline of the Bisacodyl Supply Issue

The intermittent shortages of Bisacodyl suppositories can be traced primarily to manufacturer exits:

• G&W Laboratories discontinued production of their bisacodyl suppository line, removing a major supply source from the market.
• The ASHP Drug Shortage Database has listed bisacodyl suppositories as a current or resolved shortage at various points, reflecting ongoing supply variability.
• Remaining manufacturers — Perrigo, Major Pharmaceuticals, Geri-Care, and Rugby — have continued production but have faced periods of increased demand that exceeded their manufacturing capacity.
• Oral bisacodyl tablets (5 mg) have maintained more stable supply throughout this period and are not currently listed on shortage databases.

As of early 2026, the suppository supply situation has improved but is not fully normalized. Periodic spot shortages at individual pharmacies remain common, particularly at chain locations with limited distributor flexibility.

Prescribing Implications

For providers who prescribe or recommend Bisacodyl, the current environment warrants several considerations:

Bowel Preparation Protocols

Bisacodyl is a component of many colonoscopy and surgical bowel prep regimens. If your standard protocol includes bisacodyl suppositories, consider:

• Confirming suppository availability with the patient's pharmacy before their procedure date
• Having an alternative prep regimen ready (e.g., substituting oral bisacodyl tablets or switching to a PEG-based prep)
• Providing patients with multiple pharmacy options or directing them to Medfinder for Providers to verify stock

Chronic Constipation Management

For patients using Bisacodyl as part of a chronic constipation management plan:

• Recall that stimulant laxatives including Bisacodyl are generally not recommended for use beyond 7 days without medical supervision, and long-term use beyond 4 weeks carries risks of dependency and potential colonic effects
• If patients report difficulty obtaining Bisacodyl, this may be an opportunity to reassess their bowel regimen and consider osmotic laxatives (PEG 3350) or newer prescription agents (Linaclotide, Lubiprostone, Plecanatide) for chronic management

Neurogenic Bowel Programs

Patients with spinal cord injuries or neurologic conditions who depend on bisacodyl suppositories for their bowel program are among the most affected by suppository shortages. For these patients:

• Ensure continuity of supply by identifying backup pharmacy sources
• Consider prescribing by generic name (Bisacodyl) rather than brand to allow pharmacists maximum dispensing flexibility
• Document the medical necessity clearly, as some compounding pharmacies can prepare bisacodyl suppositories if commercial products are unavailable

Current Availability Picture

Here is the form-by-form availability status as of March 2026:

• Oral tablets (5 mg, enteric-coated): Widely available. Multiple manufacturers. No current shortage. Cash price: $2–$8 for 25–100 count.
• Rectal suppositories (10 mg): Intermittently available. Perrigo, Major, Geri-Care, and Rugby are active manufacturers. Cash price: $6–$15 for 8–12 count. Spot shortages persist at some pharmacies.
• Rectal enema (10 mg): Limited availability from Fleet and other manufacturers. Less commonly stocked than tablets or suppositories.

Cost and Access Considerations

Bisacodyl remains one of the most affordable laxative options available:

• Generic oral tablets: $2–$8
• Generic suppositories: $6–$15
• Brand-name Dulcolax tablets: $6–$12

As an OTC medication, Bisacodyl is generally not covered by commercial insurance. However:

• FSA/HSA funds can be used with a prescription or Letter of Medical Necessity
• Some state Medicaid programs cover OTC laxatives when prescribed
• Discount cards (SingleCare, GoodRx) can reduce costs at the pharmacy counter, though savings are modest given the already-low price point

For patients with financial barriers, our patient savings guide covers all available discount options.

Tools and Resources for Your Practice

Several tools can help you and your patients navigate Bisacodyl availability:

Medfinder for Providers

Medfinder offers real-time pharmacy stock data that providers can use to direct patients to pharmacies with confirmed availability. This is particularly valuable for time-sensitive situations like upcoming procedures.

ASHP Drug Shortage Database

The ASHP Drug Shortage Database provides current shortage status, affected manufacturers, and estimated resolution timelines for bisacodyl and other medications.

Patient Education Resources

We've developed several patient-facing articles that you can share:

• Why Is Bisac-Evac So Hard to Find?
• How to Find Bisac-Evac in Stock Near You
• Alternatives to Bisac-Evac
• Bisac-Evac Shortage Update for Patients

Alternative Agents: A Quick Reference

When Bisacodyl is unavailable, the following OTC alternatives may be appropriate depending on the clinical scenario:

• Senna (Senokot) — Stimulant laxative, similar mechanism. Onset 6–12 hours. Widely available. Appropriate substitute for most indications.
• PEG 3350 (MiraLAX) — Osmotic laxative. Onset 1–3 days. Preferred for chronic constipation management. Excellent availability.
• Magnesium Hydroxide (Milk of Magnesia) — Saline/osmotic laxative. Onset 30 min–6 hours. Caution in renal impairment.
• Docusate Sodium (Colace) — Stool softener. Onset 12–72 hours. Best for mild constipation or as adjunct therapy.

For refractory chronic constipation, prescription options include Linaclotide (Linzess), Lubiprostone (Amitiza), and Plecanatide (Trulance).

Looking Ahead

The Bisacodyl supply chain is expected to continue stabilizing in 2026 as remaining manufacturers adjust production volumes. However, the suppository market remains concentrated among a small number of producers, which means that any future disruption at a single facility could trigger another shortage.

We recommend that practices with high bisacodyl suppository utilization (gastroenterology, colorectal surgery, rehabilitation medicine) maintain awareness of supply conditions and have documented alternative protocols ready.

Final Thoughts

Bisacodyl (Bisac-Evac) shortages primarily affect the suppository formulation and stem from manufacturer consolidation. Oral tablets remain readily available. By prescribing generically, maintaining alternative protocols, and directing patients to tools like Medfinder, providers can minimize the clinical impact of these supply disruptions on patient care.

For additional provider resources, visit medfinder.com/providers.