Usage
Docusate is prescribed for the prevention and treatment of occasional constipation. It is a stool softener, also known as an emollient laxative. It’s particularly useful when straining during bowel movements should be avoided, such as after surgery or a myocardial infarction. It can also be used to soften earwax.
Alternate Names
- Docusate Sodium
- Docusate Calcium
- Docusate Potassium
Some common brand names include Colace, Correctol, Diocto, Doc-Q-Lace, Docusoft, DSS, Silace, and Surfak.
How It Works
Pharmacodynamics: Docusate works by lowering the surface tension of the stool, allowing water and lipids to penetrate it. This increases stool mass and water content, softening the stool and facilitating easier passage.
Pharmacokinetics: Docusate is minimally absorbed orally. It is metabolized by intestinal bacteria and excreted in the bile and feces. Rectal administration as an enema also has minimal systemic absorption. The onset of action is typically 1 to 3 days after oral administration.
Mode of Action: Docusate acts as a surfactant, meaning it reduces surface tension at the interface between the stool and water. This facilitates mixing of aqueous and fatty substances within the stool, preventing dry, hard stool formation. It doesn’t stimulate bowel movement or increase peristalsis; it simply softens the stool.
Dosage
Standard Dosage
Adults:
- Oral: 50-400 mg/day of docusate sodium or 240 mg/day of docusate calcium. The dose can be taken as a single dose or in divided doses. Bedtime administration is common.
- Rectal: 200 to 283 mg rectally administered as an enema once or twice daily. Alternatively, 50 to 100 mg of docusate sodium liquid can be added to a retention or flushing enema.
Children:
- Oral: Docusate sodium:
- <3 years: 10-40 mg/day in divided doses.
- 3-6 years: 20-60 mg/day in divided doses.
- 6-12 years: 40-150 mg/day in divided doses.
-
12 years: 50-400 mg/day in divided doses.
- Rectal:
- 3 to 18 years: 50 to 100 mg docusate sodium liquid added to enema once a day.
- Alternatively: 200 to 283 mg as an enema once daily as needed.
- Docusate Calcium: Safety and efficacy not established in children under 12. For children older than 12 years, follow the adult dose.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically necessary, but starting at the lower end of the dosing range is advisable. Monitor for dehydration and electrolyte imbalances.
- Patients with Renal Impairment: No specific dosage adjustments are typically needed.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are typically needed.
- Patients with Comorbid Conditions: Consider comorbid conditions that may exacerbate or be affected by constipation.
Clinical Use Cases
Docusate is not typically used in clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Its use is primarily focused on preventing and relieving occasional constipation.
Dosage Adjustments
Dose adjustments are generally based on patient response and tolerance. If constipation persists despite therapy, investigate for underlying causes and consider other treatment options.
Side Effects
Common Side Effects
- Mild abdominal cramping
- Diarrhea
Rare but Serious Side Effects
- Severe allergic reactions (rash, itching, swelling, dizziness, difficulty breathing)
Long-Term Effects
With prolonged, excessive use, there’s a theoretical risk of electrolyte imbalances and dehydration due to diarrhea. This is rare with appropriate use.
Contraindications
- Hypersensitivity to docusate
- Fecal impaction
- Obstruction of the intestines or bowels
- Undiagnosed abdominal pain
- Nausea and vomiting
Drug Interactions
Docusate may increase the absorption of mineral oil, which can cause adverse effects. Concomitant use of mineral oil is therefore contraindicated.
Pregnancy and Breastfeeding
Docusate is generally considered safe to use during pregnancy and breastfeeding when used in recommended doses. The amount that enters breast milk is minimal and shouldn’t cause adverse effects in the infant. However, always inform your physician of any medication use during pregnancy or while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Softens stool by allowing water and fats to penetrate.
- Side Effects: Abdominal cramping, diarrhea.
- Contraindications: Hypersensitivity, bowel obstruction, fecal impaction.
- Drug Interactions: Mineral oil.
- Pregnancy & Breastfeeding: Generally safe in recommended doses.
- Dosage: See detailed dosage section.
- Monitoring Parameters: Bowel movement frequency and consistency.
Popular Combinations
Docusate is sometimes combined with stimulant laxatives like senna to provide a dual approach to constipation relief.
Precautions
- Use cautiously in patients with pre-existing conditions that could be worsened by increased bowel movements or fluid shifts.
- Adequate hydration is essential during docusate therapy.
- Avoid prolonged, unnecessary use to minimize the risk of dependence.
FAQs
Q1: What is the recommended dosage for Docusate?
A: See detailed dosage section above.
Q2: How does Docusate differ from stimulant laxatives?
A: Docusate softens the stool, while stimulant laxatives stimulate intestinal motility.
Q3: Can Docusate be used long-term?
A: It’s best used for occasional constipation. Long-term use should be under medical supervision.
Q4: Is Docusate safe in pregnancy?
A: Generally considered safe when used as directed.
Q5: What are the signs of a Docusate overdose?
A: Severe diarrhea, abdominal pain, dehydration, electrolyte imbalances.
Q6: Can Docusate be used with other laxatives?
A: It can be combined with some laxatives (e.g., senna), but avoid combining with mineral oil. Consult a physician before combining laxatives.
Q7: Are there any dietary considerations when taking Docusate?
A: Adequate fluid and fiber intake are important, even with Docusate use.
Q8: Does Docusate cause any drug interactions?
A: Avoid concomitant use with mineral oil.
Q9: What is the onset of action for Docusate?
A: Typically 1 to 3 days after oral administration.
Q10. How long should I use Docusate if I have not had a bowel movement?
A: Consult a physician if you have not had a bowel movement after a few days of using Docusate as directed.
