Docusate

Generic Name: Docusate

Docusate, also known as docusate salts or dioctyl sulfosuccinate, is a laxative of the stool softener type used to treat constipation. It is considered a good choice in children who have hard feces. For constipation that occurs as a side effect of opiate use, it may be used alone or with a stimulant laxative. It may be taken as a capsule by mouth or as a rectal suppository. Usually it works within one to three days.

Side effects are uncommon. Rarely, there may be abdominal cramps or diarrhea. Efficacy decreases with long-term use, and may cause poor bowel function. Docusate is acceptable during pregnancy and breastfeeding. It works by allowing more water to be absorbed by the feces. It typically comes in the form of a sodium, calcium, or potassium salt.

It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication and is not very expensive. In the United States, one hundred doses are about 14 USD. The sodium salt, dioctyl sodium sulfosuccinate, also is used as a food additive, emulsifier, dispersant, and wetting agent, among other uses

No health feed found.

The effects of docusate may arise from the direct laxative effects of the molecule on the intestinal mucosa, or the indirect action of local endogenous prostaglandins released from the intestine upon contact with docusate. Docusate may involve multiple mechanisms of action. It stimulates the net secretion of water, sodium, chloride, and potassium and inhibits the net absorption of bicarbonate in the small intestine in vivo. It also induces active electrolyte secretion by increasing mucosal cAMP concentrations, as cAMP inhibits coupled sodium chloride entry and stimulates active chloride secretion in vitro. In vivo, the actions of cAMP are involved in inhibiting bicarbonate absorption in the jejunum. These changes promote the passive secretion of water and potassium. Docusate may partially involve impaired solute absorption such as glucose and bicarbonate by increasing the rate of desquamation of epithelial cells and mucosal cell damage. Mucosal damage may lead to the formation and release of local prostaglandins. Altered mucosal permeability may also be seen with docusate.

Constipation

Docusate is used to treat constipation, and in painful anorectal conditions such as hemorrhoids and anal fissures, to help avoid pain caused by straining during bowel movements.

Given orally, the effects usually are seen 1 to 3 days after the first dose. Given rectally, as an enema or suppository, a bowel movement usually occurs within 5 to 20 minutes.

The drug may be used in people who are receiving opioid medication, although prolonged use may cause irritation of the gastrointestinal tract. Data supporting its efficacy in treating chronic constipation are lacking.

The effectiveness of laxatives for constipation in those receiving palliative care is unclear, as it has not been sufficiently studied. The comparative effectiveness of different laxatives in this group also is unclear as of 2015.

Other

Docusate sodium, when used with ear syringing, may help with earwax removal, particularly in the case of impaction.

Available forms

Docusate sodium may be given by mouth or rectally. It also is used as an emulsifier and dispersant in topical preparations. When taken by mouth it is typically recommended with plenty of water.

Docusate salts rarely cause side effects since they are not absorbed into the body. Occasional side effects may include

  • stomach cramping,
  • diarrhea,
  • intestinal obstruction, and
  • rash.

Throat irritation has occurred in some patients after taking liquid formulations of docusate orally.

Excessive use of docusate may cause low electrolyte levels and may also result in dependence. Docusate should not be used in people with

  • intestinal obstruction,
  • appendicitis,
  • acute stomach pain,
  •  bowel impaction, and
  • those who have nausea and vomiting.

Adult and Pediatric Dosage Forms and Strengths

Capsule as sodium

  • 50 mg
  • 100 mg
  • 250 mg

Capsule as calcium

  • 240 mg

Tablet (adult only)

  • 100 mg

Oral liquid

  • 10 mg/mL
  • 50 mg/15mL

Syrup

  • 60mg/15mL

Enema, Rectal (Sodium)

  • 100mg/5mL (pediatric only)
  • 283 mg (5 mL)

Dosage Considerations – Should be Given as Follows:

Excessive use may result in dependence.

Stool Softener

Adult, Oral

  • Docusate sodium: 50-300 mg orally once daily or divided doses
  • Docusate calcium: 240 mg orally once/day

Adult, Rectal

  • 283 mg/5mL (1 enema) rectally once daily to three times daily

Pediatric, Oral

Docusate sodium

  • Children under 2 years: Safety and efficacy not established
  • Children 2-12 years: 50-150 mg orally once/day or divided doses
  • Children over 12 years: 50-300 mg orally once daily or divided doses

Docusate calcium

  • Children under 12 years: Safety and efficacy not established
  • Children over 12 years: 240 mg orally once/day

Pediatric, Rectal

  • Children under 2 years: Safety and efficacy not established
  • Children 2-12 years: 100 mg/5 mL (1 enema) rectally once/day; alternatively, 283 mg/5 mL (1 enema) rectally once/day
  • Children over 12 years: 283 mg/5mL (1 enema) rectally once daily to three times daily

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Docusate has no known severe, serious, or moderate interactions with other drugs.

Mild interactions of docusate include:

  • mineral oil

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

  • May be taken with or without food.
  • Do not crush, chew, or break open a docusate capsule or tablet. Measure liquid docusate with a properly calibrated measure or syringe, do not use a kitchen teaspoon. The liquid may be mixed with milk, fruit juice or infant formula and drunk straight away.
  • Take docusate capsules with a full glass of water. Take extra fluids throughout the day to help the effectiveness of docusate. Water also helps to relieve constipation.
  • The rectal form of docusate should only be inserted in your rectum; it is not for use by mouth. Wash your hands and make sure your bowels and bladder are empty before you insert the enema. Lie on your left side with your knees bent and gently insert the tip of the enema into your rectum. Squeeze the tube and empty the entire contents into your rectum, try and hold the contents in for as long as possible or until you have a bowel movement.
  • Do not take more docusate than recommended or take for longer than seven days.
  • Talk to your doctor before taking if you have any stomach pain, nausea or vomiting, or have experienced a sudden change in bowel motions that has persisted for longer than two weeks.
  • Talk to your doctor if you experience any rectal bleeding, or if you fail to have a bowel movement after taking docusate for several days. A bowel movement usually occurs within one to three days of taking docusate.
  • If you are pregnant or breastfeeding, do not use docusate until you have spoken with your doctor.
  • Store docusate away from heat, moisture, and light (do not store in the bathroom). Keep out of reach of children and pets. Do not give to children under 6 years of age unless directed by a doctor.
  • This medication contains docusate. Do not take Colace, DSS, Albert Docusate, Docusate Calcium, docusate sodium, DulcoEase, Phillips Liqui Gels, Silace, or Soflax if you are allergic to docusate or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

  • Hypersensitivity
  • Intestinal obstruction, symptoms of appendicitis or acute abdominal pain, fecal impaction
  • Concomitant use of mineral oil
  • Nausea or vomiting
  • Use for longer than 7 days when self-medicating

Effects of Drug Abuse

  • Excessive use may result in dependence

Short-Term Effects

  • See "What Are Side Effects Associated with Using Docusate?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Docusate?"

Cautions

  • Electrolyte imbalance may occur with excessive use
  • Excessive use may result in dependence
  • Enema is for rectal use only; lubricate prior to insertion; discontinue use and notify health care professional if irritation occurs around the anus/rectal or if resistance is encountered with insertion; injury or damage to the rectum can occur if tube forced
  • Prior to over-the-counter (OTC) use, patient should contact healthcare professional if stomach pain, nausea, or vomiting are present, or if a sudden change in bowel habits occurs and persists over 14 days
  • Patient should discontinue use and notify healthcare professional if bleeding occurs, if bowel movement fails to occur after use, or need to continue use after using for 7 days

Pregnancy and Lactation

  • Use docusate with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
  • It is unknown whether docusate is excreted in milk; it is compatible with nursing.

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