docusate

Docusate is a stool softening laxative available over-the-counter, used to treat constipation. Docusate may be used to relieve constipation associated with opioid therapy, or in people who should avoid straining for a bowel movement, for instance, after surgery or a heart attack. Use of docusate may ease bowel movements and reduce pain in people with anorectal fissures and hemorrhoids. Docusate may also be used (off-label) for softening of earwax (cerumen) to facilitate its removal.

Docusate softens the stool by reducing the surface tension of the oil-water interface in the stool, which increases the absorption of water and fat into the stool. Studies indicate that docusate also stimulates secretion of water, sodium, chloride and potassium and inhibits the absorption of bicarbonate and glucose in the jejunum portion of the small intestine, which allows the bowel contents to retain more fluid.

Docusate may be administered orally or rectally. Rectal administration takes effect within 15 minutes while it may take 12 to 72 hours for a bowel movement to occur after oral dosing. Rectal administration has local effects, while oral docusate is systemically absorbed and is metabolized by the liver and excreted in the feces.

Excessive use of stool softeners including docusate, can cause dependence on them for bowel movements. Chronic constipation should be ideally managed with exercise and lifestyle modifications; docusate should be used only for relief from occasional constipation or in specific conditions that require avoiding straining for a bowel movement.

• Do not take/administer docusate in the following circumstances:
  • Hypersensitivity to docusate or any of its components
  • In the presence of nausea, vomiting, intestinal obstruction, fecal impaction, appendicitis or acute abdominal pain
  • Concurrently with mineral oil
• If you are self-medicating with docusate, do not take it for longer than a week
• Excessive use can cause fluid loss and electrolyte imbalance
• Excessive use may result in dependence
• Enema is for rectal use only; when using rectal docusate:
  • Lubricate prior to insertion of the enema tube
  • Discontinue use if irritation occurs around the anal or rectal area
  • Do not force the tube if there is resistance while inserting; injury or damage to the rectum can occur

Common side effects of docusate include:

• Excessive bowel activity
• Diarrhea
• Abdominal cramping
• Intestinal obstruction
• Throat irritation and bitter taste (with syrup/liquid)
• Rash (rare)
• Rectal bleeding (very rare)
• Excessive use can cause
  • Dependence and poor bowel function
  • Electrolyte imbalance
• Low magnesium (hypomagnesemia) in newborn with excessive maternal use during pregnancy

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Capsule as sodium

• 50 mg
• 100 mg
• 250 mg

Capsule as calcium

• 240 mg

Tablet (adult)

• 100 mg

Oral liquid

• 10 mg/mL
• 50 mg/15mL

Syrup

• 60mg/15mL

Enema, Rectal (Sodium)

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

Stool Softener

Adult:

Oral

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

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

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

• Most docusate overdoses are accidental in children, however, overdose may result from overuse by some people in an effort to lose weight.
• Docusate overdose may cause nausea, vomiting, abdominal cramps and diarrhea, and may lead to dehydration and electrolyte imbalance, particularly in children. In case of overdose, discontinue docusate immediately and seek medical help or contact Poison Control.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Docusate has no known severe, serious, or moderate interactions with other drugs.
• Mild interactions of docusate include:
  • mineral oil

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Occasional use of docusate as a second-line therapy during pregnancy is acceptable if increased intake of dietary fiber and fluids, and exercise do not relieve constipation.
• Chronic use of docusate during pregnancy has been reported to be associated with symptomatic low magnesium levels (hypomagnesemia) in the newborn.
• It is not known if docusate is excreted in breast milk; use of other types of laxatives may be preferable because oral docusate is systemically absorbed.

• Keep docusate out of reach of children
• Restrict docusate use only for occasional constipation; using it for regular bowel movements can cause dependence
• Consult with your doctor before taking docusate if you have nausea, vomiting, stomach pain, or changes in bowel habits that persist for longer than 2 weeks
• Discontinue docusate and seek medical help if bowel movement does not occur within 7 days of use or rectal bleeding occurs