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Medication Safety Issues
Sound-alike/look-alike issues:
Colace® may be confused with Calan®, Cozaar®
Docusate may be confused with Doxinate®
Dulcolax® (docusate) may be confused with Dulcolax® (bisacodyl)
Surfak® may be confused with Surbex®
Pronunciation
(DOK yoo sate)
U.S. Brand Names
Index Terms
Generic Available
Yes: Excludes gelcap
Canadian Brand Names
Pharmacologic Category
Use: Labeled Indications
Stool softener in patients who should avoid straining during defecation and constipation associated with hard, dry stools; prophylaxis for straining (Valsalva) following myocardial infarction. A safe agent to be used in elderly; some evidence that doses <200 mg are ineffective; stool softeners are unnecessary if stool is well hydrated or “mushy” and soft; shown to be ineffective used long-term.
Use: Unlabeled/Investigational
Ceruminolytic
Pregnancy Risk Factor
C
Lactation
Excretion in breast milk unknown/compatible
Contraindications
Hypersensitivity to docusate or any component of the formulation; concomitant use of mineral oil; intestinal obstruction, acute abdominal pain, nausea, or vomiting
Warnings/Precautions
Concerns related to adverse effects:
• Dependence: Prolonged, frequent or excessive use may result in dependence.
• Electrolyte imbalance: Prolonged, frequent or excessive use may result in electrolyte imbalance.
Adverse Reactions
1% to 10%:
Gastrointestinal: Intestinal obstruction, diarrhea, abdominal cramping
Miscellaneous: Throat irritation
Drug Interactions
There are no known significant interactions.
Mechanism of Action
Reduces surface tension of the oil-water interface of the stool resulting in enhanced incorporation of water and fat allowing for stool softening
Pharmacodynamics/Kinetics
Onset of action: 12-72 hours
Excretion: Feces
Dosage
Docusate salts are interchangeable; the amount of sodium or calcium per dosage unit is clinically insignificant
Infants and Children <3 years: Oral: 10-40 mg/day in 1-4 divided doses
Children: Oral:
3-6 years: 20-60 mg/day in 1-4 divided doses
6-12 years: 40-150 mg/day in 1-4 divided doses
Adolescents and Adults: Oral: 50-500 mg/day in 1-4 divided doses
Older Children and Adults: Rectal: Add 50-100 mg of docusate liquid to enema fluid (saline or water); administer as retention or flushing enema
Ceruminolytic (unlabeled use): Intra-aural: Administer 1 mL of docusate sodium in 2 mL syringes; if no clearance in 15 minutes, irrigate with 50-100 mL normal saline (this method is 80% effective)
Administration: Oral
Ensure adequate fluid intake. Docusate syrup should be administered with 6-8 ounces of milk, juice, or infant formula to mask the bitter taste.
Test Interactions
Decreased potassium (S), decreased chloride (S)
Dietary Considerations
Ensure adequate fluid intake.
Syrup: Should be taken with 6-8 ounces of milk, juice, or infant formula.
Patient Education
Maintain adequate hydration unless instructed to restrict fluid intake. Do not chew or break caplets; swallow whole. Docusate should be taken with a full (6-8 oz) glass of milk, fruit juice, or infant formula. Do not use if abdominal pain, nausea, or vomiting are present. Laxative use should be used for a short period of time (<1 week). Prolonged use may result in abuse, dependence, as well as fluid and electrolyte loss. Report bleeding or constipation. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant.
Geriatric Considerations
A safe agent to be used in the elderly. Some evidence that doses <200 mg are ineffective. Stool softeners are unnecessary if stool is well hydrated or “mushy” and soft; shown to be ineffective used long-term.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Throat irritation.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
None reported
Nursing: Physical Assessment/Monitoring
Monitor for effectiveness and instruct patient in proper use (avoid excessive or prolonged use) and adverse effects to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, oral, as calcium: 240 mg
Capsule, oral, as sodium: 100 mg, 250 mg [DSC]
Colace®: 50 mg [contains sodium 3 mg/capsule]; 100 mg [contains sodium 5 mg/capsule]
Capsule, liquid, oral, as calcium:
Surfak®: 240 mg
Capsule, liquid, oral, as sodium:
Docusoft-S™: 100 mg [contains sodium 5 mg/capsule]
Capsule, softgel, oral, as calcium: 240 mg
Capsule, softgel, oral, as sodium: 100 mg, 250 mg
Correctol®: 100 mg
Docu-Soft: 100 mg
DOK™: 100 mg, 250 mg
Dulcolax® Stool Softener: 100 mg [contains sodium 5 mg/softgel]
Fleet® Sof-Lax®: 100 mg [contains sodium 5 mg/softgel]
DOS®, D-S-S®: 100 mg, 250 mg
Genasoft®: 100 mg
Phillips'® Stool Softener Laxative: 100 mg [contains sodium 5.2 mg/softgel]
Liquid, oral, as sodium: 150 mg/15 mL (480 mL)
Colace®: 150 mg/15 mL (30 mL) [contains propylene glycol, sodium 1 mg/mL]
Diocto®: 150 mg/15 mL (480 mL)
Fleet® Pedia-Lax™ Liquid Stool Softener: 50 mg/15 mL (120 mL) [contains propylene glycol, sodium 13 mg/15 mL; fruit punch flavor]
Silace: 150 mg/15 mL (480 mL) [lemon-vanilla flavor]
Solution, rectal, as sodium [enema]:
Enemeez®: 283 mg/5 mL
Enemeez® Plus: 283 mg/5 mL [contains benzocaine]
Syrup, oral, as sodium: 60 mg/15 mL (480 mL)
Colace®: 60 mg/15 mL (480 mL) [alcohol free, sugar free; contains sodium 36 mg/5 mL]
Diocto®: 60 mg/15 mL (480 mL)
Silace: 20 mg/5 mL (480 mL) [peppermint flavor]
Pricing: U.S. (www.drugstore.com)
Capsules (Colace)
100 mg (60): $25.99
Capsules (Docusate Sodium)
100 mg (100): $11.99
250 mg (100): $13.99
References
Chen DA and Caparosa RJ, “A Nonprescription Cerumenolytic,” Am J Otol, 1991, 12(6):475-6.
Pietrusko RG, “Use and Abuse of Laxatives,” Am J Hosp Pharm, 1977, 34:291-300.
Schindler AM, “Isolated Neonatal Hypomagnesaemia Associated With Maternal Overuse of Stool Softener,” Lancet, 1984, 2(8406):822.
Singer AJ, Sauris E, and Viccellio AS, “Ceruminolytic Effects of Docusate Sodium: A Randomized, Controlled Trial,” Ann Emerg Med, 2000, 36(3):228-32.
International Brand Names
Lexi-Comp.com
Last full review/revision October 2009
Content last modified October 2009
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