Davendra Ramkumar and his colleagues published a systematic review of drug trials for the treatment of constipation in Am J Gastroenterol. Only polyethylene glycol and tegaserod received grade A evidence for published trials. Psyllium and lactulose received grade B evidence.
Docusate received a level 3, grade C for evidence poor quality evidence, poor evidence to support a recommendation for or against the use of the modality. I have been surprised at how docusate has been the most commonly prescribed laxative agent. Polyethylene glycol or psyllium are better evidence-based options. Docusate is often prescribed as a stool softener, and it has even less evidence that it softens stool than its poor evidence as a laxative.
My thanks to the late Dr. David Saunders for teaching me 30 years ago that docusate was not a helpful option for the management of constipation, and to Sarah Steinkruger for doing much of the research that was used in this column.
You may get diarrhoea and stomach pain, but this will usually get better within 1 or 2 days. Like all medicines, docusate may cause side effects in some people but most people have no side effects or only minor ones. When using a docusate enema you may get a burning feeling or pain around your bottom anus. Occasionally the wall of the anus may bleed. This is a reaction to the enema and it usually clears up quickly.
If the pain or bleeding does not go away or you are worried, talk to your doctor or pharmacist. In rare cases, it's possible to have a serious allergic reaction anaphylaxis to docusate.
You could be having a serious allergic reaction and may need immediate treatment in hospital. These are not all the side effects of docusate. For a full list see the leaflet inside your medicines packet.
If you're pregnant or breastfeeding, you can try to treat constipation without taking a medicine. This involves eating more fibre and drinking plenty of fluids. It may also help to do gentle exercise. If diet and lifestyle changes do not work, your doctor or midwife may recommend a laxative, such as lactulose or Fybogel. These laxatives are quite often used during pregnancy and while breastfeeding.
Docusate is occasionally used in pregnancy and there is no evidence to suggest it will harm your baby. However, other types of laxative are usually tried first, because there is more information to say that they are safe. The amounts of docusate found in breast milk are probably very small and are unlikely to affect your baby.
If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.
For more information about how laxatives can affect you and your baby, read this leaflet about treating constipation on the Best Use of Medicines in Pregnancy BUMPs website. There's very little information about taking herbal remedies and supplements with docusate.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. Docusate helps to soften your poo by increasing the amount of water in it. This makes it easier for you to go to the toilet. Docusate also stimulates the muscles that line your gut, helping poo to move poo along your bowel to your anus. Docusate capsules and liquid normally take 1 or 2 days to work. The enema usually works after 5 to 20 minutes, so it's best to stay close to a toilet.
Talk to your doctor or pharmacist if you are still constipated after a week. Take docusate for up to 1 week. If you take docusate for longer, your bowel can start to rely on it, rather than working on its own. If you are still constipated after taking docusate for a week, talk to your doctor. If your constipation is caused by an illness or a medicine you're taking, your doctor will advise you about when it's best to stop taking docusate. They can also cause an electrolyte imbalance.
This means that levels of salts and minerals like sodium, potassium and magnesium in your body get too high or too low. A severe electrolyte imbalance can cause serious health problems such as muscle spasm and twitching, and even fits or seizures. Using docusate for many weeks, even months, could also stop your bowel working properly on its own. Occasionally, you may need to take 2 different types of laxatives at the same time to get your bowels moving again.
Children: Laxatives such as docusate sodium should not be given to children under 6 years of age unless recommended by a doctor. In general, stool softeners should not be taken within 2 hours of other medications, since they may reduce the effectiveness of those medications. Talk with your doctor or pharmacist to verify that this is the case with the medications that you are taking. If you are taking any of these medications, speak with your doctor or pharmacist.
Depending on your specific circumstances, your doctor may want you to:. An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed. Medications other than those listed above may interact with this medication.
Tell your doctor or prescriber about all prescription, over-the-counter non-prescription , and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them. All material copyright MediResource Inc. Terms and conditions of use. The contents herein are for informational purposes only.
Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Source: www. About this Medication. How does this medication work? What will it do for me? A third study in compared docusate sodium mg three times daily versus placebo in six healthy patients with ileostomies and six healthy volunteers. Another study in evaluated 15 elderly nursing home residents with a randomized, double-blind crossover design. The investigators found no difference in the number of bowel movements per week or in the need for additional laxatives between the two study periods.
Larger studies were subsequently initiated in more recent years. In , a randomized controlled trial in subjects with chronic idiopathic constipation compared psyllium 5.
Furthermore, by treatment week 2, psyllium demonstrated an increase in the frequency of bowel movements, whereas docusate did not. Lastly, the most recent randomized controlled trial was published in It included 74 hospice patients in Canada, comparing docusate mg and sennosides twice daily versus placebo and sennosides for 10 days.
The study found no difference in stool frequency, volume, or consistency between docusate and placebo. A number of systematic reviews have studied the literature on bowel regimens and have noted the paucity of high-quality data supporting the efficacy of docusate, despite its widespread use. Although docusate is considered a benign therapy, there is certainly potential for harm to the patient and detrimental effects on the healthcare system.
Patients commonly complain about the unpleasant taste and lingering aftertaste, which may lead to decreased oral intake and worsening nutritional status. This process negatively impacts patient satisfaction and potentially increases healthcare costs if hospital length of stay is increased.
Another important consideration is that patients may refuse truly necessary medications due to the excessive pill burden. Costs to the healthcare system are increased needlessly when medications that do not improve outcomes are prescribed.
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