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Pronunciation
(DOK yoo sate)
Generic Available (U.S.)
Yes: Excludes enema, gelcap, tablet
Index Terms
Brand Names: U.S.
Brand Names: Canada
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
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
Metabolism/Transport Effects
None known.
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. Some products may contain sodium.
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. Report persistent constipation.
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
Instruct patient in proper use (avoid excessive or prolonged use).
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, oral, as sodium:
Colace®: 50 mg [contains sodium 3 mg/capsule]
Colace®: 100 mg [contains sodium 5 mg/capsule]
Capsule, liquid, oral, as sodium:
DocuSoft S™: 100 mg [contains sodium 5 mg/capsule]
Capsule, softgel, oral, as calcium: 240 mg
Kao-Tin: 240 mg
Kaopectate® Stool Softener: 240 mg
Capsule, softgel, oral, as sodium: 50 mg, 100 mg, 250 mg
Correctol®: 100 mg
Docu-Soft: 100 mg
Dok™: 100 mg, 250 mg
DSS®: 100 mg, 250 mg
Dulcolax®: 100 mg [contains sodium 5 mg/capsule]
Dulcolax® Stool Softener: 100 mg [contains sodium 5 mg/capsule]
Fleet® Sof-Lax®: 100 mg [contains sodium 5 mg/capsule]
Phillips'® Liquid-Gels®: 100 mg [contains sodium 5.2 mg/capsule]
Phillips'® Stool Softener Laxative: 100 mg [contains sodium 5.2 mg/capsule]
Liquid, oral, as sodium: 50 mg/5 mL (10 mL, 25 mL, 473 mL); 150 mg/15 mL (480 mL)
Diocto: 50 mg/15 mL (473 mL) [contains sodium 15 mg/5 mL]
Diocto: 150 mg/15 mL (480 mL)
Diocto: 150 mg/15 mL (480 mL) [vanilla flavor]
Fleet® Pedia-Lax™ Liquid Stool Softener: 50 mg/15 mL (118 mL) [contains propylene glycol, sodium 13 mg/15 mL; fruit-punch flavor]
Silace: 150 mg/15 mL (473 mL) [lemon-vanilla flavor]
Solution, rectal, as sodium [enema]:
Enemeez®: 283 mg/5 mL (5 mL)
Enemeez® Plus: 283 mg/5 mL (5 mL) [contains benzocaine]
Syrup, oral, as sodium: 20 mg/5 mL (25 mL, 473 mL)
Colace®: 60 mg/15 mL (473 mL) [ethanol free, sugar free; contains propylene glycol, sodium 34 mg/15 mL]
Diocto: 60 mg/15 mL (480 mL) [mint flavor]
Diocto: 60 mg/15 mL (473 mL) [contains propylene glycol, sodium 14 mg/5 mL, sodium benzoate]
Silace: 60 mg/15 mL (480 mL) [peppermint flavor]
Tablet, oral, as sodium: 100 mg
Dok™: 100 mg [scored]
Pricing: U.S. (www.drugstore.com)
Capsules (Colace)
100 mg (60): $26.99
Capsules (Docusate Sodium)
100 mg (1000): $27.99
250 mg (100): $15.99
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 January 2012
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