II. Mechanism

  1. Theoretically softens stool
    1. Allow water and fat to penetrate the fecal mass
  2. Effect probably due to induced Secretory Diarrhea
  3. Slow onset of action (24 to 48 hours)

III. Precautions

  1. Do not use longterm
  2. May also affect absorption of other medications
  3. Risk of hepatotoxicity

IV. Efficacy

  1. Docusate (Colace) appears to have no greater effect than Placebo
  2. Non-docusate Emollients (Mineral Oil, Glycerin) are effective, but have limited roles in Constipation Management

V. Medications: Docusate

  1. Other agents are preferred in most cases (low efficacy)
  2. Docusate enhances intestinal Mineral Oil absorption
    1. Do not use Docusate with Mineral Oil preparations
  3. Docusate liquid formulations were recalled in 2016 due to Bacterial contamination
    1. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm511528.htm
  4. Docusate Sodium or Dioctyl sulfosuccinate (Colace)
    1. Onset of action within 24-72 hours
    2. Adult
      1. Twice daily: 100 mg PO bid
      2. Once daily: 200 mg PO qhs
      3. Maximum daily total dose: 400 mg
    3. Pediatric
      1. Age <3 years: 10-40 mg per dose
      2. Age 3-6 years: 20-60 mg per dose
  5. Docusate Calcium (Surfak)
    1. Adult: 240 mg PO qd
    2. Child: 50-150 mg qd

VI. Medications: Non-Docusate agents (Lubricant Laxatives)

  1. Mineral Oil (use caution due to aspiration risk)
    1. Contraindications
      1. Risk of Aspiration Pneumonia (lipoid Pneumonia)
      2. Risk of malabsorption
    2. General dosing
      1. Give chilled in juice to maximize tolerability
      2. Coadminister Multivitamin daily if used chronically
    3. Child Dose (over 18 months of age)
      1. Low: 1-3 cc/kg/day divided daily to twice daily
        1. Used in maintenance of bowel regimen
      2. High dose: 15-30 ml per age in years up to 240 ml
        1. Used in acute disimpaction
        2. May repeat daily for 3-4 days
    4. Adult Dose: 5-45 ml PO qhs
  2. Glycerin Suppository
    1. One Suppository (Adult or Pediatric) PR prn
    2. Indicated in Constipation in Infants

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Cost: Medications

stool softener (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
STOOL SOFTENER 100 MG SOFTGEL Generic OTC $0.02 each
STOOL SOFTENER 250 MG SOFTGEL Generic OTC $0.05 each