Docusate: A Critical Re-evaluation of a Ubiquitous Laxative

I. Introduction: The Docusate Paradox

Docusate is a stool-softening laxative that is widely utilized for the prevention and treatment of occasional constipation.[1] First introduced in the 1950s, its long history of use and broad availability in numerous over-the-counter (OTC) formulations have cemented its status as one of the most commonly prescribed agents for this indication, particularly within the inpatient hospital setting.[2] This ubiquity, however, stands in stark contrast to a substantial and growing body of clinical evidence that questions its efficacy.

This report addresses a central paradox in modern pharmacotherapy: the profound disconnect between docusate's pervasive clinical use and the data from numerous clinical trials and systematic reviews that demonstrate its lack of efficacy when compared to placebo.[5] This paradox is not a new discovery; for decades, studies have failed to show a meaningful benefit for docusate in softening stool or increasing the frequency of bowel movements.[5] Yet, its prescription remains a common practice, a phenomenon that can be described as a form of "medical dogma." The persistence of docusate use appears to be a classic example of clinical inertia, where a treatment is continued out of tradition and a perception of safety rather than a foundation of proven benefit, fitting the description of a "Thing We Do For No Reason".[5]