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]

The objective of this report is to provide a definitive, evidence-based synthesis of docusate's pharmacology, clinical trial data, and place in therapy. By critically examining the evidence, this analysis aims to resolve the paradox of its continued use and provide clear, actionable recommendations for clinicians, pharmacists, and healthcare systems. Ultimately, docusate serves as a compelling case study in the challenges of implementing evidence-based medicine and the difficult but necessary process of de-prescribing ingrained yet ineffective therapies.[9]

II. Pharmaceutical and Chemical Profile

A. Chemical Identity and Properties

Docusate is the common pharmaceutical name for the anion bis(2-ethylhexyl) sulfosuccinate.[11] The structural formula is represented as

R−O−C(=O)−CH(SO3−​)−CH2​−C(=O)−O−R, where R is the 2-ethylhexyl group.[11] It is classified as an anionic surfactant and physically appears as a white, wax-like, plastic solid with an odor suggestive of octyl alcohol.[11]

Docusate is available as several different salts, each with a unique Chemical Abstracts Service (CAS) number. The primary CAS Number for the docusate free acid is 10041-19-7.[14] The most common salt forms include:

• Docusate Sodium (also known as dioctyl sodium sulfosuccinate, or DSS) with CAS Number 577-11-7 and molecular formula C20​H37​NaO7​S.[17]
• Docusate Calcium with CAS Number 128-49-4.[14]
• Docusate Potassium with CAS Number 7491-09-0.[15]

B. Formulations, Brand Names, and Dosing

Docusate is marketed in a wide array of formulations for both oral and rectal administration.[12] Oral formulations include capsules containing either the sodium or calcium salt, tablets, and liquid or syrup preparations.[21] It is recommended that oral liquid forms be diluted with milk, fruit juice, or infant formula to mask their inherent bitter taste.[21] Rectal administration is accomplished via enemas containing docusate sodium.[21]

The drug is sold under a vast number of brand names, with Colace® being the most widely recognized. Other common brand names include Dulcolax Stool Softener®, Surfak®, DOK®, Dioctyl®, and Docusol®.[1] Docusate is also a frequent component of combination products, most notably with the stimulant laxative senna (e.g., Senna-S®, Peri-Colace®, Colace 2-in-1®) or with iron supplements to mitigate the constipating effects of iron.[13] The various available formulations and typical dosing regimens are summarized in Table 1.

Table 1: Docusate Formulations, Brand Names, and Dosing Regimens

| Salt Form | Formulation | Common Strengths | Common Brand Names | Typical Adult Dosage | Typical Pediatric Dosage (age) |

| :--- | :--- | :--- | :--- | :--- | :--- |

| Docusate Sodium | Oral Capsules / Softgels | 50 mg, 100 mg, 250 mg | Colace®, DSS®, DOK®, Dulcolax Stool Softener® | 50-400 mg daily, single or divided doses 34 | 50-150 mg daily (2-12 yrs) 21 |

| | Oral Liquid / Syrup | 10 mg/mL, 50 mg/15 mL | Docusol®, Colace® | 50-400 mg daily, single or divided doses 34 | 20-60 mg daily (3-6 yrs); 40-150 mg daily (6-12 yrs) 34 |

| | Rectal Enema | 100 mg/5 mL, 283 mg/5 mL | Enemeez Mini®, DocuSol® | 200-283 mg once or twice daily 34 | 50-100 mg once daily (3-18 yrs) 34 |

| Docusate Calcium | Oral Capsules | 240 mg | Surfak®, Kaopectate® | 240 mg once daily 21 | Safety and efficacy not established (<12 yrs) 21 |

| Docusate Potassium | Oral Capsules | 100 mg, 240 mg | Diocto-K® | 50-400 mg daily, single or divided doses 34 | >12 years: 50-400 mg daily 34 |

C. Regulatory Status, Manufacturing, and Other Uses

Docusate is widely available over-the-counter (OTC) without a prescription.[3] Its long-standing presence has led to its inclusion on the World Health Organization's (WHO) Model List of Essential Medicines, where it is listed under the section for medicines for common symptoms in palliative care.[35] This designation, however, presents a significant contradiction when viewed against the evidence of its inefficacy. The WHO list is intended to comprise the most effective, safe, and cost-efficient medicines for priority health conditions. Docusate's inclusion appears to be a legacy decision based on historical use and perceived safety rather than on proven clinical value, especially as modern palliative care guidelines from organizations like the Canadian Society of Palliative Care Physicians now recommend

against its use.[8] This discrepancy highlights the slow pace of change in global health recommendations and the difficulty in de-implementing a long-standing therapy, even when its utility is disproven.

Docusate is produced by numerous manufacturers. Syensqo (formerly Cytec Industries) is a premier manufacturer of pharmaceutical-grade docusate sodium, and many generic versions are produced by companies such as Major Pharmaceuticals and Rugby Laboratories.[38] These products are manufactured in FDA-approved facilities under current Good Manufacturing Practices (cGMP).[38]

Beyond its medical applications, docusate sodium is also approved by the U.S. Food and Drug Administration (FDA) as a "generally recognized as safe" (GRAS) food additive. In this capacity, it serves as an emulsifier, dispersant, and wetting agent in various products, including pasteurized cheese spreads and carbonated beverages.[11] Industrially, it is widely used as a surfactant under the trade name Aerosol-OT.[11]

III. Pharmacological Profile

A. Mechanism of Action: The Surfactant Theory

Docusate is classified pharmacologically as an emollient laxative, or more commonly, a stool softener.[44] Its primary proposed mechanism of action is based on its properties as an anionic surfactant.[11] According to this theory, docusate lowers the surface tension at the oil-water interface of the fecal mass within the colon. This reduction in surface tension is thought to allow water and lipids to better penetrate the stool, resulting in a softer, more hydrated fecal mass that is easier to pass, thereby alleviating straining.[13]

In addition to its surfactant properties, some evidence suggests that docusate may exert a mild secretagogue effect in the small intestine. Studies have indicated that docusate can inhibit fluid absorption and stimulate the secretion of water and electrolytes into the jejunum, a mechanism possibly mediated by an increase in intracellular cyclic AMP.[14] However, this effect is considered to be of minor clinical significance compared to its primary role as a surfactant.

B. Pharmacokinetics: Absorption, Metabolism, and Excretion

The pharmacokinetics of docusate are not fully elucidated, and there is some conflicting information in the literature. While some sources suggest it is minimally absorbed and acts locally, leading to the conclusion that standard pharmacokinetic parameters do not apply, the weight of evidence indicates that this is not entirely accurate.[13]

• Absorption and Distribution: Small amounts of orally administered docusate salts appear to be absorbed systemically, primarily in the duodenum and jejunum.[14] The extent of absorption following rectal administration is unknown.[49] Information regarding its distribution throughout the body is also unknown.[49]
• Metabolism and Excretion: The portion of docusate that is systemically absorbed undergoes extensive first-pass metabolism in the liver.[2] It is subsequently excreted from the body via the gallbladder into the bile.[11] This is supported by animal studies using radiolabeled docusate, which confirm significant absorption followed by metabolism and excretion in both urine and feces.[51]
• Half-life: The elimination half-life of docusate is not well-established and is reported as unknown in several sources.[49]
• Onset of Action: The time to effect is dependent on the route of administration. Oral formulations typically produce a bowel movement within 12 to 72 hours, with stool softening becoming apparent after one to three days of therapy.[13] Rectal enema formulations act much more rapidly, with an onset of action between 2 and 20 minutes.[30]

The confirmation that docusate is systemically absorbed and metabolized is of critical clinical importance, as it provides the biological rationale for its most significant drug interaction. If docusate were truly unabsorbed, its potential to systemically affect other drugs would be negligible. However, its absorption explains its well-documented interaction with mineral oil.[1] Docusate's surfactant properties facilitate the gastrointestinal absorption of mineral oil, which is normally not absorbed. This can lead to a systemic foreign body reaction and inflammation in the intestinal mucosa, liver, spleen, and lymph nodes.[13] Therefore, a correct understanding of docusate's pharmacokinetics is essential for preventing this potentially harmful drug interaction.

IV. Clinical Efficacy: A Systematic Review of the Evidence

The clinical utility of docusate has been a subject of debate for decades. Despite its widespread use, a systematic review of the available evidence reveals a consistent pattern of inefficacy, particularly when subjected to the rigor of randomized controlled trials.

A. Docusate versus Placebo: Evidence of Inefficacy

Multiple randomized controlled trials (RCTs) have failed to demonstrate a benefit for docusate over placebo in treating or preventing constipation.[5] This is not a recent finding but a consistent conclusion from studies spanning several decades.

• An early trial from 1976 studied 34 elderly medical ward patients, randomizing them to docusate sodium 100 mg twice daily or a control group. The study found no statistically significant differences in the frequency or character of bowel movements, leading the authors to conclude that "whether the drug actually offers anything beyond a placebo effect... is in doubt".[5]
• A 1985 study involving healthy volunteers and patients with ileostomies found that docusate sodium 100 mg three times daily "had no effect on stool weight, stool frequency, stool water, or mean transit time" compared to placebo.[5]
• A 1991 randomized, double-blind crossover study in elderly nursing home residents using docusate calcium 240 mg twice daily found no difference compared to placebo in the number of bowel movements per week, the need for rescue laxatives, or patients' subjective experience of constipation.[5]
• A larger RCT in 1998 involving 170 subjects with chronic idiopathic constipation directly compared docusate sodium 100 mg twice daily to psyllium and placebo. The results showed that psyllium significantly increased stool water content and bowel movement frequency, whereas docusate had no effect and was not different from placebo.[5]
• A 2005 RCT in 74 hospice patients compared docusate 200 mg twice daily (in combination with sennosides) to placebo (plus sennosides). The addition of docusate provided no additional benefit, with no difference in stool frequency, volume, or consistency between the groups.[5]

The collective results of these trials, summarized in Table 2, provide strong evidence that docusate is not superior to placebo for the management of constipation.

Table 2: Summary of Key Randomized Controlled Trials Evaluating Docusate Efficacy vs. Placebo

| Year | Patient Population | Intervention | Comparator | Key Outcomes | Reference(s) |

| :--- | :--- | :--- | :--- | :--- | :--- |

| 1976 | 34 elderly medical patients | Docusate Sodium 100 mg BID | No laxative (control) | No significant difference in frequency or character of bowel movements. | 5 |

| 1985 | 12 healthy volunteers/ileostomy patients | Docusate Sodium 100 mg TID | Placebo | No effect on stool weight, frequency, water content, or transit time. | 5 |

| 1991 | 15 elderly nursing home residents | Docusate Calcium 240 mg BID | Placebo | No difference in bowel movements per week or need for rescue laxatives. | 5 |

| 1998 | 170 adults with chronic constipation | Docusate Sodium 100 mg BID | Placebo, Psyllium | No effect on stool water content or frequency; inferior to psyllium. | 5 |

| 2005 | 74 hospice patients | Docusate 200 mg BID (with senna) | Placebo (with senna) | No difference in stool frequency, volume, or consistency. | 5 |

B. Docusate versus Other Laxatives: Evidence of Inferiority

When compared directly to other classes of laxatives, docusate consistently proves to be a less effective option. As demonstrated in the 1998 trial, the bulk-forming agent psyllium was found to be superior to docusate for increasing both stool water content and frequency.[5] Modern clinical guidelines strongly favor osmotic laxatives like polyethylene glycol (PEG), often without even considering docusate as a relevant comparator due to the lack of supporting evidence.[6] The common practice of combining docusate with a stimulant laxative, such as in Senna-S® products, implicitly acknowledges docusate's inability to stimulate a bowel movement on its own; the stimulant provides the motility while docusate is intended to soften the stool, an effect which itself is not supported by evidence.[31]

C. The Special Case of Opioid-Induced Constipation (OIC)

Docusate is frequently prescribed for the prophylaxis and treatment of opioid-induced constipation (OIC), a particularly challenging type of constipation caused by the effects of opioids on gut motility. However, the evidence base for this practice is exceptionally weak.[9] The 2005 RCT in hospice patients, a population with high opioid use, found no benefit in adding docusate to a stimulant laxative regimen.[5] A more recent medication use evaluation in a long-term care facility concluded that adding docusate to other bowel regimens for OIC did not reduce the need for rescue laxatives.[9] Consequently, clinical guidelines for OIC either do not recommend docusate or do so with a very low level of confidence, citing a lack of supporting evidence.[8]

A critical and often overlooked harm associated with using docusate is the therapeutic delay it introduces. Given its oral onset of action of 1 to 3 days, prescribing docusate as a first-line agent means a patient with constipation receives a therapy with placebo-level efficacy for a significant period.[13] This delays the initiation of a proven, effective treatment like PEG or a stimulant laxative.[59] During this delay, the patient's constipation can worsen, leading to increased discomfort, fecal impaction, and the subsequent need for more invasive and costly interventions like enemas or manual disimpaction. Thus, the seemingly "safe" and "gentle" choice to start with docusate can be interpreted as a harmful one, as it represents a failure to provide timely and effective care.

V. Place in Clinical Practice: Guideline Recommendations vs. Real-World Use

A. Review of Major Clinical Practice Guidelines

An analysis of major clinical practice guidelines for constipation reveals a significant gap between evidence and historical practice, with the most current, high-level guidelines effectively excluding docusate as a recommended therapy.

The 2023 joint guideline from the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) on the pharmacological management of chronic idiopathic constipation (CIC) is particularly telling. Despite including surfactant laxatives like docusate in the initial scope of their systematic review, the final guideline explicitly states that no assessment or recommendation was provided for this class of drugs.[6] The authors note that prior guidelines had identified only small, methodologically flawed RCTs showing no superiority to placebo and inferiority to psyllium.[6] This omission by the leading gastroenterology societies in the United States is a powerful statement on docusate's lack of standing in modern, evidence-based management of constipation.

Similarly, guidelines from the European Society for Medical Oncology (ESMO) for managing constipation in patients with advanced cancer do not recommend docusate, citing inadequate evidence.[8] In contrast, some older or more general guidelines may still list stool softeners as a therapeutic option, though often as a step to be taken after more effective agents like osmotic laxatives have been tried.[61] The discrepancies among various guidelines are summarized in Table 3.

Table 3: Docusate in Clinical Practice Guidelines for Constipation

| Guideline Issuing Body | Year | Indication | Recommendation for Docusate | Reference(s) |

| :--- | :--- | :--- | :--- | :--- |

| AGA / ACG | 2023 | Chronic Idiopathic Constipation | No recommendation provided. The panel explicitly excluded surfactant laxatives from their final recommendations due to a lack of quality evidence. | 6 |

| ESMO | 2018 | Constipation in Advanced Cancer | Not recommended. Stool softeners are generally not recommended due to inadequate evidence. | 8 |

| AAFP | 2015 | Chronic Constipation | Listed as a therapeutic option, typically after osmotic laxatives. | 61 |

| AGA (on OIC) | 2019 | Opioid-Induced Constipation | Recommends traditional laxatives as first-line, but acknowledges the evidence for docusate is weak. | 8 |

B. The Persistence of Docusate in Clinical Culture

Despite the overwhelming negative evidence and its omission from key clinical guidelines, docusate remains one of the most frequently prescribed laxatives in institutional settings.[4] This persistence can be attributed to several factors that constitute the "docusate dogma." First, its long history of use has embedded it deeply within hospital formularies, pre-printed order sets, and the training of generations of clinicians. Second, it is widely perceived as a benign and safe agent, a perception that often overlooks the harm of therapeutic delay.[59] Third, the low unit cost of generic docusate creates the illusion of cost-effectiveness, which fails to account for the larger systemic costs associated with administration (nursing time) and the management of treatment failure.[4] Finally, the very name "stool softener" is intuitively appealing to both clinicians and patients, suggesting a direct and gentle solution to the problem of hard stools, even if this effect is not clinically demonstrable.

VI. Safety, Tolerability, and Drug Interactions

A. Adverse Event Profile

While generally well-tolerated, docusate is not without potential side effects. The most commonly reported adverse events are mild and gastrointestinal in nature, including stomach pain, abdominal cramping, and diarrhea.[1] Liquid formulations can cause throat irritation if not properly diluted.[22]

Serious side effects are rare but can occur. Anaphylaxis, a severe allergic reaction, has been reported, manifesting as skin rash, hives, swelling of the face, lips, or tongue, and difficulty breathing.[1] The development of rectal bleeding after administration is a serious sign and warrants immediate medical evaluation.[1] Anecdotal user reports have mentioned other effects such as vertigo and thrombocytopenia (low platelet count), though these are not well-established in the medical literature.[67]

B. Contraindications and Precautions

Docusate is contraindicated in patients with known hypersensitivity to the drug, intestinal obstruction, fecal impaction, or symptoms of appendicitis (e.g., nausea, vomiting, acute abdominal pain).[66] The rectal enema formulation should not be used in patients with active hemorrhoids, anal fissures, or inflammatory bowel disease such as ulcerative colitis or Crohn's disease.[68]

Use for longer than one week is not recommended without consulting a healthcare provider. Chronic use can lead to electrolyte imbalances (from persistent diarrhea) and potential laxative dependence, where the bowel loses its ability to function properly on its own.[1]

C. Clinically Significant Drug Interactions

The most important and well-documented drug interaction is with mineral oil. Docusate should not be administered concurrently with mineral oil laxatives.[1] As a surfactant, docusate enhances the systemic absorption of mineral oil, which can lead to the formation of foreign-body granulomas and inflammation in the intestinal mucosa, liver, spleen, and lymph nodes.[13]

Due to its surfactant properties, docusate could theoretically increase the absorption of other co-administered oral drugs. Therefore, some clinicians advise caution when using it with medications that have a narrow therapeutic index.[50] Additionally, drug databases list numerous potential interactions where docusate may decrease the therapeutic efficacy of drugs with anticholinergic properties that slow gut motility, effectively counteracting any potential laxative effect.[48]

VII. Economic and Health System Considerations

A. The Economic Burden of an Ineffective Medicine

The continued use of docusate presents an economic paradox. While the unit cost of a generic docusate capsule is low, its high prescription volume translates into a substantial and unnecessary financial burden on the healthcare system.[63] A study conducted at a single U.S. tertiary care center found that the average annual expenditure on docusate exceeded $25,000.[63] A similar analysis at McGill University Health Centre in Canada reported annual costs approaching $60,000, with a crucial finding that direct drug costs accounted for only 25% of the total expense; the remaining 75% was attributed to the labor costs of nursing administration.[4]

When these single-center costs are extrapolated across the thousands of hospitals in the United States, the national economic burden of this ineffective medication likely amounts to tens, if not hundreds, of millions of dollars annually.[63]

B. A Case for Deprescribing

Docusate represents a prime target for institutional deprescribing initiatives aimed at eliminating low-value care.[9] The financial resources allocated to docusate could be redirected to interventions with proven clinical benefit and greater cost-effectiveness. One analysis calculated that the funds spent on docusate at a single hospital in one year could have instead paid for nearly 1,400 doses of polyethylene glycol 3350, over 3,800 doses of lactulose, or over 4,500 doses of psyllium—all laxatives with superior evidence of efficacy.[10] The removal of docusate from hospital formularies and standardized electronic order sets is a clear, evidence-based strategy to reduce polypharmacy, lower healthcare costs, and, most importantly, improve patient outcomes by ensuring that individuals with constipation receive effective treatment in a timely manner.[10]

VIII. Conclusion and Recommendations for Clinical Practice

A. Synthesis of the Evidence

This comprehensive review has systematically established that docusate, also known as dioctyl sulfosuccinate, is a medication with a plausible but clinically unproven mechanism of action. For over four decades, randomized controlled trials have consistently failed to demonstrate that docusate is superior to placebo for treating constipation or softening stool. Furthermore, in head-to-head comparisons, it is less effective than other available laxative classes. Its continued, widespread use exemplifies a form of "medical dogma," sustained by historical precedent and a flawed perception of its risk-benefit profile, which fails to recognize the clinical harm of therapeutic delay and the significant, cumulative economic burden it imposes on the healthcare system.

B. Evidence-Based Recommendations

Based on a critical appraisal of the available evidence, the following recommendations are made for clinical practice:

• Recommendation 1 (Strong): Docusate should not be used for the treatment or prevention of constipation, including chronic idiopathic constipation and opioid-induced constipation, due to a profound lack of evidence supporting its efficacy.
• Recommendation 2 (Strong): For the management of constipation, clinicians should prioritize evidence-based therapies. First-line options should include osmotic laxatives (e.g., polyethylene glycol) and/or bulk-forming agents (e.g., psyllium), with the addition of stimulant laxatives (e.g., senna, bisacodyl) as needed for rescue therapy or more severe symptoms.[6]
• Recommendation 3 (Strong): Healthcare institutions, including hospitals and long-term care facilities, should initiate evidence-based deprescribing protocols to remove docusate from routine constipation order sets and should strongly consider its complete removal from the institutional formulary.[9]

C. Future Outlook

The story of docusate serves as a powerful reminder of the imperative to critically and continuously re-evaluate long-standing clinical practices against the highest standards of evidence. Moving beyond the "docusate dogma" is a necessary step toward a more rational, evidence-based, and cost-effective approach to managing one of the most common problems in medicine. Future research should focus not on re-proving docusate's inefficacy—a question that has been answered repeatedly—but on understanding and overcoming the systemic and cultural barriers that impede the de-implementation of ineffective therapies throughout healthcare.

Works cited

1. Colace Capsules (Docusate) Laxative: Uses & Side Effects - Cleveland Clinic, accessed June 19, 2025, https://my.clevelandclinic.org/health/drugs/19529-docusate-capsules
2. Docusate - LiverTox - NCBI Bookshelf, accessed June 19, 2025, https://www.ncbi.nlm.nih.gov/books/NBK548205/
3. Online Prescription for Docusate (Generic Colace) - Sesame, accessed June 19, 2025, https://sesamecare.com/medication/docusate
4. Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults, accessed June 19, 2025, https://cdn.mdedge.com/files/s3fs-public/issues/articles/jhm014020110.pdf
5. Things We Do for No Reason: Prescribing Docusate for Constipation ..., accessed June 19, 2025, https://www.mdedge.com/jhospmed/article/193136/hospital-medicine/things-we-do-no-reason-prescribing-docusate-constipation/page/0/1
6. AGA-ACG Clinical Practice Guideline on Chronic Idiopathic Constipation Treatments: Parsing Benefits and Risks - American College of Gastroenterology, accessed June 19, 2025, https://gi.org/wp-content/uploads/2023/06/1-Schoenfeld-June-2023.pdf
7. Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review, accessed June 19, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8191753/
8. Is there sufficient evidence to support the efficacy of docusate? Is ..., accessed June 19, 2025, https://inpharmd.com/inquiries/42bf91a61fb65f5d8c09ffca56c96d588667cfd248ecf0d0e0ef84ef9b3a909d
9. Medication Use Evaluation of Docusate Sodium in Constipation Prophylaxis and Opioid Induced Constipation at the WPB VA HCS Community Living Center - PubMed, accessed June 19, 2025, https://pubmed.ncbi.nlm.nih.gov/37999649/
10. Analysis of the economic burden of docusate sodium at a United States tertiary care center, accessed June 19, 2025, https://www.researchgate.net/publication/371693821_Analysis_of_the_economic_burden_of_docusate_sodium_at_a_United_States_tertiary_care_center
11. Docusate - Wikipedia, accessed June 19, 2025, https://en.wikipedia.org/wiki/Docusate
12. CAS 577-11-7 Docusate Sodium - Alfa Chemistry, accessed June 19, 2025, https://www.alfa-chemistry.com/product/docusate-sodium-cas-577-11-7-183842.html
13. Colace - Drug Summary - PDR.Net, accessed June 19, 2025, https://www.pdr.net/drug-summary/Colace-Capsules-docusate-sodium-1023
14. Docusate | C20H38O7S | CID 11339 - PubChem, accessed June 19, 2025, https://pubchem.ncbi.nlm.nih.gov/compound/Docusate
15. CAS No : 10041-19-7 | Product Name : Docusate - API - Pharmaffiliates, accessed June 19, 2025, https://www.pharmaffiliates.com/en/10041-19-7-docusate-api-pa042490000.html
16. Docusate Sodium | CAS 577-11-7 - LGC Standards, accessed June 19, 2025, https://www.lgcstandards.com/DE/en/Docusate-Sodium/p/TRC-D494660
17. 2.4 Docusate sodium | Therapeutic Goods Administration (TGA), accessed June 19, 2025, https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-march-and-july-2017/24-docusate-sodium
18. 273315 Docusate Sodium (Dioctyl Sulfosuccinate) Sodium Salt CAS: 577-11-7 - United States Biological, accessed June 19, 2025, https://www.usbio.net/biochemicals/273315/Dioctyl-Sulfosuccinate-Sodium-Salt
19. Docusate Sodium USP Related Compound B | 86878-53-7 - SynZeal, accessed June 19, 2025, https://www.synzeal.com/docusate-sodium-usp-related-compound-b
20. Docusate potassium | DrugBank Online, accessed June 19, 2025, https://go.drugbank.com/salts/DBSALT002872
21. Colace, DSS (docusate) dosing, indications, interactions, adverse effects, and more, accessed June 19, 2025, https://reference.medscape.com/drug/colace-dss-docusate-342012
22. Docusate Sodium Oral - MedCentral, accessed June 19, 2025, https://www.medcentral.com/drugs/monograph/323-382582/docusate-sodium-oral
23. Docusate - Memorial Sloan Kettering Cancer Center, accessed June 19, 2025, https://www.mskcc.org/cancer-care/patient-education/medications/adult/docusate
24. Stool Softeners | Saint Luke's Health System, accessed June 19, 2025, https://www.saintlukeskc.org/health-library/stool-softeners
25. Docusate Sodium Medicare Coverage and Co-Pay Details - GoodRx, accessed June 19, 2025, https://www.goodrx.com/docusate-sodium/medicare-coverage
26. Docusate: Side Effects, Uses, Dosage, Interactions, Warnings, accessed June 19, 2025, https://www.rxlist.com/docusate/generic-drug.htm
27. What is Docusate Oral Capsule (DOCUSATE - ORAL)? - Columbia Doctors, accessed June 19, 2025, https://www.columbiadoctors.org/health-library/drug-info/docusate-oral-capsule-docusate-oral/
28. Docusate Calcium Oral Capsule 100 mg, 240 mg | Cigna, accessed June 19, 2025, https://www.cigna.com/knowledge-center/hw/medications/docusate-calcium-oral-capsule-100-mg-240-mg-fdbm11326-9109
29. Docusate oral/rectal Uses, Side Effects & Warnings - Drugs.com, accessed June 19, 2025, https://www.drugs.com/mtm/docusate-oral-rectal.html
30. Common questions about docusate - NHS, accessed June 19, 2025, https://www.nhs.uk/medicines/docusate/common-questions-about-docusate/
31. Docusate Sodium & Senna: Stool Softener Uses & Side Effects - Cleveland Clinic, accessed June 19, 2025, https://my.clevelandclinic.org/health/drugs/20511-docusate-senna-tablets
32. Docusate - brand name list from Drugs.com, accessed June 19, 2025, https://www.drugs.com/ingredient/docusate.html
33. Miralax vs Colace: How Do They Compare for Constipation Relief? - GoodRx, accessed June 19, 2025, https://www.goodrx.com/conditions/constipation/miralax-vs-colace
34. Docusate Dosage Guide + Max Dose, Adjustments - Drugs.com, accessed June 19, 2025, https://www.drugs.com/dosage/docusate.html
35. Docusate - DrugBank, accessed June 19, 2025, https://go.drugbank.com/unearth/q?query=docusate+sodium&searcher=drugs
36. WHO Model List of Essential Medicines - World Health Organization (WHO), accessed June 19, 2025, https://apps.who.int/iris/bitstream/10665/93142/1/EML_18_eng.pdf?ua=1
37. WHO Model List of Essential Medicines - Wikipedia, accessed June 19, 2025, https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines
38. Docusate Sodium - Pharmaceutical Business review -, accessed June 19, 2025, https://www.pharmaceutical-business-review.com/products/docusate-sodium/
39. DOCUSATE API - Syensqo, accessed June 19, 2025, https://www.syensqo.com/en/brands/docusate/docusate-api
40. Major Dok 250mg 100ct Softgels *Compare to Colace Extra Strength - Amazon.com, accessed June 19, 2025, https://www.amazon.com/Major-Softgels-Compare-Colace-Strength/dp/B005TM2NKY
41. MAJOR Docusate Sodium 100 mg - Stool Softener Laxative Softgels for Constipation Relief - Stool Softeners for Women and Men - Gluten-Free - 100 Count (3 Pack) - Amazon.com, accessed June 19, 2025, https://www.amazon.com/MAJOR-Docusate-Sodium-100-Stimulant-Free/dp/B00EX5QAGQ
42. Save Money with Colace Generic Alternative: Docusate Sodium - xeteor.com, accessed June 19, 2025, https://xeteor.com/blog/save-money-on-colace-with-generic-alternative-docusate-sodium
43. Docusate-Sodium-USP | CAS 577-11-7 | DO105 | Spectrum Chemical, accessed June 19, 2025, https://www.spectrumchemical.com/docusate-sodium-usp-do105
44. Docusate - StatPearls - NCBI Bookshelf, accessed June 19, 2025, https://www.ncbi.nlm.nih.gov/books/NBK555942/
45. www.webmd.com, accessed June 19, 2025, https://www.webmd.com/drugs/2/drug-323/docusate-sodium-oral/details#:~:text=It%20works%20by%20lowering%20the,pass%20through%20your%20digestive%20tract.
46. DOCUSATE (PD013640, HNSDLXPSAYFUHK-UHFFFAOYSA-N) - Probes & Drugs, accessed June 19, 2025, https://www.probes-drugs.org/compound/PD013640/
47. DOCUSATE - Inxight Drugs - ncats, accessed June 19, 2025, https://drugs.ncats.io/drug/M7P27195AG
48. Docusate: Uses, Interactions, Mechanism of Action | DrugBank Online, accessed June 19, 2025, https://go.drugbank.com/drugs/DB11089
49. Docusate | Davis's Drug Guide for Rehabilitation Professionals, accessed June 19, 2025, https://fadavispt.mhmedical.com/content.aspx?bookid=1873§ionid=139008897
50. Docusate Salts Monograph for Professionals - Drugs.com, accessed June 19, 2025, https://www.drugs.com/monograph/docusate-salts.html
51. Docusate sodium - Registration Dossier - ECHA, accessed June 19, 2025, https://echa.europa.eu/registration-dossier/-/registered-dossier/16066/7/2/1
52. 723. Dioctyl sodium sulfosuccinate (DSS) (WHO Food Additives Series 28) - InChem.org, accessed June 19, 2025, https://www.inchem.org/documents/jecfa/jecmono/v28je16.htm
53. Docusate - WikEM, accessed June 19, 2025, https://wikem.org/wiki/Docusate
54. Docusate | Drug Lookup | Pediatric Care Online, accessed June 19, 2025, https://publications.aap.org/pediatriccare/drug-monograph/18/5270/Docusate
55. Taking or using docusate with other medicines and herbal supplements - NHS, accessed June 19, 2025, https://www.nhs.uk/medicines/docusate/taking-or-using-docusate-with-other-medicines-and-herbal-supplements/
56. Docusate Sodium Use Warnings - BuzzRx, accessed June 19, 2025, https://www.buzzrx.com/docusate-sodium/warnings
57. When to use a stool softener vs. Laxative - Medical News Today, accessed June 19, 2025, https://www.medicalnewstoday.com/articles/322621
58. FF #294 Opioid Induced Constipation - Part 1: Established Management | Palliative Care Network of Wisconsin, accessed June 19, 2025, https://www.mypcnow.org/fast-fact/opioid-induced-constipation-part-1-established-management/
59. Does colace actually help with constipation? : r/Residency - Reddit, accessed June 19, 2025, https://www.reddit.com/r/Residency/comments/110e016/does_colace_actually_help_with_constipation/
60. AGA-ACG Clinical Practice Guideline on Chronic Idiopathic Constipation Treatments: Parsing Benefits and Risks - American College of Gastroenterology, accessed June 19, 2025, https://gi.org/journals-publications/ebgi/schoenfeld2_june2023/
61. Management of Constipation in Older Adults - AAFP, accessed June 19, 2025, https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html
62. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation - PubMed, accessed June 19, 2025, https://pubmed.ncbi.nlm.nih.gov/37211380/
63. Analysis of the economic burden of docusate sodium at a United States tertiary care center, accessed June 19, 2025, https://pubmed.ncbi.nlm.nih.gov/37334679/
64. Side effects of docusate - NHS, accessed June 19, 2025, https://www.nhs.uk/medicines/docusate/side-effects-of-docusate/
65. Sennosides-Docusate Sodium Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD, accessed June 19, 2025, https://www.webmd.com/drugs/2/drug-16713/sennosides-docusate-sodium-oral/details
66. Docusate (sodium=Colace; calcium=Surfak), accessed June 19, 2025, https://glowm.com/resources/glowm/cd/pages/resources/Pharmacy/Docusate.htm
67. Docusate for Constipation Reviews - Drugs.com, accessed June 19, 2025, https://www.drugs.com/comments/docusate/for-constipation.html
68. Who can and cannot take or use docusate - NHS, accessed June 19, 2025, https://www.nhs.uk/medicines/docusate/who-can-and-cannot-take-or-use-docusate/
69. How and when to take or use docusate - NHS, accessed June 19, 2025, https://www.nhs.uk/medicines/docusate/how-and-when-to-take-or-use-docusate/