Docusate Advanced Drug Monograph

Docusate

• Name (English): Docusate
• DrugBank ID: DB11089
• Type: Small Molecule
• CAS Number: 10041-19-7
• Description: Docusate, also known as dioctyl sulfosuccinate, is a stool softener used to treat constipation. It increases water absorption in the gut, softening the stool for easier passage. It can be administered orally or rectally.
• Mechanism of Action: Docusate is a surfactant laxative that reduces the surface tension of the oil-water interface of stool. This enhances the incorporation of water and fat into the stool, resulting in a softer fecal mass. Its effects are primarily local in the jejunum.
• Pharmacokinetics:
  • Onset of Action: 6-72 hours orally, 2-15 minutes rectally.
  • Absorption: Significant amounts can be excreted in bile, indicating some absorption.
  • Excretion: Primarily in feces.
• Indications: Treatment of occasional constipation. Often used when straining during bowel movements should be avoided.
• Contraindications: Hypersensitivity to docusate, intestinal obstruction, symptoms of appendicitis or acute abdominal pain, fecal impaction, concomitant use of mineral oil, nausea or vomiting.
• Warnings/Precautions: Electrolyte imbalance with excessive use, dependence with excessive use, rectal use only for enemas (lubricate, discontinue if irritation or resistance occurs), consult healthcare professional for stomach pain, nausea, vomiting, or persistent changes in bowel habits. Discontinue and consult if bleeding occurs or if no bowel movement after use or need for continued use beyond 7 days.
• Adverse Effects: Abdominal cramping, diarrhea, excessive bowel activity, intestinal obstruction, throat irritation (with liquid/syrup forms).
• Drug Interactions: May interact with various medications, potentially decreasing the efficacy of some (e.g., some anticholinergics, opioids, calcium channel blockers) or increasing the risk of adverse effects with others (e.g., calcium polycarbophil, castor oil) or dehydration (e.g., diuretics). Mineral oil absorption may be increased with oral docusate.
• Pregnancy: Category C.
• Lactation: Unknown if excreted in milk; generally considered compatible with nursing.