What is docusate

Docusate is an emollient laxative medicine that is used to treat constipation (difficulty pooing). Docusate helps to soften your poo (stool softener) and makes your bowel movements easier to pass. Docusate stool softener (emollient laxative) encourages bowel movements by helping water and fats to get into the stool and prevent dry, hard stool masses. This type of laxative has been said to allow patient to have a bowel movement without straining. Docusate is not a stimulant laxative.

Docusate sodium is used to treat or prevent constipation, and to reduce pain or rectal damage caused by hard stools or by straining during bowel movements. Docusate may also be used for purposes not listed in this medication guide.

Docusate is helpful when you have difficulty going to the toilet because of dry poos or piles (hemorrhoids) or if you have a tear in the lining of your back passage (an anal fissure). Docusate makes your bowel movements softer and easier to pass.

You may also be given docusate if you’re going to have an x-ray of your stomach. It can help you empty your bowels beforehand.

Docusate comes as capsules and as a liquid that you swallow. Docusate also comes as an enema – a tube of liquid medicine which you squeeze into your back passage (anus).

Docusate is available on prescription. You can also buy it from pharmacies.

Warnings

Do NOT use

• If you are currently taking mineral oil, unless directed by a doctor.
• When abdominal pain, nausea, or vomiting are present.
• For longer than one week unless directed by a doctor.

Ask a doctor before use if you notice a sudden change in bowel habits that persists over a period of 2 weeks.

Stop use and ask a doctor if you have rectal bleeding or you fail to have a bowel movement after use.

If pregnant or breast-feeding, ask a health professional before use.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

Key facts

• Docusate capsules and liquid take 1 or 2 days to work.
• The docusate enema usually works within 20 minutes – so it’s best to stay close to a toilet.
• Do not give docusate to a child under 12 years old unless their doctor prescribes it.
• Do not take docusate for more than a week without talking with your doctor.
• Docusate is also known by the brand names Colace, Diocto, Dioeze, Doc-Q-Lace, Docu, Docu Soft, Doculase, Docuprene, Docusil, Docusoft S, DocuSol, DOK, DSS, Dulcolax Stool Softener, Enemeez Mini, Kao-Tin, Octycine-250, Pedia-Lax Stool Softener, Phillips Stool Softener, Promolaxin, Silace, Surfak Stool Softener, Sur-Q-Lax, Vacuant. The enema is known by the brand name Norgalax, Colace Micro-Enema, Correctol Softgel Extra Gentle, Therevac-SB, Octycine-100, Sulfolax, Kaopectate Stool Softener, DocuSol Kids, Colace Clear.

How long does it take for docusate sodium to work?

Docusate sodium capsules and liquid normally take 1 or 2 days to work. The enema usually works within 20 minutes, so it’s best to stay close to a toilet.

Talk to your doctor or pharmacist if you are still constipated after a week.

How long should I take docusate sodium for?

Take docusate sodium for up to 1 week. If you take docusate sodium for longer, your bowel can start to rely on it, rather than working on its own.

If you are still constipated after taking docusate sodium for a week, talk to your doctor.

If your constipation is caused by an illness or a medicine you’re taking, your doctor will advise you about when it’s best to stop taking docusate sodium.

Is it safe to take docusate sodium for a long time?

Ideally, you should only use docusate sodium occasionally and for a few days at a time.

Using laxatives like docusate sodium for longer can lead to long term diarrhea. They can also cause an electrolyte imbalance. This means that levels of substances like sodium, potassium and magnesium in your body get too high or too low. A severe electrolyte imbalance can cause serious health problems such as muscle spasm and twitching, and even fits (convulsions).

Using docusate sodium for many weeks, even months, could also stop your bowel working properly on its own.

Can I take different laxatives together?

For most people, 1 laxative will be enough to relieve constipation.

Occasionally, you may need to take 2 different types of laxatives at the same time to get your bowels moving again.

Only take 2 laxatives together on the advice of your doctor or pharmacist as there is an increased risk of side effects.

Are other laxatives any better?

There are other types of laxative. They work in a different way to docusate sodium but are equally good at treating constipation.

• Bulk-forming laxatives, for example Fybogel and methylcellulose. These increase the ‘bulk’ or weight of poo which in turn stimulates bowel movement. They take 2 or 3 days to work.
• Osmotic laxatives, for example lactulose. These draw water from the rest of the body into your bowel to soften your poo and make it easier to pass. They take at least 2 days to work.
• Stimulant laxatives, for example senna. These stimulate the muscles that line your gut, helping them to move poo along your gut to your back passage. Senna takes about 8 hours to work.

Is there any food and drink I need to avoid?

You can eat and drink normally while taking docusate sodium.

It might be a good idea to stop eating pastries, puddings, sweets, cheese and cake for a while as these foods can make constipation worse.

Can I drink alcohol with docusate sodium?

Yes, you can drink alcohol with docusate sodium.

Can I use docusate sodium after surgery?

It’s quite common to have constipation after surgery. Using a laxative may help relieve the discomfort.

If you have constipation after an operation, it’s better to use lactulose because it is gentler than docusate sodium. You can get it from pharmacies.

Can lifestyle changes help constipation?

It’s often possible to improve constipation without having to use laxatives. Before trying docusate sodium – or to stop constipation coming back – it may help to:

• eat more fiber – aim for about 30-35 g of fiber a day. High-fiber foods include fruit, vegetables and cereals. If you’re not used to a high-fiber diet, increase the amount of fiber you eat gradually.
• add bulking agents, such as wheat bran, to your diet. These will help make your poo softer and easier to pass (although bran and fiber can sometimes make bloating worse).
• drink plenty of water – to keep poo soft
• exercise regularly – keeping your body active will help to keep your gut moving

Who can and can’t take docusate sodium

Most adults can safely take docusate sodium, but do not give it to a child under 12 years old unless their doctor prescribes it.

• Never give docusate sodium to a child under 12 years old unless their doctor prescribes it.

Docusate isn’t suitable for some people. To make sure it is safe for you, tell your doctor or pharmacist if you have:

• ever had an allergic reaction to docusate sodium or any other medicines in the past
• ever had an allergic reaction to fructose or sorbitol (types of sugar)
• a blockage in your gut (intestine)
• chronic stomach pain that has not been checked by a doctor
• nausea, vomiting, or severe stomach pain
• stomach pains
• been feeling sick in the last 24 hours or have been sick
• been taking a mineral oil laxative such as liquid paraffin

Ask a doctor or pharmacist if it is safe for you to take docusate sodium:

• if you are on a low-salt diet (low sodium diet); or
• if you have recently had a sudden change in your bowel habits lasting for longer than 2 weeks.

Do not use an enema containing docusate sodium if you have:

• piles (hemorrhoids) or bleeding from your back passage
• sores around your back passage called anal fissures
• illnesses where your bowel or back passage become inflamed such as ulcerative colitis or Crohn’s disease
• ileus – when the muscles in your bowel aren’t able to move food and liquid along

Docusate sodium and Pregnancy and Breastfeeding

Tell your pharmacist or doctor if you’re trying to get pregnant, are already pregnant or if you’re breastfeeding.

FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

It is not known whether docusate sodium will harm an unborn baby. Do not use this medicine without a doctor’s advice if you are pregnant.

Docusate may not be suitable if you’re pregnant or breastfeeding because small amounts might be absorbed by your gut.

If you’re pregnant or breastfeeding, it’s always better to try to treat constipation without taking a medicine. Your doctor or midwife will first advise you to eat more fiber and drink plenty of fluids. It may also help to do gentle exercise.

If diet and lifestyle changes don’t work, your doctor or midwife may recommend a laxative, such as lactulose or Fybogel. These are safer laxatives to take during pregnancy and while breastfeeding.

I just found out I am pregnant. Should I stop taking docusate sodium?

You should always talk with your health care provider before making any changes in your medication. It is important to consider the benefits of treating constipation symptoms during pregnancy. Your health care provider may also want to confirm diagnosis of constipation and see how dietary and other lifestyle therapies may help.

Can use of docusate sodium during pregnancy cause birth defects?

Few studies have been done to look at the possible risks of docusate sodium during pregnancy. However, the available studies show that when used in recommended doses docusate sodium is not expected to increase the chance of birth defects.

In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk.

What if the father of the baby takes docusate sodium?

There are no studies looking at possible problems with conceiving or risks to a pregnancy when the father takes docusate sodium. In general, exposures that fathers have are unlikely to increase risks to a pregnancy.

What are the dangers of taking too much docusate sodium?

When used in recommended doses, docusate sodium is unlikely to cause problems during pregnancy. However, when more than the recommended amount of this product is used, it can lower the levels of magnesium in a person’s blood. There is one reported case of low magnesium levels in a newborn that was linked to the mother overusing docusate sodium. The baby’s main symptom was jitteriness, which went away by the second day of life. There have been no reported problems linked to the use of recommended levels of docusate sodium in pregnancy.

Docusate sodium and breastfeeding

It is not known whether docusate sodium passes into breast milk or if it could harm a nursing baby. Do not use this medicine without a doctor’s advice if you are breast-feeding a baby.

While some of the docusate sodium is absorbed by the mother, the amount that passes into milk is likely low ¹. There have been no reports of problems in babies that are breastfeeding while the mother is taking Colace (Docusate). Be sure to talk to your health care provider about all your choices for breastfeeding.

In a randomized, blinded trial, 35 postpartum breastfeeding patients received a laxative containing docusate in a dose of 120 mg daily in addition to danthron 100 mg daily. One patient stated that diarrhea occurred in her breastfed infant ². The diarrhea was most likely caused by the danthron. Danthron is a reddish, synthetic anthraquinone derivative ³. Danthron has been widely used as a laxative, but is no longer used to treat constipation and is currently used as an antioxidant in synthetic lubricants, in the synthesis of experimental antitumor agents, as a fungicide and as an intermediate for making dyes.

If diet and lifestyle changes don’t work, your doctor or midwife may recommend a laxative, such as lactulose or Fybogel. These are safer laxatives to take during pregnancy and while breastfeeding.

Cautions with other medicines

Do not take docusate with a mineral oil laxative such as liquid paraffin.

What is docusate sodium used for

Docusate is used to treat or prevent constipation, and to reduce pain or rectal damage caused by hard stools or by straining during bowel movements. Docusate may also be used for purposes not listed in this medication guide.

Docusate is helpful when you have difficulty going to the toilet because of dry poos or piles (hemorrhoids) or if you have a tear in the lining of your back passage (an anal fissure). Docusate makes your bowel movements softer and easier to pass.

You may also be given docusate sodium if you’re going to have an x-ray of your stomach. It can help you empty your bowels beforehand.

• Ask a doctor before use if you notice a sudden change in bowel habits that persists over a period of 2 weeks.
• Stop use and ask a doctor if you have rectal bleeding or you fail to have a bowel movement after use.
• If pregnant or breast-feeding, ask a health professional before use.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

Docusate dosage

Usual Adult Dose for Constipation

• Oral: 50 to 400 mg (using any of the salt forms) orally administered in 1 to 4 equally divided doses each day.
• Rectal: 200 to 283 mg rectally administered as an enema once or twice.
• Alternative: 50 to 100 mg (docusate sodium liquid) added to a retention or flushing enema once a day.

Usual Pediatric Dose for Constipation

Oral:

• less than 3 years: 10 to 40 mg (docusate sodium) orally divided in 1 to 4 doses.
• 3 to 6 years: 20 to 60 mg (docusate sodium) orally divided in 1 to 4 doses.
• 6 to 12 years: 40 to 150 mg (docusate sodium) orally divided in 1 to 4 doses.
• greater than 12 years: 50 to 400 mg (using any of the salt forms) orally administered in 1 to 4 equally divided doses each day.

Rectal:

• 3 to 18 years: 50 to 100 mg (docusate sodium liquid) added to a retention or flushing enema once a day.
• Alternative: 200 to 283 mg rectally administered as an enema once daily as needed for constipation.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Data not available

How and when to take docusate sodium

Docusate comes as capsules, liquid and an enema.

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

• Do not crush, chew, break, or open a docusate sodium capsule or tablet. Swallow it whole.
• Docusate should generally be used for a period of less than 1 week. For longer than one week see your doctor for advice.
  

Take this medicine with a full glass of water. Drink plenty of liquids while you are taking docusate sodium.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Mix the liquid with 6 to 8 ounces of milk, fruit juice, or infant formula and drink the mixture right away.

After taking docusate sodium by mouth (tablets, capsules, liquid), you should have a bowel movement within 12 to 72 hours.

• Do not take Docusate Rectal Enema by mouth. It is for use only in your rectum.

Wash your hands before and after using docusate enema.

Try to empty your bowel and bladder just before using the enema. Remove the cap from the enema applicator tip. Lie down on your left side with your knees bent, and gently insert the tip of the enema applicator into the rectum. Squeeze the tube to empty the entire contents into the rectum. Throw away the tube, even if there is still some medicine left in it. For best results, hold in the enema for as long as possible, or until you have a bowel movement.

The rectal enema should produce a bowel movement within 2 to 15 minutes.

Do not use docusate sodium for longer than 7 days unless your doctor has told you to. Call your doctor if your symptoms do not improve, or if you have not had a bowel movement within 1 to 3 days. Overuse of a stool softener can lead to serious medical problems.

Store at room temperature away from moisture and heat.

How to take docusate sodium

• Capsules – swallow the capsule whole with plenty of water.
• Liquid – this comes with a plastic cup or spoon to measure the dose. Do not use a kitchen spoon as it will not give the right amount. If you don’t have a cup or spoon, ask your pharmacist for one. When you’ve swallowed it, drink plenty of water or another drink, such as milk or orange juice.
• Enema – squeeze the tube of liquid gently into your back passage. The information leaflet which comes with your docusate will explain how to do this.

Docusate doesn’t usually upset your tummy. You can take the capsules or liquid with or without food. Try to take them at regular intervals throughout the day. Mealtimes (breakfast, lunch and dinner) are useful reminders.

There is no specific time of day to use an enema but it works quickly (usually between 5 and 20 minutes), so use it when you know you’ll be near a toilet.

How much to take

• Capsules – the normal dose is 1 capsule 3 times a day. Do not take more than 5 capsules in a day.
• Liquid – the normal dose is 2 or 3 x 5ml spoonfuls. Take this dose 3 times a day.
• Enema – normally 1 tube of liquid is all you need. If you need a second dose, you can use it later in the day or the next day.

You should feel more comfortable within 1 or 2 days of treatment. Reduce the dose as your condition gets better.

Drink plenty of fluids (6 to 8 glasses a day) while you are taking docusate sodium or your constipation may get worse.

What if I forget to take it?

If you forget a dose of docusate sodium, don’t worry, just take the next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

What if I take too much?

Taking an extra dose of docusate sodium by accident is unlikely to harm you but you should drink lots of water. You may get diarrhea and stomach pain but this should ease off within a day or two.

If you’re worried, talk to your doctor or pharmacist for advice.

Docusate sodium side effects

Like all medicines, docusate may cause side effects in some people but most people have no side effects or only minor ones.

If you get any of these side effects, talk to your doctor or pharmacist:

• feeling sick
• diarrhea
• stomach cramps
• dizziness, weakness
• gas, bloating, mild diarrhea
• rectal irritation
• sweating

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

These side effects are mild and usually go away after a couple of days.

With the docusate enema sometimes people get a burning or pain around their back passage. Occasionally the wall of the back passage may bleed. This is a reaction to the enema and it should clear up quickly. If the pain or bleeding don’t go away or you are worried about them, talk to your doctor or pharmacist.

Stop using docusate sodium and call your doctor at once if you have:

• pounding heartbeats or fluttering in your chest;
• a light-headed feeling, like you might pass out;
• rectal bleeding or irritation;
• numbness or a rash around your rectum;
• vomiting, severe diarrhea or stomach cramps; or
• continued constipation, or no bowel movement.

Gastrointestinal

Gastrointestinal side effects have included gastrointestinal cramping. Reports of bitter taste and throat irritation have been reported with administration of primarily the syrup and liquid formulations.

Dermatologic

Dermatologic side effects have included rash.

Metabolic

Metabolic side effects have included at least one case report of hypomagnesemia.

Metabolic abnormalities reported include hypomagnesemia in one woman who took docusate chronically throughout her pregnancy. Magnesium levels returned to normal following discontinuation of docusate sodium.

Serious side effects

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to docusate sodium.

• A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

• getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
• wheezing
• tightness in the chest or throat
• having trouble breathing or talking
• swelling of the mouth, face, lips, tongue or throat

These are not all the side effects of docusate sodium. For a full list see the leaflet inside your medicines packet.

How to cope with side effects

What to do about:

• feeling sick – try taking docusate sodium with meals or mixing your dose with some water or fruit juice.
• diarrhea – drink plenty of water or other fluids. It may also help to take an oral rehydration drink to prevent dehydration. You can buy sachets of powder from a pharmacy which you mix with water. Reducing the dose of docusate sodium may also help diarrhea. Don’t take any other medicines to treat diarrhea without speaking to a pharmacist or doctor.
• stomach cramps – if you get stomach cramps, reduce your dose of docusate sodium until it goes away.

1. Lewis JH, Weingold AB and the Committee of FDA-Related Matters, American College of Gastroenterology. The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol. 1985;80:912-23 https://www.ncbi.nlm.nih.gov/pubmed/2864852[↩]
2. Greenhalf JO, Leonard HS. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner. 1973;210:259-63 https://www.ncbi.nlm.nih.gov/pubmed/4570522[↩]
3. Danthron. https://pubchem.ncbi.nlm.nih.gov/compound/danthron[↩]