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. 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. May also increase absorption of other medications
  5. Risk of hepatotoxicity

IV. Efficacy

  1. Some studies suggest no greater effect than Placebo, especially for Docusate (Colace)

V. Preparations Docusate

  1. Other agents are preferred in most cases (low efficacy)
  2. 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
  3. Docusate Calcium (Surfak)
    1. Adult: 240 mg PO qd
    2. Child: 50-150 mg qd

VI. Preparations: Non-Docusate agents

  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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Cost: Medications

stool softener (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
STOOL SOFTENER 100 MG CAPSULE Generic OTC $0.02 each
STOOL SOFTENER 100 MG SOFTGEL Generic OTC $0.02 each
STOOL SOFTENER 240 MG SOFTGEL Generic OTC $0.05 each
STOOL SOFTENER 250 MG SOFTGEL Generic OTC $0.04 each
STOOL SOFTENER-LAXATIVE TABLET Generic OTC $0.02 each
docusate (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
DOCUSATE CAL 240 MG CAPSULE Generic OTC $0.05 each
DOCUSATE SODIUM 100 MG CAPSULE Generic OTC $0.02 each
DOCUSATE SODIUM 100 MG SOFTGEL Generic OTC $0.02 each
DOCUSATE SODIUM 100 MG TABLET Generic OTC $0.03 each
DOCUSATE SODIUM 250 MG CAPSULE Generic OTC $0.04 each
DOCUSATE SODIUM-SENNA TABLET Generic OTC $0.02 each
colace (on 3/23/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
COLACE 100 MG CAPSULE Generic OTC $0.02 each
COLACE 50 MG CAPSULE OTC $0.26 each
COLACE CLEAR 50 MG SOFTGEL OTC $0.26 each
COLACE-T 100 MG CAPSULE Generic OTC $0.02 each
mineral oil (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
MINERAL OIL LAXATIVE Generic OTC $0.01 per ml

Ontology: Glycerin (C0017861)

Definition (NCI) A trihydroxyalcohol with localized osmotic diuretic and laxative effects. Glycerin elevates the blood plasma osmolality thereby extracting water from tissues into interstitial fluid and plasma. This agent also prevents water reabsorption in the proximal tubule in the kidney leading to an increase in water and sodium excretion and a reduction in blood volume. Administered rectally, glycerin exerts a hyperosmotic laxative effect by attracting water into the rectum, thereby relieving constipation. In addition, glycerin is used as a solvent, humectant and vehicle in various pharmaceutical preparations.
Definition (MSH) A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent.
Definition (CSP) 1,2,3-trihydroxypropane, a key intermediate in glucose metabolism; also serves as the bridge between hydrophobic "tails" and hydrophilic "heads" of many membrane lipids; reagent is used as a water-soluble solvent and lubricant.
Concepts Pharmacologic Substance (T121) , Biologically Active Substance (T123) , Organic Chemical (T109)
MSH D005990
SnomedCT 80582002, 59018003, 387330004, 346459006, 225749008, 259474004, 404833002
LNC LP15619-7, MTHU011557
English 1,2,3-Trihydroxypropane, Glycerine, Glycerol, Glycerin (Obsolete), Glycerol analyte, laxatives glycerin, 1,2,3-propanetriol, glycerin (medication), Glycerol - chemical, Glycerol product, Glycerin, GLYCERIN, Glycerol [Chemical/Ingredient], glycerine, glycerin, glycerol, GLycerin, Glycerol product (product), Glycerin (substance), Glycerol - chemical (substance), Glycerol analyte (substance), Glycerin preparation (product), Glycerin preparation, 1,2,3-Propanetriol, Glycerol (substance), Glycerol (product), Glycerin preparation (substance)
French 1,2,3-Propanetriol, Propane-1,2,3-triol, Glycérine, Glycérol
Swedish Glycerol
Spanish 1,2,3-propanotriol, glicerina, preparado de glicerina, análito de glicerol (sustancia), glicerina (sustancia), análito de glicerol, glicerina (producto), glicerol (sustancia), glicerol, preparado de glicerina (sustancia), glicerol (producto), Glicerina, Glicerol
Czech glycerol, glycerin
Finnish Glyseroli
German Glycerol, Glycerin, Glycerinum, Glyzerin, Glyzerol
Russian GLITSEROL, GLITSERIN, ГЛИЦЕРИН, ГЛИЦЕРОЛ
Japanese グリセリン, グリセロール
Croatian Not Translated[Glycerol]
Polish Propanotriol, Glicerol, Gliceryna
Italian Glicerolo
Portuguese Glicerina, Glicerol

Ontology: Mineral Oil (C0026156)

Definition (NCI) A mixture of liquid paraffinic, naphthenic and polycyclic aromatic hydrocarbons obtained from petroleum in which the amount and types of aromatic hydrocarbons is dependent on the treatment process. Untreated and mildly treated mineral oils contain the highest amount of aromatic and unsaturated compounds and are primarily used as a lubricant base oil to produce further refined oil products. Exposure to these types of mineral oils can cause rapid respiration, cyanosis, tachycardia and low-grade fever. Untreated and mildly treated mineral oils are strongly associated with an increased risk of scrotal and skin cancer but can also cause gastrointestinal, rectal, bladder and certain respiratory-tract cancers. (NCI05)
Definition (NCI_NCI-GLOSS) A type of oil that is made from petroleum (mixture of oily liquids found in the earth). Mineral oil is used in laxatives, lubricants, creams, and lotions.
Definition (MSH) A mixture of liquid hydrocarbons obtained from petroleum. It is used as laxative, lubricant, ointment base, and emollient.
Concepts Pharmacologic Substance (T121) , Lipid (T119)
MSH D008899
SnomedCT 111089004, 354035004, 398763008, 317567003, 48350004, 330786000
English Liquid Paraffin, Oil, Mineral, Petrolatum, Liquid, Hydrocarbon oils, Liquid paraffin [eye], Liquid paraffin [laxative], MINERAL OIL MISC. OIL, MINERAL OIL @ @ OIL, MINERAL OIL OIL, Liquid petrolatum, mineral oil (medication), laxatives mineral oil, Paraffin, Liquid, Liquid Petrolatum, Paraffinum Liquidum, White Mineral Oil, MINERAL OIL, Mineral Oil [Chemical/Ingredient], mineral oils, oil mineral, liquid petrolatum, white mineral oil, mineral oil, MINERAL OIL MISCELL OIL (ML), MINERAL OIL@@MISCELL@OIL (ML), Mineral Oil Oil, liquid paraffin, Liquid petrolatum (substance), Liquid paraffin [eye] (product), Liquid paraffin [laxative] (product), Mineral oil (product), Mineral oils, Mineral Oil (Bulk), Mineral oil, Liquid paraffin, Paraffin liquid, White mineral oil, Liquid paraffin product (product), Liquid paraffin product, Mineral oil (substance), Liquid paraffin [eye] (substance), Liquid paraffin [laxative] (substance), Liquid paraffin product (substance), Mineral Oil, PARAFFIN,LIQUID
Czech minerální olej
Spanish aceite mineral, parafina líquida, producto (producto), parafina líquida (producto), parafina líquida, producto, petrolato líquido (sustancia), parafina líquida (laxante) (producto), aceite mineral (producto), parafina líquida (laxante), parafina líquida (ocular), petrolato líquido, parafina líquida (ocular) (producto), aceite mineral blanco, parafina líquida (sustancia), parafina líquida, Aceite Mineral, Parafina Liquida, Petrolato Líquido
Finnish Parafiiniöljy
Russian MASLO VAZELINOVOE, PETROLATUM ZHIDKII, VAZELINOVOE MASLO, MINERAL'NOE MASLO, PARAFIN ZHIDKII, ВАЗЕЛИНОВОЕ МАСЛО, МАСЛО ВАЗЕЛИНОВОЕ, МИНЕРАЛЬНОЕ МАСЛО, ПАРАФИН ЖИДКИЙ, ПЕТРОЛАТУМ ЖИДКИЙ
Japanese 鉱油, 流動パラフィン, 流動ワセリン, ミネラルオイル
Italian Petrolato liquido, Paraffina liquida, Olio minerale
Swedish Mineralolja
Polish Olej mineralny, Parafina ciekła
French Huile minérale, Huile de vaseline, Huile de paraffine
German Flüssiges Paraffin, Mineralöl, Paraffin, flüssiges, Paraffinöl
Portuguese Parafina Líquida, Petrolato Líquido, Óleo Mineral

Ontology: Colace (C0282139)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004143
German Colace
English colace, Colace

Ontology: Stool Softener (C0301470)

Concepts Pharmacologic Substance (T121)
SnomedCT 11783005, 419248006
Spanish ablandador fecal, laxante emoliente (sustancia), laxante emoliente, ablandador de heces, ablandador de materia fecal (producto), ablandador de materia fecal (sustancia), ablandador de materia fecal
English STOOL SOFTENER, stool softeners (medication), stool softeners, Stool Softener, [GA205] STOOL SOFTENER, stool softener, softener stool, softeners stool, Fecal softener, Faecal softener, Stool softener (product), Stool softener, Fecal softener, NOS, Stool softener, NOS, Faecal softener, NOS, Stool softener (substance)

Ontology: Emollient cathartic (C1636159)

Concepts Pharmacologic Substance (T121)
SnomedCT 418299007
Spanish catártico emoliente (sustancia), catártico emoliente
English Emollient cathartic (substance), Emollient cathartic

Ontology: Docusate (C1692318)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D004143
SnomedCT 418528006, 418700002
LNC LP171392-6
English Docusate, DOSS, Dioctylsulfosuccinate, dossing, doss, dioctylsulfosuccinate, Sulfosuccinate, Dioctyl, Dioctyl Sulfosuccinate, Docusate [Chemical/Ingredient], DOCUSATE, docusate, Dioctyl sulfosuccinate, Dioctyl sulphosuccinate, Docusate (product), Docusate (substance)
Spanish docusato (producto), docusato (sustancia), docusato, Docusato
German DOSS, Docusat, Dioctylsulfosuccinat
Portuguese Docusato