docusate calcium (dioctyl calcium sulfosuccinate)
Pro-Cal-Sof, Stool Softener, Surfak

docusate potassium
Dialose, Diocto-K, Kasof

docusate sodium (dioctyl sodium sulfosuccinate; DSS)
Colace, Diocto, Dioeze, Diosuccin, Docucal, DOK, D.O.S., Doxidan, D-S-S, Duosol, Ex-Lax, Genasoft, Modane Soft, Non-Habit Forming Stool Softener, Phillip’s Milk of Magnesia, Pro-Sof, Regulax SS, Regulex ◆, Senokot, Silace

Available forms
Available without a prescription
Capsules: 50 mg, 100 mg, 240 mg, 250 mg
Liquid: 150 mg/15 ml
Syrup: 20 mg/5 ml, 50 mg/15 ml, 60 mg/15 ml, 100 mg/30 ml
Tablets: 100 mg

Indications and dosages
 Stool softener.
docusate sodium
Adults and children age 12 and older: 50 to 200 mg P.O. daily until bowel movements are normal. Alternatively, add 50 to 100 mg to saline or oil retention enema to treat fecal impaction.
Children ages 6 to 12: 40 to 120 mg P.O. daily.
Children ages 3 to 6: 20 to 60 mg P.O. daily.
Children younger than age 3: 10 to 40 mg P.O. daily.
docusate calcium or potassium
Adults: 240 mg (calcium) or 100 to 300 mg (potassium) P.O. daily until bowel movements are normal. Higher doses are for initial therapy. Adjust dosage to individual response.
Children age 6 and older: 50 to 150 mg (calcium) or 100 mg (potassium) P.O. daily.

Pharmacodynamics
Laxative action: Docusate salts act as detergents in the intestine, reducing surface tension of interfacing liquids; this promotes incorporation of fat and additional liquid, softening the stool.

Pharmacokinetics
Absorption: Absorbed minimally in the duodenum and jejunum.
Distribution: Distributed primarily locally, in the gut.
Metabolism: None.
Excretion: Excreted in feces.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug and in those with intestinal obstruction, undiagnosed abdominal pain, vomiting or other signs of appendicitis, fecal impaction, or acute surgical abdomen.

Interactions
Drug-drug. Mineral oil: Docusate salts may increase absorption of mineral oil and cause toxicity. Separate administration times.

Adverse reactions
GI: bitter taste, mild abdominal cramping, nausea, vomiting, diarrhea, laxative dependence.

Effects on lab test results
None reported.

Overdose and treatment
No information available.

Special considerations
• Liquid or syrup must be given in 6 to 8 oz (180 to 240 ml) of milk or fruit juice or in infant’s formula to prevent throat irritation.
• Avoid using docusate sodium in sodium-restricted patients.
• Docusate salts are available with casanthranol (Peri-Colace), senna (Senokot, Gentlax), and phenolphthalein (Ex-Lax, Feen-a-Mint, Correctol).
• Docusate salts are the preferred laxative for most patients who must avoid straining at stool, such as those recovering from MI or rectal surgery. Docusate salts also are used commonly to treat patients with postpartum constipation.
Breast-feeding patients
• It’s not known whether drug appears in breast milk. Because absorption of docusate salts is minimal, they presumably pose no risk to breast-fed infants.
Geriatric patients
• Docusate salts are good choices for elderly patients because they rarely cause laxative dependence, cause fewer adverse effects, and are gentler than some other laxatives.

Patient education
• Docusate salts lose their effectiveness over time; advise patient to report failure of medication.
• Teach patient about dietary sources of bulk, which include bran and other cereals, fresh fruit, and vegetables.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use