Don't recommend docusate (Colace®) for constipation - Simple and Practical Mental Health

This article was first published on July 5, 2023. It was last reviewed/ updated on July 5, 2023.

Docusate sodium (Colace^®) and docusate calcium are surfactants that allow water to enter stool more easily and, so, help to soften stools. For decades, they have been very commonly recommended by clinicians to both outpatients and inpatients with constipation.

But you may be surprised to know that there is widespread agreement in the field that docusate has NOT been shown to be effective for preventing or treating constipation and it appears to be no more effective than placebo (Canadian Agency for Drugs and Technologies in Health, 2014; Bharucha et al., 2013).

A practice guideline from leading US gastroenterology organizations did not even mention stool softeners like docusate in the review and recommendations on various options for treating chronic idiopathic constipation (Chang et al., 2023).

In fact, many efforts are being made to reduce the prescribing of docusate (Shair et al., 2023; von Maltzahn et al., 2022; Fakheri and Volpicelli, 2019; Pasay et al., 2017; MacMillan et al., 2016). In some places, docusate has been taken off the formulary (source).

Docusate MAY have a role in some patients

Even though docusate is of little or no use in reducing constipation, it could still be considered in a few selected patients:

1. To soften hard stools that are painful to pass.

2. To reduce straining at stools in some patients, for example, patients who recently had rectal surgery or a myocardial infarction (Schuster et al., 2015).

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References

Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013 Jan;144(1):218-38. doi: 10.1053/j.gastro.2012.10.028. PMID: 23261065; PMCID: PMC3531555.

Canadian Agency for Drugs and Technologies in Health. Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Jun 26. PMID: 25520993.

Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, Greer KB, Hanson B, Harris LA, Ko C, Murad MH, Patel A, Shah ED, Lembo AJ, Sultan S. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol. 2023 Jun 1;118(6):936-954. doi: 10.14309/ajg.0000000000002227. Epub 2023 May 19. PMID: 37204227.

Fakheri RJ, Volpicelli FM. Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults. J Hosp Med. 2019 Feb;14(2):110-113. doi: 10.12788/jhm.3124. PMID: 30785419.

MacMillan TE, Kamali R, Cavalcanti RB. Missed Opportunity to Deprescribe: Docusate for Constipation in Medical Inpatients. Am J Med. 2016 Sep;129(9):1001.e1-7. doi: 10.1016/j.amjmed.2016.04.008. Epub 2016 May 3. PMID: 27154771.

Pasay D, Guirguis M, Shkrobot R, Slobodan J, Bresee L. Association of Dissemination of an Educational Communication Tool With Docusate Administration. JAMA Intern Med. 2017 Oct 1;177(10):1433-1436. doi: 10.1001/jamainternmed.2017.3605. PMID: 28783816; PMCID: PMC5710216.

Schuster BG, Kosar L, Kamrul R. Constipation in older adults: stepwise approach to keep things moving. Can Fam Physician. 2015 Feb;61(2):152-8. PMID: 25676646; PMCID: PMC4325863.

Shair KA, Espinosa SM, Kwon JY, Gococo-Benore DA, McCormick BJ, Heckman MG, Seim LA, Cowdell JC. A Quality Improvement Approach to Decrease the Utilization of Docusate in Hospitalized Patients. Qual Manag Health Care. 2023 Feb 20. doi: 10.1097/QMH.0000000000000406. Epub ahead of print. PMID: 36807543.

von Maltzahn M, Tanzini RM, Leu R, Wong CL. When less may be more: Discontinuing docusate from a standardized hospital order set. J Geriatr Oncol. 2022 Jan;13(1):111-113. doi: 10.1016/j.jgo.2021.06.005. Epub 2021 Jul 1. PMID: 34217638.

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Docusate MAY have a role in some patients

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