Docusate, also known as docusate salts or dioctyl sulfosuccinate, is a laxative of the stool softener type used to treat constipation. It is considered a good choice in children who have hard feces. Use for constipation, however, is poorly supported by evidence. It may be taken by mouth or used rectally. By mouth a bowel movement often occurs in 1 to 3 days, while rectal use may be effective within 20 minutes.
|Trade names||Colace, Ex-Lax Stool Softener, others|
|By mouth or rectally|
|Drug class||Stool softener|
|Onset of action||12 hrs to 5 days|
|Duration of action||3 days|
|E number||E480 (thickeners, ...) |
|CompTox Dashboard (EPA)|
|ECHA InfoCard||100.008.553 |
|Chemical and physical data|
|Molar mass||444.56 g/mol g·mol−1|
|3D model (JSmol)|
|Melting point||153 to 157 °C (307 to 315 °F)|
|Solubility in water||1 in 70 parts mg/mL (20 °C)|
Side effects are uncommon. Rarely, there may be abdominal cramps or diarrhea. Efficacy decreases with long-term use, and may cause poor bowel function. Docusate is acceptable during pregnancy and breastfeeding. It works by allowing more water to be absorbed by the feces. It typically comes in the form of a sodium, calcium, or potassium salt.
It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. It is available as a generic medication and is not very expensive. In the United States, one hundred doses are about US$14. The sodium salt, dioctyl sodium sulfosuccinate, also is used as a food additive, emulsifier, dispersant, and wetting agent, among other uses. In 2016 it was the 127th most prescribed medication in the United States with more than 5 million prescriptions.
Docusate is frequently used to treat constipation, and in painful anorectal conditions such as hemorrhoids and anal fissures, to help avoid pain caused by straining during bowel movements. However, the available evidence does not support its use for these purposes. Multiple studies have found docusate to be no more effective than a placebo for improving constipation. Others have found it to be less useful for the treatment of chronic constipation than psyllium.
The medication may be given to people who are receiving opioid medication, although prolonged use may cause irritation of the gastrointestinal tract. Data supporting its efficacy in treating chronic constipation are lacking.
Docusate sodium, when used with ear syringing, may help with earwax removal, particularly in the case of impaction.
Docusate sodium may be given by mouth or rectally. It also is used as an emulsifier and dispersant in topical preparations. When taken by mouth it is typically recommended with plenty of water.
Possible side effects are typically mild and include stomach pain, diarrhea, or cramping. Serious allergic reactions may occur with the drug. The most severe side effect of docusate, although very rare, is rectal bleeding.
Docusate might increase resorption of other drugs, for example, dantron (1,8-dihydroxyanthraquinone).
Dioctyl sodium sulfosuccinate is used as a surfactant in a wide range of applications, often under the name Aerosol-OT. It is unusual in that it is able to form microemulsions without the use of co-surfactants, and it has a rich variety of aqueous-phase behavior including multiple liquid crystalline phases.
Solubility of dioctyl sodium sulfosuccinate in water is 1:70 (14 g/l) at 25 °C, increasing to 1:20 at 70 °C. Solubility is better in less polar solvents: 1:30 in ethanol, 1:1 in chloroform and diethylether, and practically unlimited in petroleum ether (25 °C). It also is highly soluble in glycerol, although this is a rather polar solvent.
Docusate salts include docusate calcium, docusate sodium, and docusate potassium.
Mechanism of action
Docusate does not stay in the gastrointestinal tract, but is absorbed into the bloodstream and excreted via the gallbladder after undergoing extensive metabolism.
The effect of docusate may not necessarily be all due to its surfactant properties. Perfusion studies suggest that docusate inhibits fluid absorption or stimulates secretion in the portion of the small intestine known as the jejunum.
Toxicity for different species varies widely, but dioctyl sulfosuccinate biodegrades quickly in soil and water, a typical finding being >90% in 12 to 17 days. In the atmosphere, it is predicted to be removed by a photochemical reaction with an estimated half-life of 18 hours.
Dioctyl sodium sulfosuccinate is a strong irritant for eyes and lungs, and also a skin irritant. Ingestion may cause the side effects described above, such as diarrhea, intestinal bloating, and occasionally cramping pains. Dioctyl sodium sulfosuccinate is not known to be carcinogenic, mutagenic, or teratogenic.
In a 2010 study, dioctyl sodium sulfosuccinate exhibited higher toxicity against bacteria (Vibrio fischeri, Anabaena sp.) and algae (Pseudokirchneriella subcapitata) than did a number of fluorinated surfactants (PFOS, PFOA, or PFBS). Measuring bioluminescence inhibition of the bacteria and growth inhibition of the algae, the ED50 were in the range of 43–75 mg/l. Combinations of the fluorinated compounds with dioctyl sodium sulfosuccinate showed mid to highly synergistic effects in most settings, meaning that such combinations are significantly more toxic than the individual substances.
The substance is highly toxic for rainbow trout with a median lethal concentration (LC50) of 0.56 mg/l after 48 hours for the pure substance. It is only slightly to moderately toxic for rainbow trout fingerlings, and slightly toxic for harlequin rasboras (LC50 27 mg/l of a 60% formulation after 48 hours).
Society and culture
In the U.S., dioctyl sodium sulfosuccinate is available under multiple brand names: Aqualax, Calube, Colace, Colace Micro-Enema, Correctol Softgel Extra Gentle, DC-240, Dialose, Diocto, Dioctocal, Dioctosoftez, Dioctyn, Dionex, Doc-Q-Lace, Docu Soft, Docucal, Doculax, Docusoft S, DOK, DOS, Doss-Relief, DSS, Dulcolax - Stool Softener (not to be confused with another drug marketed under the Dulcolax brand, bisacodyl, which is a stimulant laxative), Ex-Lax Stool Softener, Fleet Sof-Lax, Genasoft, Kasof, Laxa-basic, Modane Soft, Octycine-100, Pedia-Lax, Preferred Plus Pharmacy Stool Softener, Regulax SS, Sulfalax Calcium, Sur-Q-Lax, Surfak Stool Softener, and Therevac-SB. Generic preparations are also available.
In the UK, dioctyl sodium sulfosuccinate is sold under the brand name Docusol (Typharm Ltd) and DulcoEase (Boehringer Ingelheim).
In Australia, dioctyl sodium sulfosuccinate is sold as Coloxyl and Coloxyl with senna.
In India, preparations include Laxatin by Alembic, Doslax by Raptakos Laboratories, Cellubril by AstraZeneca, and Laxicon by Stadmed.
- 2013 Nurse's Drug Handbook. Burlington, MA: Jones & Bartlett Learning. 2013. p. 366. ISBN 9781449642846.
- "Docusate Salts". The American Society of Health-System Pharmacists. Archived from the original on 23 September 2015. Retrieved 11 August 2015.
- American Society of Health-System Pharmacists (15 August 2011). "Stool Softeners". Archived from the original on 5 September 2015.
- Fakheri, RJ; Volpicelli, FM (February 2019). "Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults". Journal of Hospital Medicine. 14 (2): 110–13. doi:10.12788/jhm.3124. PMID 30785419.
- Canadian Agency for Drugs and Technologies in Health (26 June 2014). "Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness". CADTH Rapid Response Reports. PMID 25520993.
- "Docusate sodium". 18 December 2004. Retrieved 6 March 2019.
- Yaffe, Sumner J. (2011). Drugs in pregnancy and lactation : a reference guide to fetal and neonatal risk (9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 1651. ISBN 9781608317080.
- Hamilton, Richard J. (2013). Tarascon pocket pharmacopoeia : 2013 classic shirt-pocket edition (27 ed.). Burlington, Ma.: Jones & Bartlett Learning. p. 112. ISBN 9781449665869.
- "World Health Organization model list of essential medicines: 21st list 2019". 2019. hdl:10665/325771. Cite journal requires
- Michael, fcompiled by; Ash, Irene (2004). Handbook of preservatives. Endicott, N.Y.: Synapse information resources. p. 375. ISBN 9781890595661.
- "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
- Candy, B; Jones, L; Larkin, PJ; Vickerstaff, V; Tookman, A; Stone, P (May 2015). "Laxatives for the management of constipation in people receiving palliative care" (PDF). Cochrane Database of Systematic Reviews. 13 (5): CD003448. doi:10.1002/14651858.CD003448.pub4. PMID 25967924.
- Ramkumar, D; Rao, SS (April 2005). "Efficacy and safety of traditional medical therapies for chronic constipation: systematic review". American Journal of Gastroenterology. 100 (4): 936–71. doi:10.1111/j.1572-0241.2005.40925.x. PMID 15784043.
- Portalatin, Meredith; Winstead, Nathaniel (March 2012). "Medical Management of Constipation". Clinics in Colon and Rectal Surgery. 25 (1): 12–19. doi:10.1055/s-0032-1301754. ISSN 1531-0043. PMC 3348737. PMID 23449608.
- Dinnendahl, V; Fricke, U, eds. (2010). Arzneistoff-Profile (in German). 2 (23 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. ISBN 978-3-7741-9846-3.
- GlobalRPH.com: How effective is docusate as a cerumenolytic agent? Archived 23 November 2010 at the Wayback Machine
- drugs.com: Docusate Archived 16 July 2010 at the Wayback Machine
- Nave, Sandrine; Eastoe, Julian; Penfold, Jeff (November 2000). "What Is So Special about Aerosol-OT? 1. Aqueous Systems". Langmuir. 16 (23): 8733–8740. doi:10.1021/la000341q.
- Jasek, W, ed. (2008). Austria-Codex Stoffliste (in German) (41 ed.). Vienna: Österreichischer Apothekerverlag. p. 316. ISBN 978-3-85200-190-6.
- Flynn, P.F. (2004). "Multidimensional multinuclear solution NMR studies of encapsulated macromolecules". Prog. Nucl. Magn. Reson. Spectrosc. 45 (1–2): 31–51. doi:10.1016/j.pnmrs.2004.04.003.
- Hazardous Substances Data Bank: Bis(2-Ethylhexyl) Sodium Sulfosuccinate Archived 2017-09-08 at the Wayback Machine
- ScienceLab.com: Docusate sodium Material Safety Data Sheet Archived 2006-10-17 at the Wayback Machine
- Rosal, R; Rodea-Palomares, I; Boltes, K; Fernández-Piñas, F; Leganés, F; Petre, A (2010). "Ecotoxicological assessment of surfactants in the aquatic environment: combined toxicity of docusate sodium with chlorinated pollutants". Chemosphere. 81 (2): 288–93. Bibcode:2010Chmsp..81..288R. doi:10.1016/j.chemosphere.2010.05.050. PMID 20579683.