Docusate

Stool softener, Surfactant

Docusate (sodium or calcium)

Colace (sodium), Surfak (calcium); many generics OTC

Experience

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Problems

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Titration strategies

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Effects

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Pharmacy

Starting dose

100-200 mg PO once or twice daily; pediatric weight-based

Preparations

50, 100, 250 mg capsules; 50 mg/5 mL syrup; OTC

US FDA Max

~500 mg/d typical

Common uses

Classification(s)

Classes

Stool softener, Surfactant

Pharmacology

Routes

Oral, rectal

Onset

1-3 days

Duration

Hours

Half-life

Not meaningfully described

Bioavailability

Local action; minimal systemic effect

Pregnancy

Generally considered safe.^{[citation needed]}

Legal status

OTC in US

Purported mechanism

Docusate is an anionic surfactant that lowers the surface tension at the oil-water interface in the gut, allowing water and fats to penetrate stool and producing softer consistency without stimulating motility.▲0▼ Evidence for clinical benefit in routine constipation is surprisingly weak; multiple RCTs in hospitalized patients show no advantage over placebo. Continues to be widely used in practice (especially as adjunct to opioid-induced constipation regimens) despite the modest evidence base.