We all see it on our patients’ med lists when they are admitted, but does Docusate actually work?
-Early studies showed Docusate softened stool by increasing water content, decreased the need for enemas, decreased the need for manual disimpaction, and had positive endorsements from hospital formularies and from the World Health Organization!
-Replicated studies have shown that Docusate failed to show ANY benefit in multiple outcomes (stool frequency, stool quality, subjective patient experience). This also leads to potential complications including an unpleasant taste that may affect oral intake and nutritional status, may impact absorption of other proven treatments, waiting for docusate to fail may delay appropriate treatment of constipation (more prolonged hospital stay and cost), and possible bacterial contamination causing iatrogenic infections.
-From a quality improvement perspective, Docusate has an estimated cost of $100 million per year for North America (including nursing and pharmacy labor costs) for a medication that does not improve outcomes!
Next steps
- Stop Docusate and discuss why discontinuing medication with your patient
- Individualize treatment plans for each patient based on the clinical context and cause of constipation
- Consider non-pharmacologic treatments such as dietary modification, mobilization, chewing gum, and biofeedback
- If pharmacotherapy is required, use laxatives with stronger evidence for efficacy (polyethylene glycol, psyllium, lactulose, sennosides)
- Use the above medications as prophylaxis during admission rather than playing catch up several days later.
Dylan Olson, MD
PGY-3
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.