Docusate

Docusate
Docusate sodium
Names
Trade namesColace, Ex-Lax Stool Softener, others
IUPAC name
  • Sodium 1,4-bis(2-ethylhexoxy)-1,4-dioxobutane-2-sulfonate
Clinical data
Drug classStool softener
Pregnancy
category
  • US: C (Risk not ruled out)[1]
    Routes of
    use    		By mouth or rectally
    Onset of action12 hrs to 5 days[2]
    Duration of action3 days[2]
    Defined daily dose0.15 g (by mouth)[3]
    External links
    AHFS/Drugs.comMonograph
    MedlinePlusa601113
    Legal
    License data
    Legal status
    Chemical and physical data
    FormulaC20H37NaO7S
    Molar mass444.56 g·mol−1
    3D model (JSmol)
    Density1.1 g/cm3
    Melting point153 to 157 °C (307 to 315 °F)
    Solubility in water1 in 70 parts mg/mL (20 °C)
    SMILES
    • [Na+].[O-]S(=O)(=O)C(C(=O)OCC(CC)CCCC)CC(=O)OCC(CC)CCCC
    InChI
    • InChI=1S/C20H38O7S.Na/c1-5-9-11-16(7-3)14-26-19(21)13-18(28(23,24)25)20(22)27-15-17(8-4)12-10-6-2;/h16-18H,5-15H2,1-4H3,(H,23,24,25);/q;+1/p-1
    • Key:APSBXTVYXVQYAB-UHFFFAOYSA-M

    Docusate, also known as docusate salts or dioctyl sulfosuccinate,[4] is a laxative of the stool softener type used to treat constipation.[2] It is considered a good choice in children who have hard feces.[2] Use for constipation, however, is poorly supported by evidence.[5][6] It may be taken by mouth or used rectally.[2] By mouth a bowel movement often occurs in 1 to 3 days,[2] while rectal use may be effective within 20 minutes.[7]

    Side effects are uncommon.[2] Rarely, there may be abdominal cramps or diarrhea.[2] Efficacy decreases with long-term use, and may cause poor bowel function.[1] Docusate is acceptable during pregnancy and breastfeeding.[8] It works by allowing more water to be absorbed by the feces.[1][9] It typically comes in the form of a sodium, calcium, or potassium salt.[2]

    It is on the World Health Organization's List of Essential Medicines.[10] It is available as a generic medication and is not very expensive.[9] In the United States, one hundred doses are about US$14.[2] The sodium salt, dioctyl sodium sulfosuccinate, also is used as a food additive, emulsifier, dispersant, and wetting agent, among other uses.[11] In 2016 it was the 127th most prescribed medication in the United States with more than 5 million prescriptions.[12]

    Medical use

    Constipation

    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.[13] Multiple studies have found docusate to be no more effective than a placebo for improving constipation.[5][6][14][15] Others have found it to be less useful for the treatment of chronic constipation than psyllium.[16]

    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.[15][17]

    Other

    Docusate sodium, when used with ear syringing, may help with earwax removal, particularly in the case of impaction.[18]

    Docusate sodium is approved and recommended as safe during pregnancy and breastfeeding.[19]

    Dosage

    The defined daily dose is 0.15 g (by mouth).[3] The typically dose in adults is 12.5 to 50 mg two to four times per day.[20]

    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.

    Side effects

    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.[21]

    Docusate is not recommended in people with appendicitis, acute abdomen, or ileus.[17]

    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.[22]

    Interactions

    Docusate might increase resorption of other drugs, for example, dantron (1,8-dihydroxyanthraquinone).[17]

    Chemistry

    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.

    The ester groups are easily cleaved under basic conditions, but are stable against acids.[17]

    Docusate salts include docusate calcium, docusate sodium, and docusate potassium.[1][4]

    Mechanism of action

    Docusate does not stay in the gastrointestinal tract, but is absorbed into the bloodstream and excreted via the gallbladder[17] 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.

    Society and culture

    Cost

    It is available as a generic medication and is not very expensive.[9] In the United States, one hundred doses are about US$14.[2] In 2016 it was the 127th most prescribed medication in the United States with more than 5 million prescriptions.[12]

    • Docusate costs (US)
      Docusate costs (US)
    • Docusate prescriptions (US)
      Docusate prescriptions (US)

    Other uses

    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.[23]

    • It is used as an excipient in the production of tablets (as a lubricant) and suspensions (as an emulsifier).[24]
    • It is the most widely used surfactant in reverse micelle encapsulation studies.[25]

    Dioctyl sodium sulfosuccinate is approved for use in a variety of food products. It is approved for use as a surface active agent, stabilizer, thickener, wetting agent, processing aid, solubilizing agent, emulsifying agent, and dispersing agent in foods. The highest amount found in food products is 0.5% by weight, which include pasteurized cheese spreads, cream cheeses and salad dressings.[26]

    The FDA determined that dioctyl sodium sulfosuccinate is generally recognized as safe (GRAS) for use as wetting agents or solubilizers for flavor emulsion stabilizers in carbonated and non-carbonated drinks at levels up to 10 parts per million.[27]

    Brandnames

    An example of a stool softener

    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.

    Other animals

    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.[28]

    Marine species

    Dioctyl sodium sulfosuccinate has been determined to be of low toxicity for crustaceans such as the hermit crab Clibanarius erythropus and the shrimp Crangon crangon.

    Toxicity for molluscs varies widely, with 48-hour LD50 found between 5 mg/l for the common limpet and 100 mg/l for the common periwinkle. Various species of phytoplankton have an LD50 around 8 mg/l.

    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.[29]

    Freshwater species

    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).

    References

    1. 1 2 3 4 2013 Nurse's Drug Handbook. Burlington, MA: Jones & Bartlett Learning. 2013. p. 366. ISBN 9781449642846. Archived from the original on 5 March 2016. Retrieved 12 August 2015.
    2. 1 2 3 4 5 6 7 8 9 10 11 "Docusate Salts". The American Society of Health-System Pharmacists. Archived from the original on 23 September 2015. Retrieved 11 August 2015.
    3. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 29 October 2020. Retrieved 22 September 2020.
    4. 1 2 American Society of Health-System Pharmacists (15 August 2011). "Stool Softeners". Archived from the original on 5 September 2015.
    5. 1 2 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.
    6. 1 2 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. Archived from the original on 13 March 2019. Retrieved 27 April 2019.
    7. ↑ "Docusate sodium". 18 December 2004. Archived from the original on 21 July 2011. Retrieved 6 March 2019. {{cite web}}: External link in |authorlink1= (help)
    8. ↑ 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. Archived from the original on 5 March 2016. Retrieved 12 August 2015.
    9. 1 2 3 Hamilton, Richard J. (2013). Tarascon pocket pharmacopoeia : 2013 classic shirt-pocket edition (27 ed.). Burlington, Ma.: Jones & Bartlett Learning. p. 112. ISBN 9781449665869. Archived from the original on 5 March 2016. Retrieved 11 August 2015.
    10. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
    11. ↑ Michael, fcompiled by; Ash, Irene (2004). Handbook of preservatives. Endicott, N.Y.: Synapse information resources. p. 375. ISBN 9781890595661. Archived from the original on 5 March 2016. Retrieved 12 August 2015.
    12. 1 2 "The Top 300 of 2019". clincalc.com. Archived from the original on 12 February 2021. Retrieved 22 December 2018.
    13. ↑ Moe, Samantha (25 April 2016). "#161 Docusate: A Placebo Pill for Soft Poops". CFPCLearn. Archived from the original on 25 March 2023. Retrieved 16 June 2023.
    14. ↑ 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. Archived (PDF) from the original on 22 July 2018. Retrieved 1 September 2019.
    15. 1 2 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.
    16. ↑ 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.
    17. 1 2 3 4 5 Dinnendahl, V; Fricke, U, eds. (2010). Arzneistoff-Profile (in German). Vol. 2 (23 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. ISBN 978-3-7741-9846-3.{{cite book}}: CS1 maint: unrecognized language (link)
    18. ↑ GlobalRPH.com: How effective is docusate as a cerumenolytic agent? Archived 23 November 2010 at the Wayback Machine
    19. ↑ Mahadevan, U; Kane, S (July 2006). "American gastroenterological association institute medical position statement on the use of gastrointestinal medications in pregnancy". Gastroenterology. 131 (1): 278–82. doi:10.1053/j.gastro.2006.04.048. PMID 16831610.
    20. ↑ "Docusate - WikEM". www.wikem.org. Archived from the original on 20 October 2020. Retrieved 5 August 2020.
    21. ↑ drugs.com: Docusate Archived 16 July 2010 at the Wayback Machine
    22. ↑ ScienceLab.com: Docusate sodium Material Safety Data Sheet Archived 2006-10-17 at the Wayback Machine
    23. ↑ 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.
    24. ↑ Jasek, W, ed. (2008). Austria-Codex Stoffliste (in German) (41 ed.). Vienna: Österreichischer Apothekerverlag. p. 316. ISBN 978-3-85200-190-6.{{cite book}}: CS1 maint: unrecognized language (link)
    25. ↑ 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.
    26. ↑ "CFR - Code of Federal Regulations Title 21". www.accessdata.fda.gov. Archived from the original on 5 June 2018. Retrieved 29 January 2020.
    27. ↑ Center for Food Safety and Applied Nutrition. (1998, July 20). GRAS Notice Inventory Agency Response Letter GRAS Notice No. GRN 000006. Retrieved January 24, 2020, from https://wayback.archive-it.org/7993/20171031034954/https://www.fda.gov/Food/ IngredientsPackagingLabeling/GRAS/NoticeInventory/ucm154917.htm
    28. ↑ Hazardous Substances Data Bank: Bis(2-Ethylhexyl) Sodium Sulfosuccinate Archived 2017-09-08 at the Wayback Machine
    29. ↑ 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.
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