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Stimulant + softener laxative Pregnancy: There is inadequate evidence of the safety of co-danthramer preparations in pregnancy and lactation and therefore its use is not recommended.

Co-danthramer

Co-danthramer is a combination stimulant laxative containing dantron with poloxamer, used principally to treat constipation in palliative care, particularly opioid-induced constipation.

Adult dose

Dose: Constipation in terminally ill patients: Adults 5 to 10 ml of Danlax Suspension at night; elderly 2.5 to 5 ml at night. Strength as printed in SPC section 2: 'Dantron BP 25.0mg, Poloxamer 188 USNF 200.0mg' (the SPC does not state the volume this composition refers to).
Route: Oral (suspension)
Frequency: At night
The pinned product is DANLAX SUSPENSION (PL204160686, Crescent Pharma Limited), an oral suspension of dantron and poloxamer 188 (co-danthramer). It matches the page's oral route and laxative use, but it covers the SUSPENSION ONLY: any capsule form or other-strength (e.g. 'strong') suspension that the page may mention is NOT covered by this SPC and no dose is given for it. SPC §4.1 (verbatim): 'Constipation in terminally ill patients of all ages.' §3: 'Oral Suspension'. §2 (verbatim, as printed): 'Dantron BP 25.0mg Poloxamer 188 USNF 200.0mg' - no volume or unit of reference is printed (checked against the SPC PDF text layer), so the dose is written in ml of Danlax Suspension and no per-ml strength is stated. VERBATIM §4.2: 'Dose: Adults: 5 to 10 ml at night Children: 2.5 to 5 ml at night Elderly: 2.5 to 5 ml at night Method of Administration: To be taken by mouth.' The SPC prints no maximum dose, no duration and no renal or hepatic adjustment, so none is given. WARNINGS (verbatim §4.4): 'co-danthramer preparations should not be given to infants in nappies and be used with caution in all incontinent patients'; 'Oral administration of Dantron has been reported to cause intestinal tumours in rats and mice. It has also been reported to be hepatocarcinogenic in rats as well as in mice. There is no sound evidence to conclude a no effect dose and therefore there may be a risk of such effects in humans.'; may cause staining of the buttocks in incontinent and/or bedridden patients, which 'may lead to superficial sloughing of the skin'.

Paediatric dose

Dose: Constipation in terminally ill patients: Children 2.5 to 5 ml of Danlax Suspension at night (the SPC defines no age range for 'Children')
Route: Oral (suspension)
Frequency: At night
VERBATIM §4.2: 'Children: 2.5 to 5 ml at night'. The SPC gives no age band, no per-kg figure and no neonatal figure; none is added. §4.1 covers 'terminally ill patients of all ages'. §4.4: co-danthramer preparations 'should not be given to infants in nappies'. Strength as printed in §2: 'Dantron BP 25.0mg, Poloxamer 188 USNF 200.0mg' (volume of reference not printed).

Dose adjustments

Renal

No renal dose adjustment or renal precaution is printed in SPC sections 4.2-4.4.

Hepatic

No hepatic dose adjustment is printed in SPC sections 4.2-4.4. §4.4 reports that oral dantron has been reported to be hepatocarcinogenic in rats and mice, with no sound evidence of a no-effect dose and therefore a possible risk in humans.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Acute or painful conditions of the abdomen (should not be given in common with other gastrointestinal evacuants)
  • Constipation whose cause is suspected to be intestinal inflammation or obstruction

Side effects

  • Pink colouration of urine
  • Staining of anal skin
  • Staining of the buttocks in incontinent and/or bedridden patients, which may lead to superficial sloughing of the skin (SPC §4.4)

Interactions

  • None known (SPC §4.5)

Monitoring

  • No monitoring schedule is printed in the SPC; §4.4 advises caution in all incontinent patients and that preparations should not be given to infants in nappies because of staining and superficial skin sloughing

Clinical monograph

How it works

Dantron stimulates colonic peristalsis by acting on the myenteric plexus, while the poloxamer acts as a faecal softening and wetting agent.

Prescribing in practice

  • Restrict use to palliative care patients because dantron is potentially carcinogenic (based on rodent data) and may discolour the urine red.
  • Avoid in patients with faecal impaction or intestinal obstruction, and avoid prolonged skin contact as dantron can cause a perianal contact dermatitis, especially in incontinent patients.
  • Counsel that prolonged contact with skin, including in those who are incontinent or who wear napkins, should be avoided to reduce irritation and excoriation.

Monitoring

Monitor bowel frequency and stool consistency and review for skin irritation, dehydration or electrolyte disturbance with prolonged use.

Counselling the patient

  • Expect the urine to turn a reddish colour, which is harmless.
  • Wipe away any spilled liquid promptly and protect the skin to prevent soreness.
  • Maintain a good fluid intake.

Evidence & guidelines

Its place in therapy is established by clinical experience in palliative care and current prescribing references rather than by large trials.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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