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Stimulant + softener laxative Pregnancy: Co-danthrusate should not be used during pregnancy or lactation.

Co-danthrusate

Brand names: Normax

Co-danthrusate is a combination stimulant laxative containing dantron with docusate sodium, used to treat constipation in palliative care, including opioid-induced constipation.

Adult dose

Dose: Constipation in terminally ill patients: 1-3 capsules in adults including elderly patients (each capsule contains 50 mg dantron and 60 mg docusate sodium)
Route: Oral
Frequency: Doses are usually given at bedtime
The pinned product is CO-DANTHRUSATE 50/60MG CAPSULES (PL284440228, Activase Pharmaceuticals Limited): same medicine, oral capsule, same dantron 50 mg / docusate sodium 60 mg strength. The SPC is a generic-name product and does not name Normax. SPC §2 (verbatim): 'Each capsule contains 50 mg Dantron and 60 mg Docusate sodium Excipient with known effect: Each capsule contains 95 mg of lactose'. §4.1 (verbatim): 'Constipation in terminally ill patients of all ages'. VERBATIM §4.2: 'Adults and elderly Co-danthrusate Capsules are given in doses of 1-3 capsules in adults including elderly patients. Paediatric population Children between the ages of 6 to 12 years are given 1 capsule. Doses are usually given at bedtime. Children under 6 years - not recommended. Method of Administration: Oral'. The SPC prints no maximum daily dose, no number of doses per day beyond 'usually given at bedtime', and no duration, so none is given. WARNINGS (verbatim §4.4): 'Prolonged use is not recommended. Dantron-containing laxatives like co-danthrusate should not be used for the general management of constipation in the elderly.' 'In experimental animals, Dantron has been associated with adenocarcinomas in the bowel and tumours in the liver. A theoretical risk of similar effects in humans cannot be excluded.' Dantron/metabolites 'may cause perineal erythema in patients with urinary and or faecal incontinence' so use with caution in all incontinent patients. The capsules contain lactose (§4.4: not for patients with rare hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption).

Paediatric dose

Dose: Constipation in terminally ill patients: children aged 6 to 12 years, 1 capsule (50 mg dantron and 60 mg docusate sodium per capsule); children under 6 years - not recommended
Route: Oral
Frequency: Doses are usually given at bedtime
VERBATIM §4.2: 'Children between the ages of 6 to 12 years are given 1 capsule. Doses are usually given at bedtime. Children under 6 years - not recommended.' The SPC does not state whether 12 is inside or outside the band and prints no per-kg figure; none is added.

Dose adjustments

Renal

No renal dose adjustment 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 notes that in experimental animals dantron has been associated with tumours in the liver and bowel, and that a theoretical risk of similar effects in humans cannot be excluded.

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

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
  • Intestinal obstruction (contraindicated, like all laxatives)
  • Undiagnosed abdominal pain (contraindicated)
  • Children under 6 years - not recommended (SPC §4.2)
  • Not for the general management of constipation in the elderly (SPC §4.4)

Side effects

  • Occasionally an orange tint in the urine due to the dantron component
  • A mild griping feeling in the abdomen
  • Skin rash
  • Skin irritation, skin discolouration and superficial sloughing of the perianal skin after prolonged use
  • Prolonged use or high doses: fluid and electrolyte imbalance, colonic atony, melanosis coli (discolouration of the colonic mucosa) and tolerance to the effects

Interactions

  • Docusates may enhance the gastrointestinal or hepatic cell uptake of other drugs, potentiating their activity and possibly increasing their toxicity
  • Should not be used with liquid paraffin

Monitoring

  • No monitoring schedule is printed in the SPC; §4.4 flags perineal erythema in patients with urinary and/or faecal incontinence (use with caution in all incontinent patients), and §4.8 notes fluid and electrolyte imbalance with prolonged use or high doses

Clinical monograph

How it works

Dantron stimulates colonic peristalsis via the myenteric plexus while docusate sodium acts as a softening and wetting agent that allows water to penetrate the stool.

Prescribing in practice

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

Monitoring

Monitor bowel frequency and stool consistency and review for skin irritation and fluid or electrolyte disturbance during prolonged use.

Counselling the patient

  • Expect harmless reddish discolouration of the urine.
  • Clean the skin promptly if any liquid is spilled to prevent soreness.
  • Keep well hydrated.

Evidence & guidelines

Its use is supported by clinical experience in palliative care and current prescribing references rather than by large randomised 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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