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Stool softener (anionic surfactant) Pregnancy: Considered safe — minimal systemic absorption.

Docusate sodium

Brand names: Dioctyl, Docusol, Docusate (Norgalax mini-enema), Docusate-Senna (Manevac alternative)

Adult dose

Dose: Constipation: up to 500 mg/day in divided doses (typically 100 mg TDS or 200 mg BD). Effect over 1–3 days. Faecal impaction: Norgalax mini-enema 120 mg single dose (works within 5–20 minutes).
Route: Oral / Rectal
Frequency: BD–TDS (oral) or single (enema)
Max: 500 mg/day oral
Take with plenty of water. Effect is gradual — not for acute constipation relief.

Paediatric dose

Route: Oral
Frequency: BD–TDS
6 mo–2 yrs: 12.5 mg TDS. 2–12 yrs: 12.5–25 mg TDS. ≥12 yrs: adult dose. Paediatric solution available.

Clinical pearls

  • Mechanism: surfactant action lowers stool surface tension → water and fat penetrate stool → softer stool. NOT a stimulant — slow onset (1–3 days oral).
  • Best evidence for use is in COMBINATION with a stimulant (senna or bisacodyl) — meta-analyses show docusate alone is barely better than placebo for chronic constipation.
  • Useful in opioid-induced constipation as adjunct to senna — co-prescribe regular co-danthramer/co-danthrusate for palliative care patients on opioids.
  • Norgalax mini-enema useful for proctology pre-procedure (digital exam, sigmoidoscopy preparation) — works within 20 min.
  • Liquid paraffin combination historically used (Mil-Par) but now avoided — risk of pulmonary granulomas if aspirated.
  • First-line for stool softening in pregnancy and breastfeeding (minimal absorption).

Contraindications

  • Bowel obstruction
  • Acute abdominal pain of unknown cause
  • Severe abdominal pain, nausea, vomiting
  • Hypersensitivity to docusate
  • Concurrent liquid paraffin (↑ paraffin absorption — granuloma risk)

Side effects

  • Abdominal cramps (mild)
  • Diarrhoea (excessive dose)
  • Nausea
  • Rash (rare)
  • Bitter taste (oral solution)

Interactions

  • Liquid paraffin: ↑ paraffin absorption from gut — risk of paraffin granulomas — avoid combination
  • Generally well-tolerated; minimal systemic interactions

Monitoring

  • Bowel diary; stool consistency (Bristol scale)

Reference: BNFc; BNF 90; BNF for Children 2024; SmPC Docusol / Norgalax; NICE CKS Constipation; Cochrane Review on stool softeners. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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