DUD-CUSATE?

What do you tell your patients about this common stool softener?

Click here for previous newsletters.

1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "I've been taking Colace for my constipation due to my Tylenol #3's but it's really not doing much for me. Is there something better I could try?"

Concise Conclusion: Studies consistently show Colace (docusate) performs no better than placebo for constipation. Specifically in your case, I would recommend a stimulant laxative like senna or bisacodyl.

Quick Wrap-up: The reputation docusate has as a stool softener doesn't hold up under scrutiny. A randomized, double-blind, placebo-controlled trial in hospice patients found no difference in stool frequency, volume, or consistency between docusate plus sennosides and placebo plus sennosides. Other trials comparing docusate directly to psyllium found psyllium clearly superior for both stool water content and bowel movement frequency. CADTH reviewed the totality of evidence and concluded docusate is no more effective than placebo in the prevention or management of constipation. In this case, a stimulant is preferred as it's opioid-induced constipation.

Dive Deeper

1) Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness - NCBI Bookshelf

We hope you found this useful. Reply with any feedback or topic suggestions — your input helps shape the newsletter.