Can Docusate (Colace) be taken with Bisacodyl (Dulcolax) daily?

From the Guidelines

Yes, Colace (docusate sodium) can be taken with Dulcolax (bisacodyl) daily, as they work differently to relieve constipation, with Colace being a stool softener and Dulcolax being a stimulant laxative, as suggested by the American Gastroenterological Association and the American College of Gastroenterology clinical practice guideline 1.

Key Points to Consider

• Colace increases water absorption in the stool, making it easier to pass, while Dulcolax increases intestinal contractions to move stool through the colon.
• A typical regimen might include 100 mg of Colace once or twice daily along with 5-10 mg of Dulcolax daily.
• However, this combination should only be used short-term (less than 1-2 weeks) as prolonged use can lead to dependence, electrolyte imbalances, or dehydration, as noted in the guideline 1.
• It's essential to maintain adequate fluid intake (at least 6-8 glasses of water daily) while taking these medications.
• If constipation persists beyond a week, it's crucial to consult a healthcare provider as it may indicate an underlying condition requiring different treatment, as recommended by the guideline 1.

Important Considerations

• Start with the lowest effective dose and consider trying just one medication before combining them.
• The guideline suggests that stimulant laxatives, such as bisacodyl, can be used short-term or as rescue therapy for chronic idiopathic constipation, with a strong recommendation based on moderate certainty of evidence 1.
• The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of various agents, including fiber, osmotic laxatives, stimulant laxatives, secretagogues, and serotonin type 4 agonist, using the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention 1.

From the Research

Interaction between Colace and Dulcolax

• Colace (docusate) and Dulcolax (bisacodyl) are both laxatives used to treat constipation, but they work in different ways.
• Colace is a stool softener that helps increase the amount of water in the stool, making it softer and easier to pass.
• Dulcolax is a stimulant laxative that works by increasing the amount of fluid in the intestines and stimulating the intestinal muscles to move stool through the digestive system more quickly.

Safety of Daily Use

• According to the study 2, docusate (Colace) and bisacodyl (Dulcolax) are both listed as interventions for idiopathic chronic constipation, but it does not provide information on their combined use.
• The study 3 discusses the long-term treatment with stimulant laxatives, including bisacodyl, and notes that the evidence base does not support use of stimulant laxatives for more than four weeks due to potential harmful long-term colonic effects and possible carcinogenic risk.
• There is no direct evidence in the provided studies to support or refute the daily use of Colace and Dulcolax together.

Potential Side Effects

• The study 3 reports that adverse events (AEs) associated with bisacodyl were generally mild, but frequent (up to 72%), mostly diarrhea and abdominal pain.
• It is essential to consider the potential side effects of both medications when taking them together, although there is no specific information available in the provided studies.