From the Guidelines
Stool softeners, such as docusate, are not recommended for prophylaxis of opioid-induced constipation, as they have been shown to be less effective than stimulant laxatives alone 1.
Alternatives to Stool Softeners
Instead, the following alternatives can be considered:
- Stimulant laxatives, such as sennosides, which can be used alone or in combination with other agents
- Polyethylene glycol (PEG) with 8 oz of water 2 times daily
- Increasing fluid intake and dietary fiber
- Regular physical activity
Treatment of Constipation
If constipation develops, the cause and severity must be assessed to rule out obstruction. Treatment options may include:
- Adding bisacodyl 10-15 mg, 2-3 times daily with a goal of 1 nonforced bowel movement every 1-2 days
- Using glycerine suppositories or manual disimpaction
- Considering methylnaltrexone for opioid-induced constipation
- Using prokinetic agents, such as metoclopramide, to enhance gastric antral contractility
Important Considerations
It is essential to note that opioid-induced constipation can be a significant issue, and patients do not develop tolerance to this adverse effect 1. Therefore, prophylactic bowel regimens are recommended for nearly all patients taking opioids. Additionally, if constipation persists despite treatment, it is crucial to reassess the cause and severity of constipation and consider alternative treatments or referral to specialized palliative care services 1.
From the FDA Drug Label
Purpose Stool softener The answer to the question is docusate (PO), as it is directly stated as a stool softener 2.
- Key points:
From the Research
Stool Softener Efficacy
- The efficacy of stool softeners, such as docusate sodium, has been compared to other treatments like psyllium in several studies 5, 6.
- A study published in 1998 found that psyllium was superior to docusate sodium for softening stools and increasing stool water content in patients with chronic idiopathic constipation 5.
- Another study published in 2021 found that docusate did not show any benefits for constipation when compared to placebo or psyllium, and that psyllium and sennosides were more effective than docusate 6.
Alternative Treatments
- A systematic review published in 2007 found that there were various interventions available for the treatment of constipation, including non-drug interventions, arachis oil, biofeedback, bisacodyl, and others 7.
- A more recent systematic review published in 2021 found good evidence to recommend polyethylene glycol or senna as first-line laxatives, and moderate evidence supporting fiber supplements, fruits, stimulant laxatives, and magnesium-based products 8.
Specific Patient Populations
- A study published in 2021 found that docusate sodium and senna glycoside were ineffective in preventing and treating constipation following rotator cuff repair 9.
- Another study published in 2021 found that docusate was not effective for use in constipation in older people, and that psyllium and sennosides were more effective than docusate 6.