From the Guidelines
Docusate is most similar to other stool softeners that work through surfactant properties, with sodium picosulfate being the closest alternative, as both medications function by reducing surface tension of stool, allowing water and fats to penetrate more easily, resulting in softer bowel movements. The medications that are similar to docusate include:
- Calcium docusate, a different salt form of the same active ingredient
- Poloxamer 188, which works in a similar way to reduce surface tension and soften stool
- Sodium lauryl sulfoacetate, a wetting agent similar to docusate, often used in combination with osmotic agents in enemas 1 These medications are typically used for constipation, particularly when straining should be avoided, such as after surgery or in patients with cardiovascular conditions. Unlike stimulant laxatives (bisacodyl, senna) or osmotic agents (polyethylene glycol, lactulose), stool softeners work more gently and don't stimulate intestinal contractions. They typically take 1-3 days to work effectively. The standard adult dose for docusate sodium is 100-300 mg daily, divided into one or two doses. These medications are generally well-tolerated but may cause mild abdominal cramping or diarrhea if overused, as noted in studies on the management of constipation in various patient populations 1. In comparison to other laxatives, such as polyethylene glycol (PEG) and lactulose, which are osmotic agents that increase the amount of water in the large bowel, docusate and similar stool softeners have a more gentle mechanism of action and are often preferred in certain patient populations, such as those with advanced cancer or neurological dysfunction 1.
From the FDA Drug Label
Purpose Stool softener Active ingredient (in each capsule) Docusate sodium 100 mg The most similar to docusate is another stool softener.
- Docusate sodium is the active ingredient in docusate, so other medications with the same active ingredient would be most similar. 2 2
From the Research
Similarities to Docusate
- Senna is often used in combination with docusate for the treatment of constipation, as seen in studies 3, 4, 5
- Psyllium and sennosides have been shown to be more effective than docusate in treating constipation 6
- Polyethylene glycol 3350 and lactulose are also used as alternatives to docusate for the treatment of constipation 3, 4
- Bisacodyl is another laxative that is commonly used, similar to docusate, for the treatment of constipation 3
Comparison of Efficacy
- Studies have shown that docusate is not effective in treating constipation in certain populations, such as older adults 7, 6
- Senna and lactulose have been found to be more effective than docusate in treating constipation in long-term care settings 4
- The combination of senna and docusate has been shown to be effective in reducing time to first bowel movement after surgery 5