Can I give one or two tablets of Pericolace (docusate) to a patient who has not had a bowel movement since yesterday?

Management of Constipation in a Patient Without Bowel Movement Since Yesterday

Two tablets of Pericolace (docusate sodium with senna) can be administered to a patient who has not had a bowel movement since yesterday, as the guidelines recommend increasing laxative doses for patients with constipation, particularly using combination products containing stimulant laxatives. 1

Understanding Pericolace and Its Components

• Pericolace contains docusate sodium (stool softener) and senna (stimulant laxative) in combination 1
• For patients with constipation, particularly those in palliative care settings, guidelines recommend using stimulant laxatives with or without stool softeners 1
• The goal of laxative therapy is to achieve one non-forced bowel movement every 1-2 days 1

Evidence-Based Approach to Dosing

• For patients experiencing constipation, increasing the dose of laxative with stool softener to 2-3 tablets BID-TID is recommended in palliative care guidelines 1
• The National Comprehensive Cancer Network (NCCN) guidelines specifically mention increasing senna with docusate to 2-3 tablets BID-TID for patients with constipation 1
• Missing just one day of bowel movements warrants intervention to prevent more severe constipation 1

Important Considerations

• Efficacy of components: Recent evidence suggests that docusate alone has limited efficacy in preventing or treating constipation 1, 2, 3
• The stimulant component (senna) is likely the more effective agent in the combination 4
• A study comparing sennosides-only protocols with sennosides plus docusate protocols found that sennosides alone produced more bowel movements than the combination 4

Monitoring and Follow-up

• After administering the medication, monitor for:
  • Effectiveness (bowel movement within 8-12 hours) 1
  • Potential adverse effects such as cramping or diarrhea 4
• If constipation persists beyond 2-3 days despite increased dosing, consider:
  • Adding other laxatives such as polyethylene glycol (1 capful/8 oz water BID) 1
  • Evaluating for impaction or obstruction 1
  • Assessing for other causes of constipation (medications, hypercalcemia, hypothyroidism) 1

Caution

• While two tablets is appropriate for short-term management, avoid prolonged use of stimulant laxatives at high doses 1
• Ensure adequate fluid intake when administering laxatives 1
• If the patient develops diarrhea, reduce the dose back to one tablet 4

Alternative Approaches

• If Pericolace is ineffective, consider using osmotic laxatives like polyethylene glycol which have stronger evidence for efficacy 1
• For severe or persistent constipation, consider adding bisacodyl suppositories or glycerin suppositories 1