Colace (Docusate) Starting Dose
For adults and children 12 years and older, the starting dose of Colace (docusate sodium) is 100 mg once daily, which can be taken as a single dose or divided throughout the day, with a range of 1-3 capsules (100-300 mg) daily. 1
Dosing by Age Group
Adults and adolescents (≥12 years):
- Starting dose: 100 mg (1 capsule) daily 1
- Can be titrated up to 300 mg daily (1-3 capsules) 1
- May be taken as a single daily dose or in divided doses 1
Children 2 to under 12 years:
- Dose: 100 mg (1 capsule) daily 1
Children under 2 years:
- Consult a physician before use 1
Important Clinical Considerations
Efficacy concerns: The evidence strongly suggests that docusate has limited effectiveness as a laxative. Research demonstrates that psyllium is superior to docusate for both stool softening and overall laxative efficacy in chronic constipation 2. In hospitalized cancer patients, a sennosides-only protocol was more effective than sennosides plus docusate (400-600 mg/day), with 62.5% vs 32% of patients having bowel movements on more than 50% of days 3.
Common prescribing patterns to avoid:
- Docusate is frequently prescribed despite poor evidence for efficacy 4
- When combined with polyethylene glycol 3350 after surgery, adding docusate did not reduce time to first bowel movement compared to placebo 5
- In patients requiring opioids, docusate monotherapy is inadequate; these patients need more effective laxatives 4
Alternative First-Line Recommendations
For chronic idiopathic constipation, current guidelines recommend more effective agents over docusate 6:
- Polyethylene glycol (PEG): Starting dose <$50/month, titrate per symptom response 6
- Magnesium oxide: 400-500 mg daily 6
- Bisacodyl: 5 mg daily for short-term or rescue use 6
Clinical pearl: If docusate is already prescribed, this represents a deprescribing opportunity, as 80% of patients continue it unnecessarily on discharge despite its known ineffectiveness 4. Consider switching to evidence-based alternatives like PEG or osmotic laxatives for better outcomes.