Docusate Dosing for Children
For children 2 to under 12 years of age, give 1 softgel (typically 50-100 mg) daily; for children 12 years and older, give 1 to 3 softgels daily (50-300 mg total), taken as a single dose or divided; and for children under 2 years, consult a physician before use. 1
Age-Based Dosing Algorithm
Children Under 2 Years
- Do not administer without physician consultation 1
- This age group requires individualized assessment due to limited safety data and immature drug elimination pathways 2
Children 2 to Under 12 Years
- Dose: 1 softgel (50-100 mg) once daily 1
- Administer with a full glass of water 1
- This can be given as a single daily dose 1
Children 12 Years and Older (Adolescents)
- Dose: 1 to 3 softgels daily (50-300 mg total) 1
- May be taken as a single daily dose or divided throughout the day 1
- Administer with a full glass of water 1
Critical Clinical Considerations
Evidence Quality Concerns
- Docusate has poor evidence for efficacy in treating constipation, with studies showing it may be less effective than stimulant laxatives alone 3, 4
- In hospitalized patients, a sennosides-only protocol produced more bowel movements than sennosides plus docusate, with 62.5% versus 32% achieving bowel movements on more than 50% of days 3
- Docusate is frequently prescribed despite known ineffectiveness, representing a missed opportunity for evidence-based prescribing 4
When Docusate May Be Inappropriate
- For patients on opioids: Consider stimulant laxatives (sennosides) as first-line rather than docusate monotherapy, as 28% of opioid users receive inadequate laxative therapy when given docusate alone 4
- For active constipation: Stimulant laxatives are more effective than stool softeners 3
Common Pitfalls to Avoid
- Do not rely on docusate as monotherapy for opioid-induced constipation - it is insufficient for this indication 4
- Avoid unnecessary continuation - 80% of patients on docusate have it continued on discharge despite lack of efficacy, contributing to polypharmacy 4
- Do not exceed recommended doses without medical supervision 1