From the Guidelines
For a patient with coronary artery disease (CAD) who needs a stool softener, docusate sodium is generally a safe first-line option. This recommendation is based on the American Gastroenterological Association's guideline on the medical management of opioid-induced constipation, which provides a framework for understanding the mechanisms and uses of different laxatives 1. According to the guideline, stool softeners like docusate sodium work by allowing water and lipids to penetrate the stool, thereby hydrating and softening the fecal material.
The key considerations for CAD patients include avoiding straining during bowel movements, which can temporarily increase blood pressure and heart rate. Docusate sodium, at a dose of 100 mg taken orally once or twice daily, is a suitable option as it helps make the stool softer and easier to pass without straining. Other options like polyethylene glycol (PEG) at 17 grams mixed in water once daily can also be considered, as it draws water into the intestines to soften the stool.
It's crucial for CAD patients to avoid stimulant laxatives like bisacodyl or senna when possible, due to potential risks of electrolyte disturbances or rapid heart rate in some patients. Lifestyle modifications are also essential and should accompany medication use, including:
- Increased water intake (at least 8 glasses daily)
- Regular physical activity as tolerated
- A diet rich in fruits, vegetables, and whole grains to provide natural fiber
If constipation persists despite these measures, the patient should consult their healthcare provider for further evaluation. The American Gastroenterological Association's guideline provides a strong recommendation for the use of certain laxatives based on their mechanisms of action and the strength of evidence supporting their use 1.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL - 50 Softgel Bottle Carton VALUMEDS Compare to the active ingredient in Dulcolax ® Stool Softener STOOL SOFTENER DOCUSATE SODIUM 100 MG GENTLE RELIEF EFFECTIVE STIMULANT FREE 50 SOFTGELS Docusate sodium can be used as a stool softener for patients with Coronary Artery Disease (CAD).
- The drug label does not provide any information that would contraindicate its use in CAD patients.
- Docusate sodium is a gentle and effective stool softener that is stimulant free 2
From the Research
Stool Softener for CAD Patient
- The use of psyllium as a stool softener for Coronary Artery Disease (CAD) patients has been studied in several research papers 3, 4, 5.
- Psyllium is a soluble gel-forming fiber that has been shown to bind to bile acids in the gut and prevent their normal reabsorption, which can help lower cholesterol levels 4.
- Studies have found that psyllium can be useful as an adjunct to dietary therapy in the treatment of patients with mild-to-moderate hypercholesterolemia, and can provide an added benefit on cholesterol lowering when combined with other cholesterol-lowering drugs such as statins 4.
- Additionally, psyllium has been found to attenuate salt-accelerated hypertension in stroke-prone spontaneously hypertensive rats, suggesting a potential benefit for CAD patients with hypertension 5.
- However, the effectiveness of docusate, another type of stool softener, for constipation in older people, including those with CAD, has been found to be lacking, with psyllium and sennosides showing more effectiveness compared to docusate 6.
- It is also important to note that a diet high in saturated fatty acids can contribute to atherosclerotic cardiovascular disease risk, and limiting intake of saturated fats, particularly for people with clinical ASCVD, dyslipidemia, or diabetes mellitus, is recommended 7.