docusate sodium/senna

REMS

PO: Treatment of constipation associated with dry, hard stools and decreased intestinal motility.
Prevention of opioid-induced constipation.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Abdominal pain, nausea, or vomiting, especially when associated with fever or other signs of an acute abdomen;
Concomitant use of mineral oil.

Use Cautiously in:

Excessive or prolonged use may lead to dependence, fluid and electrolyte imbalance, and vitamin and mineral deficiencies.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rashes

F and E: dehydration, electrolyte imbalances

GI: abdominal cramps, diarrhea, nausea, vomiting

GU: urine discoloration

Interactions ⬆ ⬇

Drug-drug:

None significant.

Availability ⬆ ⬇

Tablets: Docusate sodium 50 mg and sennosides 8.6 mg^OTC

Route/Dosage ⬆ ⬇

PO (Adults and Children >12 yr): 2 tablets once daily at bedtime; maximum 4 tablets twice daily.
PO (Children 6–12 yr): 1 tablet once daily at bedtime; maximum: 2 tablets twice daily.
PO (Children 2–6 yr): 1/2 tablet once daily at bedtime; maximum: 1 tablet twice daily.

US Brand Names ⬆ ⬇

Peri-Colace, Senna Plus, Senokot-S

Action ⬆ ⬇

Senna's metabolite acts as a local irritant on the colon stimulating peristalsis.
Docusate promotes incorporation of water into stool, resulting in softer fecal mass.

Therapeutic effects:

Softening and passage of stool.

Classifications ⬆ ⬇

Therapeutic Classification: laxatives

Pharmacologic Classification: stimulant laxatives, stool softeners

Pharmacokinetics ⬆ ⬇

Absorption: Docusate: small amounts may be absorbed from the small intestine after oral administration.

Distribution: Unknown.

Metabolism/Excretion: Senna: metabolized in the liver and eliminated in bile and urine. Docusate: eliminated in bile.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(softening of stool)

ROUTE	ONSET	PEAK	DURATION
PO	6–12 hr	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Advise patients that laxatives should be used only for short-term therapy. Long-term therapy may cause electrolyte imbalance and dependence.
Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake (6–8 full glasses/day), and increasing mobility. Normal bowel habits are variable and may vary from 3 times/day to 3 times/wk.
Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present.

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Indications ⬇