Softening Laxatives

Docusate sodium, Poloxamer

[This monograph does not include the use of Arachis Oil or Liquid Paraffin as Stool Softeners for management of constipation or use of Docusate sodium for bowel cleansing for abdominal radiological procedures]

 Issues for Surgery

Risk of constipation if omitted for prolonged period, which may further be exacerbated by medications administered perioperatively e.g. opioids.

  Advice in the Perioperative period

Elective and Emergency Surgery
Continue, if required (including combination products).

Combination Products: -

• Co-danthramer (poloxamer + dantron) – also see Stimulant Laxatives monograph and under Further Information
• Co-danthrusate (docusate + dantron) – also see Stimulant Laxatives monograph and under Further Information

EXCEPT:

• for patients having bowel cleansing agents prior to surgery – also see Bowel Cleansing Agents monograph

Post-operative Advice
Resume post-operatively, if needed, once enteral intake resumed. 

If concomitant use of opioids or other medication that may cause constipation, or antibiotics that may cause diarrhoea, monitor response to treatment and adjust dose accordingly.

Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively.

Patients undergoing Colorectal Surgery
Review the need for softening laxatives post-operatively.

  Interaction(s) with Common Anaesthetic Agents

  Interaction(s) with other Common Medicines used in the Perioperative Period

  Further Information

Co-danthramer and Co-danthrusate
Co-danthramer and co-danthrusate are only licensed for constipation in terminally ill patients since dantron is a potential human carcinogen^{4, 6}.

  References

1. Summary of Product Characteristics – Dioctyl® (docusate) 100 mg Capsules. UCB Pharma Limited. Accessed via www.medicines.org.uk 12/08/2021 [date of revision of the text November 2020]
2. Laxatives. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed on 12^th August 2021]
3. Docusate Sodium. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed on 12^th August 2021]
4. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed on 12^th August 2021]
5. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12^th August 2021]
6. Dantron. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed on 19^th September 2021]