Stool Softener-Stimulant Lax (sennosides/docusate sodium)

Docusate salts should be administered in doses only large enough to produce softening of the stools. The oral dosage of the docusate salts varies widely according to the severity of the condition and the response of the patient and should be adjusted to individual response.

The usual oral dosage of docusate salts in adults and children older than 12 years of age is 50-360 mg daily. The usual oral dosage is 50-150 mg daily in children 2-12 years of age and 25 mg daily in children younger than 2 years of age. Alternatively, children 3-6 years of age may receive oral docusate sodium dosages of 20-60 mg daily and children younger than 3 years of age may receive 10-40 mg daily. Doses at the higher end of these dosage ranges may be required initially. The drugs may be administered in divided doses but usually one bedtime dose is sufficient. One manufacturer suggests adding 50-100 mg of docusate sodium as an oral liquid (not syrup) to saline or oil retention enemas for rectal use.

Docusate salts are administered orally. The sodium salt of docusate may be administered rectally. Oral liquids (not syrups) of docusate sodium should be diluted with 120 mL of milk, fruit juice, or infant formula to mask their bitter taste.

Anthraquinone laxatives are administered orally, usually in a single dose at bedtime.

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Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

Stimulant Laxatives/Selected Bowel Preparations

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Osmotic laxatives and stimulant laxatives may have additive adverse effects.(1)

CLINICAL EFFECTS: Concurrent use of stimulant laxatives and Sutab tablets (sodium sulfate, magnesium sulfate, and potassium chloride) may increase the risk of mucosal ulceration, ischemic colitis, gastric ulcerations, or gastritis.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The manufacturer of Sutab tablets (sodium sulfate, magnesium sulfate and potassium chloride) recommends avoiding the use of stimulant laxatives while using this bowel preparation product.(1)

DISCUSSION: Osmotic laxative products may produce colonic mucosal aphthous ulcerations which reports have shown can lead to ischemic colitis requiring hospitalization. Using stimulant laxatives in addition may increase this risk.(1)

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Laxatives/Trofinetide

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Trofinetide commonly causes diarrhea of mild to moderate severity. Laxatives may increase the incidence or severity of diarrhea.(1)

CLINICAL EFFECTS: Concurrent use of laxatives with trofinetide may increase the risk of severe diarrhea.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Patients should stop laxatives before starting trofinetide. If diarrhea occurs, consider anti-diarrheal treatment and monitor hydration status. If severe diarrhea or dehydration occurs, interrupt, reduce dose, or discontinue trofinetide.(1)

DISCUSSION: In clinical trials, 85% of patients on trofinetide developed diarrhea. Concurrent use of laxatives may increase this risk.(1)

Laxatives; Stool Softeners/Tenapanor

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Tenapanor commonly causes diarrhea of mild to moderate severity. Laxatives and stool softeners may increase the incidence or severity of diarrhea.(1)

CLINICAL EFFECTS: Concurrent use of laxatives or stool softeners with tenapanor may increase the risk of severe diarrhea.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The US manufacturer of tenapanor states that patients should be instructed to avoid stool softeners and laxatives with tenapanor. If severe diarrhea occurs, tenapanor should be discontinued.(1)

DISCUSSION: In clinical trials, 43-53% of CKD patients on dialysis treated with tenapanor developed diarrhea. Diarrhea usually occurred soon after treatment initiation and was severe in 5% of patients.(1)

There are no moderate interactions for this drug.

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• Appendicitis
• Gastrointestinal obstruction
• Gastrointestinal perforation
• Toxic colitis
• Toxic megacolon

• Appendicitis
• Inflammatory bowel disease

• Fecal incontinence

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Rare or Very Rare

• Hypocalcemia
• Hypokalemia
• Metabolic acidosis
• Metabolic alkalosis
• Proteinuria
• Skin rash
• Tetany

More Frequent

• Abdominal pain with cramps

Less Frequent

• Diarrhea
• Eructation
• Nausea

Rare or Very Rare

• Abdominal pain with cramps
• Allergic dermatitis
• Arthritis
• Cachexia
• Hematuria
• Melanosis of colon
• Osteomalacia
• Pruritus of skin
• Skin rash
• Urine discoloration
• Urticaria

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