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Docusate sodium

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VOL: 101, ISSUE: 13, PAGE NO: 33

Proprietary names

- Dioctyl (capsules).

- Docusol (adult/paediatric oral solutions).

- Fletcher’s Enemette, Norgalax Micro-enema (enemas).

Classification

- Legal: pharmacy.

- Functional: laxative.

- Chemical: anionic surfactant.

Action

- Increases water penetration to soften stools for easier passage.

Indications

- Nurse prescriber: prevention and treatment of chronic constipation.

- Adjunct in abdominal radiological procedures.

- Pre- and postoperative in obstetrics, prior to proctoscopy, sigmoidoscopy or X-ray (Fletcher’s Enemette).

- Endoscopic examination (Norgalax).

Interactions

- Mineral oil.

- Anthraquinones (increased absorption).

Contraindications

- Intestinal obstructions.

- Haemorrhoids.

- Anal fissure.

- Inflammatory bowel disease.

- Rectocolitis. 

- Anal bleeding.

- Abdominal pain.

- Nausea.

Cautions

- Breastfeeding.

- Prior to surgery or instrumentation, or in severe constipation, do not use unless obstruction, impaction and colonic dilatation have been excluded.

- Do not give with liquid paraffin. 

- Rectal preparations not indicated with haemorrhoids or anal fissure.

- Prolonged use can precipitate onset of atonic non-functioning colon and hypokalaemia.

- Dioctyl and Norgalax not recommended for children.

- Docusol not recommended for children under six months.

- Fletcher’s Enemette not recommended for children under three years.

Common side-effects

- Abdominal cramps.

- Local irritation (enema).

- Nausea.

- Anorexia.

- Hypocalcaemia.

Nursing considerations

- Assess: cause of constipation - is fluid, fibre or exercise missing from lifestyle; fluid balance.

- Evaluate therapeutic response (decreased constipation).

- Drug should be discontinued if cramping, rectal bleeding, nausea or vomiting occur. 

- Administer alone for better absorption.

- Do not administer within one hour of other drugs, antacids or milk.

- Tablets/solution to be taken with full glass of water.

- Do not use undue force when giving enema.

Patient teaching

- Onset of action generally 1-2 days after oral administration, 5-20 minutes after enema.

- Swallow tablets whole, do not chew them.

- Health education: other possible means of avoiding constipation.

- Inform that normal bowel movements do not always occur daily.

- Do not use in the presence of abdominal pain, nausea, vomiting.

- Notify clinician if constipation is unrelieved or symptoms of electrolyte imbalance occur (muscle cramps, pain, weakness, dizziness). 

- If diarrhoea occurs, discontinue use.

- Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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