Inpatient laxative use is common and frequently persists following hospital discharge. While seemingly trivial, the routine use of docusate products in a constrained health care system is wasteful.
CADTH (Canadian Agency for Drugs and Technologies in Health), in a recent update of a 2014 publication, reviewed clinical effectiveness of docusate in an attempt to inform decisions about the prevention and management of constipation. The key messages from this document are listed below.
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The Clinical Effectiveness of Docusate:
For the prevention and management of constipation:
- There is little evidence to support the use of docusate in hospitalized patients or long-term care residents.
- Docusate does not increase stool frequency or soften stools compared with placebo.
- Docusate does not improve the symptoms of constipation.
- Docusate does not improve the difficulties or completeness of stool evacuation in patients taking opioids.
When asked for advice on this topic, Dr.Ted Xenodemetropoulos, gastroenterologist at McMaster University/Hamilton Health Sciences, who is spearheading a GI eConsult project with the Hamilton FHT, stated, “Despite commonplace use, docusate has very little in the way of specific high-quality evidence to support its efficacy in constipation management. PEG 3350 has better quality data, and would be the preferred laxative in basic constipation management approaches.”
Resource Demand and Risks Associated with Docusate Use:
A 2015 review from the McGill University Health Centre documented the costs in their institution and found that docusate use contributed to high costs and risks related to: pharmacy inventory management and distribution; nursing administration time; polypharmacy; downstream investigations (eg,
testing) in the case of laxative-induced diarrhea; and nearly $9.7 million (CAD) spent on stool softeners in ODBP beneficiaries in Ontario.
So, What Can We Do?
We might consider doing as our neighbours do in the West: Alberta Health Services, with 111 acute care facilities (8,500 beds) and 24,000 long-term care beds, demonstrated that a communication document supported by live presentations was associated with decreased administration of docusate up to 6 months, with a levelling of the association after one year. Significant systemic change can be achieved without extensive and complex interventions if the evidence and messaging are aligned.