Rethinking Docusate’s Role in Opioid-Induced Constipation: A Critical Analysis of the Evidence

Abstract

Opioid induced constipation (OIC) is a predictable and preventable adverse effect of opioid use. Docusate is often utilized for OIC prophylaxis and treatment because of its low cost, easy accessibility and tolerability. However, the costs of docusate use may not outweigh the benefits given limited reported efficacy. The authors seek to provide the first critical review of clinical evidence for docusate use in OIC management. PubMed, Google Scholar, OVID Medline, and EMBASE were queried for primary literature, guidelines, and consensus recommendations (CR) evaluating docusate use for OIC management. Thirteen guidelines or CR and four primary literature studies were evaluated. The primary literature studies had significant design limitations and collectively revealed non-compelling evidence for use. The majority of guidelines or CR that endorsed the use of docusate for OIC prophylaxis or treatment did not cite primary evidence to support their recommendations. The inclusion of docusate in major guidelines and CR for OIC management is weakly evidence based, though docusate use is still widely recommended. Institutions and health care providers should consider careful evaluation of OIC protocols and/or algorithms to ensure integration of evidence-based therapy and reduce unnecessary drug use and associated costs, which may include removal of docusate.

KEYWORDS:

• Docusate
• stool softener
• opioid induced constipation
• treatment
• prophylaxis

Declaration of interest

No potential conflict of interest was reported by the author(s).

Acknowledgements

The authors would like to acknowledge Matthew Roslund and Laura Dixon for their significant contributions to the literature search conducted in this manuscript, and Dr. Verina Mansour for her contributions to manuscript development.

Notes

1 Codanthrusate was withdrawn from American, Canadian, and European markets in 1980s-1990s due to genotoxicity, danthron was a laxative used for constipation in terminally ill patients.