Stool Softener-Lax 8.6-50mg Tablets
It is used to treat constipation.
Drug Class
Laxative, Stool Softener
Pharmacologic Class
Surfactant Laxative (Docusate), Stimulant Laxative (Senna)
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medicine is a combination of a stool softener and a laxative. Docusate helps to soften the stool by allowing more water to mix with it, making it easier to pass. Senna is a stimulant laxative that helps your bowels move by making the muscles in your intestines contract. It's used for temporary relief of occasional constipation, especially when hard stools are a problem.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. If you take this medication once a day, it's best to take it at bedtime. Always take it with a full glass of water. Additionally, avoid taking other medications within 2 hours of taking this drug.
Storing and Disposing of Your Medication
To keep your medication effective and safe, store it at room temperature in a dry place, away from the bathroom. Keep all medications in a secure location, out of the reach of children and pets. When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. Instead, check with your pharmacist for guidance on the best disposal method, or look into local drug take-back programs.
What to Do If You Miss a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, be sure not to take it more frequently than directed by your doctor.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. If you take this medication once a day, it's best to take it at bedtime. Always take it with a full glass of water. Additionally, avoid taking other medications within 2 hours of taking this drug.
Storing and Disposing of Your Medication
To keep your medication effective and safe, store it at room temperature in a dry place, away from the bathroom. Keep all medications in a secure location, out of the reach of children and pets. When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. Instead, check with your pharmacist for guidance on the best disposal method, or look into local drug take-back programs.
What to Do If You Miss a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, be sure not to take it more frequently than directed by your doctor.
Lifestyle & Tips
- Drink plenty of fluids (6-8 glasses of water daily) to help prevent dehydration and aid in stool softening.
- Increase dietary fiber intake (fruits, vegetables, whole grains) to promote regular bowel movements.
- Engage in regular physical activity, which can help stimulate bowel function.
- Do not use for more than 7 days unless directed by a doctor.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
2 tablets once daily at bedtime
Dose Range:
1 - 4 mg
Condition-Specific Dosing:
constipation:
Initial dose 2 tablets once daily at bedtime; may increase to 4 tablets daily in divided doses if needed. Do not exceed recommended dosage. Use for short-term relief (typically 1 week or less).
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (consult physician)
Child:
Children 6 to under 12 years: 1 tablet once daily at bedtime; maximum 2 tablets daily. Children under 6 years: Consult a physician.
Adolescent:
Adolescents 12 years and older: Same as adult dosing.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended for short-term use.
Moderate:
Use with caution; monitor for electrolyte imbalance with prolonged use.
Severe:
Use with caution; avoid prolonged use due to potential for electrolyte imbalance and fluid retention. Consult physician.
Dialysis:
Not well-studied; use with caution and under medical supervision due to potential for electrolyte disturbances.
Hepatic Impairment:
Mild:
No specific adjustment recommended for short-term use.
Moderate:
Use with caution; monitor for adverse effects.
Severe:
Use with caution; avoid prolonged use. Consult physician.
Pharmacology
Mechanism of Action
Docusate sodium is an anionic surfactant that lowers the surface tension of the stool, allowing water and fats to penetrate and soften the fecal mass. Senna glycosides (sennosides) are prodrugs that are metabolized by colonic bacteria into active anthrone derivatives. These active metabolites stimulate colonic peristalsis by direct action on the colonic mucosa and nerve plexus, and also increase water and electrolyte secretion into the colon, leading to increased stool volume and softer consistency.
Pharmacokinetics
Absorption:
Bioavailability:
Docusate: Minimally absorbed systemically. Senna: Poorly absorbed as parent compound; active metabolites are absorbed from the colon.
Tmax:
Not precisely defined for combination; Docusate: Not applicable for systemic Tmax; Senna: Active metabolites reach peak concentration in 6-16 hours.
FoodEffect:
Not significant for efficacy; can be taken with or without food.
Distribution:
Vd:
Not available
ProteinBinding:
Not available
CnssPenetration:
No
Elimination:
HalfLife:
Docusate: Not well-defined due to minimal systemic absorption. Senna: Active metabolites have a half-life of approximately 6-10 hours.
Clearance:
Not available
ExcretionRoute:
Docusate: Primarily excreted in bile and feces. Senna: Active metabolites primarily excreted in urine and feces.
Unchanged:
Not available
Pharmacodynamics
OnsetOfAction:
6-12 hours (may take up to 24 hours)
PeakEffect:
Not precisely defined; typically within 8-12 hours
DurationOfAction:
Variable, typically resolves with bowel movement
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Immediately
If you experience any of the following symptoms, call your doctor or seek medical attention right away, as they may be signs of a severe and potentially life-threatening side effect:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you have side effects that bother you or do not go away, contact your doctor for advice.
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
If you experience any of the following symptoms, call your doctor or seek medical attention right away, as they may be signs of a severe and potentially life-threatening side effect:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you have side effects that bother you or do not go away, contact your doctor for advice.
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe abdominal pain, cramping, or nausea/vomiting (stop use and consult doctor)
- Rectal bleeding or failure to have a bowel movement after using the laxative (may indicate a serious condition, consult doctor immediately)
- Signs of dehydration (e.g., extreme thirst, decreased urination, dizziness)
- Muscle weakness or cramps (may indicate electrolyte imbalance)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
Certain health conditions, including:
+ Bowel blockage
+ Abdominal pain
+ Upset stomach
+ Rectal bleeding
+ Vomiting
+ Changes in bowel habits that have lasted more than 2 weeks
* If you are currently taking mineral oil
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or adjust the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
Certain health conditions, including:
+ Bowel blockage
+ Abdominal pain
+ Upset stomach
+ Rectal bleeding
+ Vomiting
+ Changes in bowel habits that have lasted more than 2 weeks
* If you are currently taking mineral oil
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or adjust the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. To avoid potential complications, do not use this drug for more than 7 days unless your doctor has specifically instructed you to do so. Additionally, refrain from using other laxatives or stool softeners concurrently with this medication unless your doctor has advised you to do so. If you experience rectal bleeding or fail to have a bowel movement after using this drug, consult your doctor promptly. If you are pregnant, planning to become pregnant, or are currently breast-feeding, it is crucial to discuss your situation with your doctor, as you will need to carefully weigh the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe abdominal pain
- Diarrhea (potentially severe, leading to fluid and electrolyte loss)
- Dehydration
- Hypokalemia (low potassium, leading to muscle weakness, cramps, irregular heartbeats)
- Nausea
- Vomiting
What to Do:
Discontinue use. Seek immediate medical attention. Management is supportive, focusing on fluid and electrolyte replacement. Call 1-800-222-1222 (Poison Control Center).
Drug Interactions
Major Interactions
- Mineral oil (concurrent use with docusate may increase absorption of mineral oil, leading to potential for lipid pneumonia if aspirated or systemic granulomas)
Moderate Interactions
- Digoxin (prolonged use of senna can cause hypokalemia, increasing risk of digoxin toxicity)
- Diuretics (thiazide diuretics, loop diuretics - increased risk of hypokalemia with prolonged senna use)
- Corticosteroids (increased risk of hypokalemia with prolonged senna use)
- Antiarrhythmics (e.g., quinidine, amiodarone - increased risk of arrhythmias due to hypokalemia with prolonged senna use)
Monitoring
Routine Monitoring
Bowel movements
Frequency: Daily during use
Target: Regular, soft stools
Action Threshold: No bowel movement after 3 days, severe abdominal pain, rectal bleeding, or continued constipation beyond 7 days (discontinue and consult physician).
Electrolyte levels (Potassium)
Frequency: Not routinely for short-term use; consider for prolonged use or in at-risk patients (e.g., on diuretics, cardiac conditions)
Target: 3.5-5.0 mEq/L
Action Threshold: Below normal range, especially with symptoms like muscle weakness, cramps, or arrhythmias.
Symptom Monitoring
- Abdominal pain or cramping
- Nausea or vomiting
- Rectal bleeding
- Dizziness or lightheadedness (signs of dehydration/electrolyte imbalance)
- Muscle weakness or cramps (signs of hypokalemia)
Special Patient Groups
Pregnancy
Generally, stimulant laxatives like senna are not recommended for routine or prolonged use during pregnancy due to potential for uterine contractions and electrolyte imbalance. Docusate is generally considered safer. Use this combination only if clearly needed and under medical supervision, typically for short-term relief.
Trimester-Specific Risks:
First Trimester:
Limited data; generally avoid stimulant laxatives unless medically necessary.
Second Trimester:
Limited data; generally avoid stimulant laxatives unless medically necessary.
Third Trimester:
Limited data; generally avoid stimulant laxatives unless medically necessary. Potential for uterine stimulation.
Lactation
Both docusate and senna metabolites are excreted in breast milk. Docusate is minimally absorbed by the mother and infant. Senna metabolites can cause loose stools or diarrhea in the breastfed infant, though this is uncommon with typical doses. Use with caution and monitor infant for diarrhea. Considered compatible with breastfeeding by some experts for short-term use.
Infant Risk:
Low to moderate risk of loose stools/diarrhea in infant, especially with senna component. Monitor infant for changes in bowel habits.
Pediatric Use
Not recommended for children under 2 years of age without consulting a physician. For children 2-12 years, use specific pediatric dosing and only under medical guidance. Prolonged use can lead to laxative dependence and electrolyte imbalances.
Geriatric Use
Elderly patients may be more susceptible to fluid and electrolyte imbalances (especially hypokalemia) with prolonged use of stimulant laxatives. Start with the lowest effective dose and monitor closely for dehydration and electrolyte disturbances. Avoid prolonged use.
Clinical Information
Clinical Pearls
- This combination product is intended for short-term relief of occasional constipation, typically when hard stools are a contributing factor.
- Emphasize the importance of adequate fluid intake and dietary fiber alongside laxative use.
- Advise patients that a bowel movement may not occur for 6-12 hours after taking the medication.
- Caution against prolonged use (more than 7 days) as it can lead to laxative dependence, electrolyte imbalances, and worsening constipation.
- Not for use in patients with undiagnosed abdominal pain, nausea, vomiting, or suspected intestinal obstruction.
Alternative Therapies
- Bulk-forming laxatives (e.g., psyllium, methylcellulose)
- Osmotic laxatives (e.g., polyethylene glycol, magnesium hydroxide, lactulose)
- Stool softeners (e.g., docusate sodium monotherapy)
- Stimulant laxatives (e.g., bisacodyl, senna monotherapy)
- Lubricant laxatives (e.g., mineral oil - generally not recommended due to safety concerns)
- Lifestyle modifications (increased fiber, fluids, exercise)
Cost & Coverage
Average Cost:
$5 - $20 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Often OTC, may not be covered by prescription plans unless prescribed. Some FSA/HSA eligible.
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.