It sometimes drives me crazy to see patients on Colace, or docusate sodium which is its generic drug name. It is known as a stool softener, fairly harmless drug. So many patients may get started on this medication if they have occasional or frequent constipation.  Yes pretty harmless … but also fairly useless too.  It has been shown that docusate sodium is not effective for treating chronic constipation.  As such, many patients who have or at risk for constipation will often need additional laxatives to help manage their constipation because docusate sodium alone is INEFFECTIVE.  Yet we see countless patients on this medication because it is known to be gentle and mild, so what’s the problem?

Many elderly patients cannot swallow pills, so they end up taking their medications crushed and mixed with apple sauce or other soft food. The problem with docusate sodium is that it is a gel capsule that cannot be crushed. One nurse told me that she will use a needle to draw out the medication from the capsule and give to the patient. That’s creative… but takes a lot of work for such a useless drug.  Many times, the capsule may be switched to a liquid formulation so it may be easier to take.   Easier to take – yes but definitely not pleasant to take. If you haven’t tried to taste liquid Colace, you should try it. It looks like a chocolate thick liquid and it is GROSS. Again for such a useless drug that taste disgusting, why are we still shovelling it to the poor patient’s mouth. They have enough other pills to take already.

We are in a culture where a drug is quick to start but seems that we hesitate a lot before we decide it is time to stop a drug.  As in the case of Colace, it is clear from the evidence that it doesn’t work to treat chronic constipation but many physicians may say, what’s the harm in continuing even if it may not work. Why rock the boat when it ain’t broken? Besides, it is a very cheap drug – costs about 3 cents per capsule.

But many don’t appreciate how much work is involved to dispense that little shiny red gel capsule.  Without even thinking about the manufacturing process, the pharmacy needs to first carry the inventory, dispensing in the packaging as appropriate such as a vial, a blister pack, weekly pouch etc. Then it goes through several checks by pharmacy staff, finally delivering the drug to the patient (or hospital ward / nursing home). The nurse then have to verify the medication, open the packaging and put in a medication cup ready for the patient.  If this is a nursing home setting where the patient is frail or has dementia, extra time is needed to allow the patient to swallow the pill, or sometimes find creative ways to ensure the patient takes the medication before he or she wanders off or start acting out.  When considering all the time and resources in getting this shiny red gel capsule to the end user, it definitely costs more than 3 cents.. but wait, it doesn’t work at all and so why are we exhausting all the efforts to prescribe, dispense and administer such a useless drug.  Isn’t it easier and cost effective to just stop the drug?