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Prenatal Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Gabriele Saccone, Kerri Sendek
Constipation is common in pregnancy, probably because of decreased bowel peristalsis (possibly related to increased progesterone). Constipation is reported by nearly 70% of women in the mid-trimester. In nonpregnant adults, exercise, increase in water intake, dietary counseling, and certain foods (e.g., prunes) have been shown to relieve constipation. If these self-help measures are inadequate, the pregnant woman should then try daily bran or wheat fiber supplements. There is insufficient evidence to comprehensively assess the effectiveness and safety of interventions (pharmacological and nonpharmacological) for treating constipation in pregnancy, due to limited data (few studies with small sample size and no meta-analyses). Compared with bulk-forming laxatives, stimulant laxatives (e.g., senna 14 mg or dioctyl sodium succinate 120 mg and dihydroxyanthraquinone 100 mg—Normax) appear to be more effective in improving constipation (moderate-quality evidence), but are accompanied by an increase in diarrhea and abdominal discomfort. Docusate sodium is a similar stimulant laxative, and it is widely available. Additionally, dietary fiber supplements (e.g., 10 mg/day of either corn-based biscuits—Fibermed—or 23 g wheat bran) increase the frequency of defecation and are associated with softer stools [139]. These findings in pregnant women are consistent with nonpregnant evidence.
Gastrointestinal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Liquid paraffin, castor oil and soap enemas should be avoided in pregnancy. Docusate sodium (dioctyl sodium sulphosuccinate), which acts as a stimulant as well as a softening agent, is safe for use in pregnancy.
Motility disorders
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Second-line therapy would involve the addition of an osmotic laxative such as lactulose or magnesium salts (Table 7.4). Further therapy would include bowel stimulants such as bisacodyl, senna or sodium picosulphate. Stool softeners such as docusate sodium are unpredictable in their effects. In severe cases, rectal enemata such as sodium phosphate or sodium citrate may be beneficial. A recent metaanalysis of differing pharmacological therapies in constipation found a paucity of well-conducted randomized controlled trials. It concluded, however, that both fibre and laxatives increase bowel frequency. Fibre improved the associated symptoms of pain, whereas cisapride and lactulose improved stool consistency. There was no convincing evidence of the superiority of fibre over laxatives, or whether one class of laxatives was superior to another.97
Analysis of the economic burden of docusate sodium at a United States tertiary care center
Published in Hospital Practice, 2023
Alexander J Kaye, Suzanne Atkin, Aidan Ziobro, Jason Donnelly, Sushil Ahlawat
There are several medication options that can be used to treat constipation in the hospital. Docusate sodium (hence forth docusate) is a well-known stool softener and a commonly used agent for treating constipation in the inpatient setting. Docusate acts as a surfactant laxative, theoretically creating a lower surface tension between an oil and water interface of the stool, allowing for easier passage [8]. It has been well established that docusate is an ineffective medication [9–11]. Not only is docusate known not to have clinical benefit, it also carries the potential harms of polypharmacy, an unpleasant taste with lingering aftertaste, a delay in the administration of more effective constipation medications, and possible impaired absorption of other medications [11–14].
Prescribing patterns for treating common complications of spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Shikha Gupta, Mary Ann McColl, Karen Smith, Alexander McColl
Bowel dysfunction after SCI affects 95% of people resulting in difficulty in evacuation, constipation, and bowel incontinence.19 Seventeen prescriptions were issued for this condition – 11 (65%) were stool softeners, specifically Colace/Soflax/docusate sodium. An additional 17 (16%) participants were issued 20 prescriptions for 8 different drugs to manage upper gastro-intestinal complaints. The majority of these medications (90%) were anti-reflux agents, such as proton pump inhibitors (especially Pantoprazole) and H2 agonists. Others included anti-emetic agents and bile-acid sequestrants, each prescribed to two patients.
Therapies for multidrug resistant and extensively drug-resistant non-fermenting gram-negative bacteria causing nosocomial infections: a perilous journey toward ‘molecularly targeted’ therapy
Published in Expert Review of Anti-infective Therapy, 2018
Nadim G. El Chakhtoura, Elie Saade, Alina Iovleva, Mohamad Yasmin, Brigid Wilson, Federico Perez, Robert A. Bonomo
Bcc organisms are also remarkable in their ability to contaminate environmental surfaces and drug solutions and cause outbreaks in vulnerable populations including hospitalized and intensive care unit patients, cancer patients and transplant recipients [61–69]. A recent report describes a multi-state outbreak related to oral liquid docusate sodium, a common stool softener [70,71]. Owing to lifestyle-specific chlorhexidine tolerance mechanisms via efflux pump mutants, Bcc organisms can also contaminate disinfecting solutions such as the widely used chlorhexidine and can be a cause of outbreaks in that context [72,73].