Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Enema, Rectal:
DocuSol Plus Mini-Enema: Benzocaine 20 mg and docusate sodium 283 mg (5 ea)
Pharmacology
Mechanism of Action
Docusate is a stool softener; benzocaine is a local anesthetic.
Pharmacokinetics/Pharmacodynamics
Onset of Action
Rectal: 2 to 15 minutes.
Use: Labeled Indications
Constipation: Relief of occasional constipation (irregularity) in patients ≥12 years of age who experience painful bowel movements.
Contraindications
OTC labeling: When used for self-medication, do not use for longer than 7 days; when abdominal pain, nausea, or vomiting is present; or concomitantly with mineral oil (oral products only); hypersensitivity to benzocaine or any component of the formulation.
Dosage and Administration
Dosing: Adult
Constipation: Rectal: Benzocaine 20 mg/docusate sodium 283 mg per 5 mL: 5 mL (1 unit) 1 to 3 times daily.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Constipation: Children ≥12 years and Adolescents: Rectal: Enema (benzocaine 20 mg/docusate sodium 283 mg per 5 mL unit): 5 mL (1 unit) 1 to 3 times daily; produces a bowel movement within 2 to 15 minutes; may use up to 7 days or as directed by a physician. Note: If transitioning off bisacodyl product, allow 3 days before initiating benzocaine/docusate therapy; typically not used concomitantly with mineral oil.
Administration
Rectal: For rectal use only. Lubricate tip prior to insertion by placing a few drops of the liquid from the enema on the shaft prior to insertion; may also apply a few drops of enema contents or lubricant to the anus prior to insertion. Gently insert lubricated applicator tip into rectum. Grasp bottle firmly and squeeze slowly to empty the contents. Discard after administration.
Storage
Store at 15°C to 30°C (59°F to 86°F).
Drug Interactions
Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Monitor therapy
Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Monitor therapy
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Monitor therapy
Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Monitor therapy
Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Monitor therapy
Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Monitor therapy
Adverse Reactions
There are no adverse reactions listed in the manufacturer's labeling. Also see Docusate monograph.
Warnings/Precautions
Concurrent drug therapy issues:
- Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Dosage forms specific issues:
- Enema: For rectal use only; lubricate tip prior to insertion. Discontinue use and notify health care provider if rash around the anus/rectal irritation occurs or if resistance is encountered with insertion; forcing the tube may result in injury or damage to the rectum.
Other warnings/precautions:
- Self-medication (OTC use): When used for self-medication (OTC), patients should be instructed to discontinue use and notify a health care provider if rectal bleeding occurs, if a sudden change in bowel habits occurs and persists over 14 days, or if a bowel movement fails to occur after use.
Monitoring Parameters
Periodic rectal exams are recommended in patients with impaired rectal function, especially loss of sensation.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber rectal irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
