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GeriPal has put together a taste test on “Liquid Bowel Medications” which was inspired from a great selection of comments from our previous posts on medications that should never be prescribed to hospice patients. We have a fine selection of medications including sorbitol, lactulose, and liquid (and crushed!) docusate.

The conclusions are pretty clear. First, one should never give liquid docusate (colace) by mouth. Second, one should never, never, never ever crush docusate and mix it with applesauce.

This really begs the question whether colace should be prescribed in the hospice setting or in frail elderly patients, as both groups are at risk for losing their ability to swallow large pills. There is also very little evidence that docusate works. In a 2008 nonrandomized cohort study done in hospitalized patients with cancer, a senna only protocol was more effective than a senna+colace protocol. Even though this study was small, with only 30 patients in each group, it should make us question the continued use of this medication.

by: Eric Widera (@ewidera)

This Post Has 15 Comments

  1. I LOVED this! Everyone should see this. The one thing I wondered is the whole smell thing… Does Lactulose really smell bad, b/c I can imagine that would be a reason to give sorbitol over lactulose, especially for patients who seem to have hyperosmia. So, from the taste test it seems like sorbitol is the winner… Oh, and I also want to see how polyethylene glycol (aka miralax) stacks up, smell and taste wise… Oh and it was nice for you to talk about consistency, though it seemed like sorbitol and lactulose both have similar consistency? (Loved the comment about the legs on lactulose. 😉 All in all, Oscar material!

  2. That was very cleverly done…
    and thanks for getting this message out really loud and clear on FB too!
    I enjoyed this(while I hated my colace testing on Palliative care in the last January!)

  3. That was very cleverly done…
    and thanks for getting this message out really loud and clear on FB too!
    I enjoyed this(while I hated my colace testing on Palliative care in the last January!)

  4. The worst thing about lactulose was the deep green coloration and a very sweet aroma. The consistency is very much like a syrup, so much so that I heard that one patient only would take it if he could poor it over his pancakes (it wouldn't be bad for this purpose). Sorbitol is less of a syrup but still sweet.

  5. Haha! This was great! Next you should try the dietary supplements, like Ensure and Boost. Would love to see your reactions!

  6. Very sophisticated and well controlled reactions to tasting the docusate. Was that because you were being videoed? Because when our patients with dementia are fed this stuff, they push it back out and "refuse" to eat. If we keep putting it in their mouths, often with other tasteful crushed meds, they stop taking anything from the nurses and often start to push away the food. Bad people with dementia. Bad "combative" people with dementia. Must be a personality trait. Could be disease related. Maybe we should give them neuroleptics….. Sigh.

  7. Strong work doctors. Stuff is nasty. All housestaff should be made to taste docusate before prescribing!

    (PEG-3350 is not too bad, pretty neutral overall.)

  8. Patrice—I think your point about patients with dementia is really important. In these patients, liquid docusate (colace) could have serious adverse consequences. It is very easy to see how the situation you describe would happen, where the patient will get agitated anytime a provider comes to them with a medicine or food, in fear that they will be fed some foul conconction.

    There is really no good reason to give a patient liquid colace. Just don't do it. Get this medicine off your hospital, hospice, and nursing home formularies.

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