Consolidating Medications to Reduce Polypharmacy

Constipation is often a chronic problem in the elderly and there are many diseases and obviously many medications that can cause constipation.  There are ways to try to minimize pill burden in this patient population when reducing the actual number may not be possible. Consolidating medications to reduce polypharmacy is one of those strategies.

I will often see patients on chronic opioids also on numerous constipation medications.  Here’s a list of constipation medications I recently came across.

  • Dulcolax 5 mg daily
  • Senna one tablet twice daily
  • Colace 100 mg daily
  • Miralax 17 grams daily

It is always important to try to get the history as to why a patient would be taking duplicate stimulant laxatives like Senna and Dulcolax, but here’s a case where we should be able to discontinue the Dulcolax (bisacodyl) and increase the Senna or vice versa.

Another option to try to reduce pill burden would be to use the Senna-S product which contains the stool softener docusate (Colace) as well as the stimulant Senna.  So instead of the current regimen, we could look to discontinue Dulcolax and Colace and go to Senna-S one tablet twice daily and will likely need to titrate upward another tab or two with the DC of Dulcolax.

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  1. AnneK

    I keep hearing again and again that Docusate is not effective for treating constipation. In fact , I have not seen many studies to prove its effectiveness as a stool softener or for constipation
    Yet, it is most often prescribed as first line in hospitals.
    What are people’s comments on docusate? What is the experience of other pharmacists. Any links to any good articles or research studies on docusate?

  2. BM

    I guess it’s pt specific. I’m anemic- on iron 325 mg – 2 tabs po bid- and Docusate is my best friend! I have tried iron and no Docusate and and it was not a fun experience- brick is all I’m saying! I’m gonna try the senna-s or senna by itself to see how that works- bisacodyl tablet works too, but wow is it wicked!! Colace is great for me so far….but others might need something else to get it mushin and pushin! I don’t need any other problems besides my anemia!


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Written By Eric Christianson

January 31, 2016

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