Treatment Name: Senna + Docusate (Senokot-S®, Senna-S®)

Senna + Docusate (Senokot-S®, Senna-S®) is a Supportive Care Therapy to prevent or treat Constipation

How does senna + docusate work?
Senna + Docusate (Senokot-S®, Senna-S®) is a laxative and stool softener combination designed to both stimulate the bowels and soften stool. Both medications are combined into a single tablet that is available over-the-counter without a prescription. Docusate, without senna, is sometimes referred to as Colace®.

Senna (also known as sennosides) is a natural remedy derived from the senna plant, which acts as a mild stimulant of intestinal movement
Docusate is a detergent that coats stool while it is in the intestine, causing it to absorb water and become soft

Goals of therapy:
Senna + docusate is used to relieve occasional constipation. It can help to keep bowel movements regular during treatments that slow down the intestines. Certain chemotherapy agents, opioid pain medications, certain types of cancer, as well as other medications can all cause the gut to slow down. Senna + docusate is commonly taken on a scheduled basis with the goal of preventing constipation. When a medicine is taken to prevent constipation, it is known as prophylaxis, or prophylactic therapy. Senna + docusate may also be used to treat mild cases of constipation.

Schedule

Senna + docusate (Senna-S) is commonly taken at home on a scheduled basis to prevent constipation and maintain normal, regular bowel movements daily or every other day. Each tablet contains 8.6 mg of senna and 50 mg of docusate. When dosed adequately, senna + docusate usually produces a bowel movement between 6 and 12 hours after a dose. Ask your doctor before starting senna + docusate if you have noticed a sudden change in bowel movements that does not resolve and continues for 1 week or more or if you notice any bleeding from the rectum.

Usual starting senna + docusate (Senokot-S®, Senna-S®) doses:
- 2 tablets by mouth once daily (at bedtime)
  or
- 1 tablet by mouth twice daily
Dosing range, including maximum dose (increase to effect):
- Range: 1 tablet once daily to 4 tablets twice daily

Senna + docusate is usually taken at home. Typical duration of therapy is until senna + docusate no longer works in relieving constipation, or constipation is resolved and senna + docusate is no longer needed. Senna + docusate may be useful in combination with other laxatives long-term to maintain regular bowel movements during treatment.

Side Effects

In the senna + docusate drug label information (Senokot-S®, Senna-S® package insert), the most commonly reported side effects from senna + docusate (Senokot-S®, Senna-S) are shown here. The exact percentages of patients that will experience these side effects is unknown because the frequency has not been defined in the package insert:

Note: Nausea or vomiting may also be due to other medications, conditions, or severe constipation rather than senna plus docusate.

Side effect videos
ConstipationDiarrheaPain

Monitoring

How often is monitoring needed?
Labs (blood tests) are usually not necessary to start or continue senna + docusate therapy

How often is imaging needed?
Imaging may be checked if there is concern of a small bowel obstruction (SBO) or blockage. Imaging may include: Abdominal X-ray, or CT scan of the abdomen and pelvis

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue senna + docusate as planned, add additional laxatives, place you on “bowel rest” (nothing by mouth until the obstruction clears), or switch to an alternative therapy for constipation.

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

Questions to ask your Doctor Nurse Pharmacist

Questions to ask your Nurse Doctor Pharmacist

Questions to ask your Pharmacist Doctor Nurse

ChemoExperts Tips

Senna + docusate is an inexpensive, yet effective over-the-counter remedy for constipation
We refer to docusate + senna as “the mush and the push”, as the tablet combines a stool softener (the mush) with a stimulant (the push) to move stool along. The combination of these two medications helps to minimize passing hardened stools which can be experienced by those who use senna alone
To maintain regular bowel movements, scheduled senna + docusate may be combined with over-the-counter polyethylene glycol (Miralax®) as needed. Talk to your doctor or pharmacist if you have trouble maintaining normal bowel movements
Walking helps to stimulate the bowels to move stool down the intestinal tract. A diet high in fiber (found in fruits, vegetables, and whole grains) also helps to maintain a healthy colon (large intestine)
If you are receiving chemotherapy, do NOT attempt to use an enema or suppository unless you have discussed this with your doctor. Use of enemas or suppositories could cause a tear in the rectum and may lead to a serious infection
It is important to have regular bowel movements, usually once daily or every other day. Otherwise, your small bowel (intestine) may become blocked. Call your doctor if you have not had a bowel movement for 3 days or more, especially if you feel bloated. If you feel pain in your abdomen/belly, feel nauseated, or vomit at any point while constipated, call your doctor immediately
A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
Senna + docusate can be stored at room temperature between 59°F – 86°F

Patient Assistance & Co-payment Coverage

References

1) Senokot-S® drug label information.

Created: July 8, 2017 Updated: October 24, 2018

What is Constipation?

What is constipation?

Constipation means bowel movements happen less often than usual, or the stool becomes hard, dry, or difficult to pass. Constipation does not only mean “not going often,” but can also include straining, feeling like the bowel does not empty fully, or having pain when trying to go.

What does constipation look like?

Constipation may look like fewer bowel movements, hard or lumpy stool, straining, stomach cramps, bloating, or a feeling of fullness. Some patients also feel nauseated or have a decreased appetite because stool is moving too slowly through the intestines. In very severe cases, stool can build up in the intestines and cause a blockage.

Who gets constipation?

Constipation can happen due to low fluid intake, not enough dietary fiber, decreased physical activity, changes in routine, or certain medications. In patients with cancer, constipation is common because cancer treatment can affect diet, activity, and normal bowel function. One common cause of constipation in patients with cancer is the use of opioid pain medications. Opioids slow the movement of the intestines, reduce normal gut secretions, and can make stool drier and harder.

How is constipation prevented?

Prevention usually starts with simple daily habits such as drinking enough fluids, staying as active as possible, and eating fiber when appropriate. Patients who are at high risk of constipation, such as those receiving opioid pain medications, may be started on a bowel regimen with certain laxatives to help prevent constipation. Medications that are commonly used as part of a bowel regimen include sennosides + docusate (Senna-S®) and polyethylene glycol (MiraLAX®).

How is constipation treated?

Treatment depends on the cause and how severe the constipation is. Common medication options include stimulant laxatives, osmotic laxatives, and enemas. Stool softeners help make stool easier to pass, while stimulant laxatives help the bowel contract and move stool along. Osmotic laxatives work by pulling water into the bowel to soften stool and help it move. Some examples of these medications, most of which are available over-the-counter (OTC), include:

Stimulant laxatives
- Sennosides (Senna®)
- Bisacodyl (Dulcolax®)
Osmotic laxatives
- Polyethylene glycol (MiraLAX®)
- Magnesium citrate
- Magnesium hydroxide
- Lactulose
- Sorbitol
Enemas
- Sodium phosphate (Fleet®)
- Mineral oil
- Glycerin
- Tap water

For patients that have low white blood cells (neutrophils) or low platelets, it is not recommended to treat constipation with enemas.

For constipation related to opioids, if regular laxatives do not work well enough, some patients may need additional medications that are specifically used for opioid-induced constipation such as methylnaltrexone (Relistor®), naldemedine (Symproic®), or naloxegol (Movantik®).

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.