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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:

  • Abdominal cramps (Belly cramps)
  • Diarrhea (loose stools)
  • Nausea (rare)
  • Vomiting (rare)

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

Side effect videos Side Effect Videos
ConstipationConstipationDiarrheaDiarrheaPainPain

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.

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

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Senna + Docusate (Senokot-S®, Senna-S®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Senna + Docusate (Senokot-S®, Senna-S®). Depending upon your income, they may be able to help cover the cost of:

  • Senna + Docusate (Senokot-S®, Senna-S®)

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Senna + Docusate (Senokot-S®, Senna-S®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

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References

1) Senokot-S® drug label information.

Created: July 8, 2017 Updated: July 8, 2017

What is Constipation?

Many treatment options for constipation exist. Watch our video to learn more about constipation and available treatments.