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Benzocaine and docusate (United States: Not available): Drug information

Benzocaine and docusate (United States: Not available): Drug information
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Brand Names: US
  • DocuSol Plus Mini-Enema [OTC] [DSC]
Pharmacologic Category
  • Analgesic, Topical;
  • Local Anesthetic;
  • Stool Softener
Dosing: Adult
Constipation

Constipation: Rectal: Benzocaine 20 mg/docusate sodium 283 mg per 5 mL: 5 mL (1 unit) 1 to 3 times daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Benzocaine and docusate (United States: Not available): Pediatric drug information")

Constipation

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.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely necessary due to low systemic absorption.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely necessary due to low systemic absorption.

Adverse Reactions

There are no adverse reactions listed in the manufacturer's labeling. Also see Docusate monograph.

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.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

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.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Enema, Rectal:

DocuSol Plus Mini-Enema: Benzocaine 20 mg and docusate sodium 283 mg (5 ea [DSC])

Generic Equivalent Available: US

No

Pricing: US

Enema (Enemeez Plus Rectal)

20-283 mg (per mL): $0.86

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

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. For best results, administer while lying on the left side with knees bent; may also administer while seated on toilet or kneeling with head and chest forward until side of face is resting on the surface. Gently insert lubricated applicator tip into rectum. Grasp bottle firmly and squeeze slowly to empty the contents; keep tube squeezed until removed from the rectum. Discard after administration.

Administration: Pediatric

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. Keep the bottle squeezed until it is removed from the rectum. Discard after administration.

Use: Labeled Indications

Constipation: Relief of occasional constipation (irregularity) in patients ≥12 years of age who experience painful bowel movements.

Medication Safety Issues
Pediatric patients: High-risk medication:

KIDs List: Benzocaine, when used in pediatric patients <2 years of age for teething or pharyngitis, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be avoided due to risk of methemoglobinemia (strong recommendation; high quality of evidence) (PPA [Meyers 2020]).

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Articaine: May increase adverse/toxic effects of Local Anesthetics. Risk C: Monitor

Dapsone (Topical): May increase adverse/toxic effects of Methemoglobinemia Associated Agents. Risk C: Monitor

Local Anesthetics: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor

Methemoglobinemia Associated Agents: May increase adverse/toxic effects of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor

Nitric Oxide: May increase adverse/toxic effects of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor

Prilocaine: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor for signs of methemoglobinemia when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid use of these agents with prilocaine/lidocaine cream in infants less than 12 months of age. Risk C: Monitor

Primaquine: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Primaquine. Specifically, the risk for methemoglobinemia may be increased. Management: Avoid concomitant use of primaquine and other drugs that are associated with methemoglobinemia when possible. If combined, monitor methemoglobin levels closely. Risk D: Consider Therapy Modification

ROPivacaine: May increase adverse/toxic effects of Local Anesthetics. Risk C: Monitor

Sodium Nitrite: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor

Pregnancy Considerations

Refer to individual monographs.

Breastfeeding Considerations

Refer to individual monographs.

Monitoring Parameters

Periodic rectal exams are recommended in patients with impaired rectal function, especially loss of sensation.

Mechanism of Action

Docusate is a stool softener; benzocaine is a local anesthetic.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Rectal: 2 to 15 minutes.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (PR) Puerto Rico: Docusol plus | Enemeez plus | Vacuant plus
  1. Docusol Plus (benzocaine and docusate) [prescribing information]. Phoenix, AZ: Summit Pharmaceuticals; November 2022.
  2. Enemeez and Enemeez Plus (benzocaine and docusate) [prescribing information]. Phoenix, AZ: Alliance Labs, LLC; February 2024.
  3. Meyers RS, Thackray J, Matson KL, et al. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr Pharmacol Ther. 2020;25(3):175-191. [PubMed 32265601]
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