A stimulant laxative (dantron with docusate) for palliative care

Co-danthrusate

A combination stimulant laxative used mainly for constipation in people receiving palliative care.

What is Co-danthrusate?

Co-danthrusate is a combination stimulant laxative made of dantron and docusate, used to relieve constipation. Like co-danthramer, its use is limited mainly to constipation in people who are terminally ill, because dantron has been linked to a possible cancer risk in long-term animal studies. It works by stimulating the bowel while the docusate helps soften the stool. It often turns the urine red or pink, which is harmless, and in people who are incontinent it can cause skin soreness or burns with prolonged skin contact, so keeping the skin clean and dry matters.

Education and reference only. This is a plain-language guide to Co-danthrusate — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review
Class: Stimulant laxative combination (palliative care) → Brands: Normax
Co-danthrusate (Stimulant laxative combination (palliative care)) — Meds Global Health reference card
Co-danthrusate — Stimulant laxative combination (palliative care).

What it is

Co-danthrusate is a laxative that combines two ingredients: dantron, a stimulant that makes the bowel move, and docusate, a softener that helps water mix into the stool. Together they relieve constipation. As with co-danthramer, the important point is that its use is restricted mainly to constipation in people receiving palliative or end-of-life care, because dantron has been linked, in long-term animal studies, to a possible risk of cancer. It is taken by mouth as capsules or a liquid and is prescribed by a doctor or specialist team rather than used as a routine laxative.

How it works

Co-danthrusate works in two complementary ways. The dantron part is a stimulant laxative that encourages the muscles of the bowel to contract and move the stool along, while the docusate part is a stool softener that lets water and fat mix into the stool to make it easier to pass. This makes it useful for palliative-care constipation, including the slowing of the bowel caused by strong painkillers such as opioids. As with co-danthramer, the dantron part carries the concern about a possible cancer risk in long-term animal studies, which is why its use is reserved mainly for terminal illness.

Company & origin

Originated / developed by: Generic (long-established).

A combination stimulant laxative (dantron with docusate) used in the UK mainly for constipation in people receiving palliative or end-of-life care.

Practical use

How to take Co-danthrusate

General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.

  • Take it by mouth as prescribed for constipation, usually in the evening.
  • Do not be alarmed if your urine turns red or pink; this is a harmless effect of dantron.
  • Keep the skin clean and dry, and change soiled pads promptly, to avoid skin soreness or burns from prolonged contact.
  • Use it only as prescribed, as it is reserved mainly for constipation in palliative care.
  • Drink enough fluids and tell your team if constipation does not improve.

Weighing it up

Advantages & disadvantages of Co-danthrusate

Advantages

  • Relieves constipation by both stimulating the bowel and softening the stool.
  • Particularly useful for constipation caused by strong painkillers in palliative care.
  • Available as capsules or a liquid to suit different people.

Disadvantages

  • Use is limited mainly to palliative care because dantron has been linked to a possible cancer risk in long-term animal studies.
  • Can cause skin soreness or burns with prolonged skin contact in people who are incontinent.
  • Turns the urine red or pink, which is harmless but can be alarming.

Practical use

Good to know

The same key points apply to co-danthrusate as to co-danthramer. Its use is limited mainly to constipation in people who are terminally ill, because dantron has been linked to a possible cancer risk in long-term animal studies, so it is not a routine laxative. It commonly turns the urine red or pink, which is harmless and not a sign of bleeding, although it can be alarming if unexpected. Importantly, in people who are incontinent or whose skin stays in contact with soiled pads, it can cause soreness or even skin burns where it remains in prolonged contact, so keeping the skin clean and dry and changing soiled pads promptly is important. It is often a helpful choice for opioid-related constipation in palliative care.

Who should not take it / use with caution

  • People who have had a serious allergic reaction to its ingredients should not use it.
  • It should not be used by people with a bowel blockage or undiagnosed tummy pain.
  • It is generally avoided in incontinent people where prolonged skin contact is likely, unless the skin can be kept clean and dry.
  • It is reserved mainly for palliative care rather than routine constipation, because of the dantron cancer-risk concern.

Monitoring

  • Checking that constipation is improving and the dose is right.
  • Watching for skin soreness in people who are incontinent.
  • Reviewing ongoing need, given its use is reserved mainly for palliative care.

Side effects

  • A harmless red or pink colouring of the urine.
  • Tummy cramps or griping pain, as with other stimulant laxatives.
  • Diarrhoea if the dose is too much.
  • Skin soreness or burns where it stays in prolonged contact with the skin in incontinent people.

Key interactions

  • It has few specific medicine interactions, but other laxatives can add to its effect.
  • Severe diarrhoea from overuse could affect fluid and salt balance and the action of some medicines.
  • Tell your team about all your medicines, particularly other bowel medicines.

Available as: Capsules and an oral liquid (suspension).

Answers

Co-danthrusate: frequently asked questions

What is co-danthrusate used for?

It is a combination stimulant laxative used mainly to relieve constipation in people receiving palliative or end-of-life care.

How is it different from co-danthramer?

Both contain dantron, but co-danthrusate is paired with docusate as the softener, while co-danthramer uses poloxamer; the dantron cautions are the same.

Why has my urine turned red?

Co-danthrusate commonly turns the urine red or pink; this is a harmless effect of dantron and is not a sign of bleeding.

Can it harm the skin?

In people who are incontinent it can cause skin soreness or burns where it stays in prolonged contact, so keeping the skin clean and dry is important.

Why is its use limited?

Dantron has been linked to a possible cancer risk in long-term animal studies, so co-danthrusate is kept mainly for terminally ill patients.

The wider class

About Stimulant laxative combination (palliative care)

Co-danthrusate belongs to the stimulant laxative combination (palliative care) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.

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Authoritative sources

  • BNF
  • NICE CKS

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