Mila kula anganggit sêrat punika, supados kawontênanipun têtuwuhan tuwin oyod-oyodan ingkang kathah paedahipun, sagêda kasumêrêpan ing akathah, dene ingkang kula wastani têtuwuhan wau kathah ingkang kaanggêp rêrungkudan kemawon, inggih lêrês ngantos sapriki jampi Jawi sampun kangge, ananging kadospundi kanggenipun sarta rekanipun angangge jampi wau, makatên ugi namanipun tanêman ingkang kangge jampi asring kadamêl wados, mila pangupadosipun katêrangan bab jampi-jampi Jawi asring botên sagêd kadugèn, sarta kawruh bab jampi-jampi wau asring ical sarêng ingkang gadhah kawruh wau tilar ing donya, awit kawruhipun dipun damêl wados.

Senin, 05 September 2011

SENNAE FOLIUM 23 - Pelangsing Alami

SENNAE FOLIUM 23 - Pelangsing Alami


Use a Senna Laxative and Improve Digestion!

You may have come across a lot of products containing herbs which have specific uses for specific situations.  Some of them may help in weight loss, others in increasing appetite.  All this is good, however you need something to balance out the equation, something that helps you cleanse your body on a regular basis.  What you need is Senna, a natural herb that is recognized for its laxative properties.  You can find this specific herb used in a lot of laxative products out in the market, with an active compound known as Anthraquinones being the major agent in prompting your body to eliminate all stored wastes in the instestines, pushing all those unneeded toxins forcefully out of your body.  It’s also quite fortunate that this herb absorbs water, making it more convenient for you to perform bowel movement, especially if you’ve been experiencing constipation for a lot of times.  There are a lot of herbs that are known for its different uses. One of these herbs is Senna. Senna is a natural herb usually used for its laxative properties. Sometimes, it is used in other laxative products. The reason why it has laxative properties is because of an active compound called Anthraquinones which is works by aggravating the lower intestinal tract and prompts the body that you would need to push out waste. The good thing about this is that it absorbs water and this makes the stools easier to pass especially for those who are naturally constipated.  If you’re looking for some means to help you achieve good digestion, then perhaps you’d like to look into a Senna Laxative.

This one of a kind stimulant works great for people who also have hemorrhoids, as well as those who’ve had their share of rectal surgery.  It immediately takes effect after consumption, so your body wouldn’t have time to absorb any liquid substances, causing your stool to be a lot softer and easier to let out.  This eases any inconvenience you feel in your rectum.  Take note, you may also experience some cramps when using senna-based stimulants so make sure you follow the instructions on the correct consumption.

You don’t need to take in large doses at first, give it some time before your body gets used to the effects.  It’s truly helpful for people experiencing constipation, but as stated, always remember to use it correctly.  If you are in dire need of a colon cleansing, then you’re best finding something that packs a bit more punch compared to other stimulants containing such an ingredient, but trust me when I say you don’t want to this regularly.
Any Senna laxative can make for a very good alternative to weight loss, apart from relieving you of constipation and indigestion problems.

Cegah OBESITAS dengan senna leaf

Daun senna atau Cassia angustifolia, tanaman perdu dari daerah Arab atau Afrika Utara. Sejak 3500 tahun yang lalu, tanaman ini sudah digunakan untuk mengobati kaum bangsawan dan elite. Popularitas daun sena sebagai herba meningkat ketika tanaman ini menyebar ke Eropa.

Selama berabad-abad daun senna sudah digunakan sebagai obat untuk menghilangkan sembelit, penyakit yang disebabkan oleh konsumsi makanan berkualitas buruk. Jika sembelit berlanjut, akan menjadi racun bagi tubuh. Karena mengandung komponen anthraquinon atau sennosida seperti glikosida dianthrone, naftalene glikosida dan hidroksianthrasen, daun senna sering digunakan untuk mengatasi konstipasi. Senosida mempercepat gerakan hasil pencernaan di usus sehingga menaikkan volume hasil pencernaan dan meningkatkan gerakan peristaltik usus sehingga air yang terserap usus terserap oleh usus sedikit dan feces tetap lembek. Daun senna sangat efektif dalam melarutkan lemak dan racun untuk mengembalikan kebugaran tubuh, efeknya akan terasa 10-12 jam berikutnya.

SENNA nama asli dari teh daun jati cina tanaman asli Afrika, Timur Tengah (khususnya Mesir dan Sudan). Pertama kali diperkenalkan pada abad ke-9 karena efek medisnya oleh ahli medis Arab, Serapion dan Sesue yang kemudian memberinya nama dalam bahasa Arab dan menggunakannya sebagai laxative atau obat pencahar.

sumber:
http://apps.who.int/medicinedocs/en/...tml#Js2200e.26
http://mahkotadewa.net/kesehatan/teh...jati_cina.html
http://www.florahealth.com/flora/Hea.../SennaLeaf.htm



SENNAE FOLIUM 22 - Pro dan Kontra

SENNAE FOLIUM 22 - Pro dan Kontra


The Pros And Cons Of Senna Leaf

Senna leaf is a popular herbal medicine used by many people from the past centuries and even until now because of the benefits that if offers to people who use them. This is usually used as an herbal pill or a tea that a lot of people take since it is a great laxative. This is the best cure for people who suffer from constipation since the active ingredient of this herbal medicine helps in getting rid of your bodily toxins. Many people use this herbal medicine in order to help them avoid colon cancer.

In case you are one of those people who are weight conscious, then you may also use this herbal medicine since this can help you lose weight. This is very effective since many people who are very watchful of their diet and those people who want to get rid of their excess fats proved that this herbal medicine can really help you get rid of toxins which would sometimes be the result of people gaining a lot of weight. Because of the active ingredient which makes it an active laxative, this is usually found in most diet pills which promise to keep people thin.

This herbal medicine might be approved by many people but there are some who contradicts such use of this herbal medicine. Since such herb is a very powerful laxative, people who use them would not know when they need to go to the bathroom. It is definitely not advisable for those people who work in offices or those who do not work from their homes because you would not be able to control your bowel movement. This is also not advisable for pregnant women because it might lead to premature contractions which might cause premature delivery or worse, miscarriage.

It may also cause dehydration since once you take such herbal medicine, you might suffer from uncontrolled diarrhea, thus the problem of dehydration and aside from that, you might also experience stomach cramps which is often experience by people who are suffering from diarrhea.

These are the pros and cons when taking advantage of such senna leaf and if you want to try it out, you may want to consult your physician so as to advise you whether or not it can help you get rid of the toxins and clean your colon or if it really is a great idea for people who want to lose weight or not. Always remember that when taking any medicine, it would always be a smart idea to consult your doctor first so you would not be able to deal with problems that might be caused by taking something which is not healthy and not the right thing to do.


The Pros and Cons of Senna Tea

Senna tea is an ancient global remedy for constipation.
Source: Wikimedia Commons

Senna tea, or senna leaf tea as it is sometimes known, has been used for centuries to treat constipation. While it is most commonly used as a laxative, recently it has been getting a great deal of attention from dieters who believe that drinker senna tea will help them slim down and lose weight. While there are are some excellent medicinal qualities to senna leaves, there are also some serious side effects to this powerful herb.

Senna refers to a genus of approximately 250 species of perennials, shrubs, and trees growing in various parts of the world. Senna alexandrina grows in the Middle East, Southeast Asia, China and parts of Africa - namely Saudi Arabia, Djibouti and Somalia. Senna was introduced to Europe by Arabian physicians somewhere around the ninth or tenth century as a laxative. It is also sometimes known by the names Alexandrian senna or Tinnevelly senna. Senna marilandica grows wild throughout the midwestern United States and is a much hardier version of senna. Native Americans also used it as a laxative.

Benefits of Senna Tea


While Senna Tea has been mainly used as a natural stool softener and home remedy for constipation, different species have various other medicinal qualities. Infusions are made by steeping leaves or in some cases the black pulp of branches to make medicinal teas. Alexandrian senna has been used for hundreds of years as a laxative, and is still the primary ingredient in many commercially prepared laxatives. When made as a herbal tea, senna leaves are often accompanied by coriander to reduce stomach cramping or griping. Senna tea has a sweet taste and a pleasant aroma. In some parts of the world, senna leaf tea is simply enjoyed as a flavorful alternative to hot coffee or tea. These teas are made with a milder species of senna than the senna alexandrina used as a laxative.

Species of Senna Leaf  
Medical Condition Treated  
alata
ringworm
obtusifolia
ringworm
sophera
ringworm
sieberiana
venereal disease
obtusifolia
hypertension, high cholesterol, constipation,skin diseases, eye disorders
surattensis
venereal disease
reticulata
bacterial and fungal infections
fistula
mild treatment for constipation
marilandica
mild treatment for constipation
alexandrina
strong treatment for constipation
Senna leaf tea is used for a variety of ailments.

Dried senna alexandrina commonly prescribed for constipation.
Source: Wikimedia Commons

Senna leaves are brewed into a robust tea, explaining the nickname "Coffeeweed."
Source: Wikimedia Commons

Dangers of Using Senna Tea

Too frequently people assume that because something is "all-natural" or made without chemicals it is safe to use as desired. It is also human nature to believe that because an item is for sale in a retail store such as a health food store or natural remedy website, it is safe to use. Herbal remedies have been prescribed through the ages by experienced herbalists and practitioners of natural medicine, and patients would be warned of side effects and the dangers of interacting herbs. Now that herbal teas and supplements are so easily accessible to anyone online or in a retail store, it is imperative to understand exactly what is contained in the natural remedy you are considering. Senna is an excellent example of how the powerful properties of some herbal remedies can make the users seriously ill, or even cause death. Senna goes to work fast - it can cause bowel movements that are quick and violent. Senna leaves can interact with commonly prescribed medication for diuretics (to induce urination) and many heart medications. It can also have a negative reaction when taken with over-the-counter medication such as Tylenol or milk of magnesia, and other herbs such as aloe vera or rhubarb. This is especially concerning given the number of people experimenting with "senna slimming tea" for it's laxative and appetite suppressing properties, or for those who are drinking excessive quantities of the tea as part of a colon cleanse. Excess or frequent drinking of senna leaf tea can cause the following:
  • nausea
  • vomiting
  • abdominal pain, cramping, or griping
  • inflammation of the gastro-intestinal tract
  • deterioration in bowel function
  • rounding or clubbing of fingers and toes
  • damage to the colon
     
  • can be addictive - there IS such a thing as laxative dependency which occurs in individuals with eating disorders.
     
Senna leaf tea is NOT safe for pregnant women or nursing mothers, or people with hemorrhoids, ulcers, colitis or spastic constipation. It should only be taken in consultation with an experienced herbalist or naturopath.

If You Buy Senna Tea

If you are planning to purchase senna leaf tea, consider that there isn't a standard requirement for the potency or species of senna used - there isn't a government regulation in Canada or the United States requiring the disclosure of this information on the packaging. Unless you are comfortable with your own research into the brand or it is recommended by your health practitioner, please exercise caution when purchasing senna tea. Begin with a very small dose of the tea to determine your body's reaction to it. Do not continue taking senna leaf tea for more than one week at a time. Should you experience extreme stomach cramping or numbness or swelling of the mouth, tongue or lips seek medical attention immediately.




SENNAE FOLIUM 21 - Constipation 4

SENNAE FOLIUM 21 - Constipation 4

Stimulant Laxatives and the Digestive Tract

Constipation (and also hemorrhoids) is an embarrassing condition that no one likes to discuss.
The truth is constipation is something many people in the Western world suffer from on a chronic (long-term) basis.
Both chronic and acute (abrupt onset) constipation can be a significant source of discomfort. Moreover, the extra straining to pass stool can cause hemorrhoids, or make pre-existing hemorrhoids worse, so constipation is something to avoid if at all possible.
Laxatives are frequently used to treat constipation yet most people don’t know exactly what they are, how they work or that the long-term abuse of self-administered stimulant laxatives can have long-term effects on the way your bowel works.
This article is going to give a description of how laxatives work. It is also going to discuss the worrisome side effects of stimulant laxatives, and the dangers of laxative abuse.
Finally, it will suggest safe ways to take stimulant laxatives on a long-term basis.

Why Do We Become Constipated?

In order to understand how laxatives work, it’s important to know why we become constipated in the first place.
One of the reasons we become constipated is because there’s not enough gut motor activity to propel the stool toward the rectum and completely evacuate the bowels.
Stool is formed in the colon, which is at the lower end of the gastrointestinal tract. By the time digested food reaches the colon, most of the nutrients have been absorbed.
It’s your colon’s job to remove fluid from the intestinal contents and expel the waste.
Your colon does this by absorbing fluid and using muscular peristaltic contractions to push the stool to the rectum which acts as a temporary storage facility for the unneeded material. As the rectal walls expand, a nervous signal is generated, stimulating the desire to defecate.
Normally, waste products are excreted within 35 - 70 hours, resulting in a normal bowel movement 3-12 times per week. However, if there’s a slowing of peristalsis then the colon has more time to soak up water from the stool and it can become hard and dry so it’s difficult to expel.
Equally, if there’s anything affecting the muscles, then it doesn’t matter how many nerve impulses arrive, not much will happen. That’s a form of constipation.

How is Constipation Treated?

There are a number of different approaches to treating constipation including lifestyle measures and laxatives.

Lifestyle measures as a treatment for constipation

Potentially beneficial lifestyle changes for temporary constipation include increasing intake of dietary fiber, increasing fluid intake, and enhancing physical activity.
Slowly increasing the amount of fiber in the diet to 20-25 g per day may improve bowel function by adding bulk and softening the stool.
There aren’t any data from placebo-controlled studies that support the use of hydration, or even exercise as primary therapies for chronic constipation. Nevertheless, some people may benefit from these easy first line types of therapies. And, there are other benefits that could accrue from things such as increasing exercise.

Laxatives as a treatment for constipation

If lifestyle measures are not effective, you should try laxatives.
Basically, there are four types of laxatives as summarized in Table 1: Bulking agents, osmotic laxatives, stimulant laxatives, and stool softeners.i

Table 1. Laxatives Commonly Used for Constipation
Type of Laxative Maximal Recommended Dose
How It Works
How Long It Takes
Bulking Agent  

 
Bran fiber Psyllium (Metamucil)
Methylcellulose (Citrucel)
Polycarbophil (Fibercon)
Titrate up to 20 g
Absorbs water to form soft, bulky stool
12-72 h
Osmotic Laxative  

 
Saline laxative: Magnesium hydroxide
Sodium phosphate
Poorly absorbed sugar:
Lactulose, sorbitol, mannitol, lactitol, glycerin suppositories
Polyethylene glycol 3350 (Miralax)

15-30 ml once or twice daily
10-25 ml with 12 oz of water as needed

15-30 ml once or twice a day
17-36 g once or twice a day
Draws water into the colon from surrounding tissues prompting normal contraction of intestinal muscles
1 h-several days
.
. 30 min- 3 h
Stimulant Laxative  

 
Diphenylmethane derivatives:Bisacodyl (Dulcolax, Correctol)
Sodium picosulfate (Lubrilax, Sur-lax)
Anthraquinones:
Senna (Senokot, Ex-Lax)
Cascara sagrada (Colamin, Sagrada-lax)
Castor oil (Purge, Neoloid, Emulsoil)

5-10 mg every night
5-15 mg every night

 
187 mg daily (equivalent to 20-30 mg sennoside B)
300 mg (or 5 ml) daily (equivalent to 20-30 mg cascaroside A)
15-30 ml daily
Triggers peristalsis in addition to water and electrolyte secretion to eliminate stool
6- 24 h
Stool Softener  

 
Ducosate 100 mg twice a day
Works by making your stools more permeable to fat and water making them softer and easier to pass.
12 h- 5 days

Bulking agents, mainly fiber, but also other polymers, accomplish their action by increasing the volume of the stool, and will both soften the stool and increase colonic activity. This stimulates the bowel to pass the stool in a normal manner; gas and bloating are common side effects. Bulking agents may work as quickly as 12 hours after use or take as long as 3 days to be effective.
Osmotic laxatives pull water into the bowel from surrounding tissues which increases the size and pliability of the stool. When ingested on an empty stomach, they may take only 1 to 2 hours to take effect. Dehydration can occur when osmotic laxatives are overused.
Stimulant laxatives increase colonic motility and secretion by stimulating the colonic nerves. They work within 6 hours when administered orally and within 30 minutes to 2 hours when given intrarectally. Stimulant laxatives may cause abdominal cramps.
Stool softeners soften stool by allowing water to interact more effectively with solid stool. Ducosate is also thought to exert a stimulant laxative effect. A laxative effect usually occurs within 1 to 3 days of administration. But your body can quickly get tolerant of these, so they’re unlikely to be much use for a chronic situation.

What Are the Major Stimulant Laxatives?

The major stimulant laxatives are diphenylmethane derivatives and anthraquinones.
Diphenylmethane stimulant laxatives (e.g., bisacodyl) have a profound effect on colonic stimulation and are unique in that dosing titration is based on an individual’s response versus a conventional dosing range.
Anthraquinone stimulant laxatives are naturally occurring herbal products (glycosides) found in extracts of senna leaf and pod (a Middle Eastern laxative), aloe (known worldwide), cascara sagrada (a North American laxative), buckthorn (also known as frangula; a European laxative), and rhubarb root (the prominent Chinese laxative).
Anthroquinone glycosides are converted by colonic bacteria to their active form. These molecules promote water retention in the stool and stimulate increased peristalsis. Onset of action is 6 hours, which is the time required for transport of the laxative to the colon. With rectal stimulation, the time to evacuation is within 30 minutes to 2 hours.
As summarized in the Table below, anthoquinone laxatives include senna, aloe, cascara sagrada, buckthorn, and rhubarb root.

Herbal Stimulant Laxatives Plant Active Ingredient Intermediates
Senna Cassia angustifoliaCassia acutifolia Sennoside A+B Rhein
Aloe Aloe ferox Aloe barbadensis Aloines A+B Aloe-emodin
Cascara sagrada Rhamnus purshiana Cascaroside A+B Aloe-emodin
Buckthorn (frangula) Rhamnus frangula Franguline A+B Emodin
Rhubarb root Rheum palmatum Sennoside A+B Rhein, emodin

Note: To clear up any confusion, the active ingredients in the table above are all types of Anthroquinones. For example 20mg of sennoside B is also the same as saying 20mg of anthroquinones. It is important to understand this, to understand fully the discussion below.
Senna. The dried leaflets and pods of Cassia senna is most often referred to as senna. These preparations contain the strong glycosides sennoside A and B. The typical dose is 187 mg (equivalent to 20-30 mg of sennoside B). Similar activities are found in Rhubarb root preparations, although rhubarb is more commonly used in Asia.
Cascara sagrada. Considered “sacred” bark by those using it, cascara sagrada comes in a variety of forms, in tablets, capsules, and liquid extracts. It is cascaroside A+B which give cascara sagrada its laxative action. A typical dosage of cascara sagrada is 300 mg capsule (corresponding to 20-30 mg cascaroside A) taken in the early evening to stimulate a bowel movement in the morning.
Aloe. Alois powder is the solid residue obtained by evaporating the liquid which drains from the cut leaves of Aloe ferox. It is the aloin that is converted into emodin-derivatives within the colon that is responsible for its laxative effect. The optimum dose is the smallest dosage necessary to obtain a soft stool; for many this is one 250 mg capsule while others may need 450 mg or more to obtain this effect.
Anthroquinones are also present in vegetables such as cabbage and lettuce, being particularly high in beans (36 mg/kg fresh weight). Needless to say, these vegetables are very effective in helping overcome constipation.
Herbal stimulant laxatives are frequently used to treat constipation because they are assumed safe. However, you should understand that herbal products are not reviewed or approved by the US Food and Drug Administration, and that many questions regarding their efficacy and safety profiles remain unanswered. The use of herbal stimulants should be considered only after lifestyle, and bulk laxatives have proven ineffective.
They are contraindicated in cases of bowel obstruction, acute intestinal inflammation and abdominal pain of unknown origin. They should not be used in children under 12 or in pregnant or nursing mothers.

What Are the Side-Effects of Stimulant Laxatives?

The side-effects of stimulant laxatives are:
  • Diarrhea
  • Loose stools
  • Vomiting
  • Abdominal cramps
  • Bloating
  • Rectal irritation
Cascara sagrada and senna commonly cause yellow-brown urine; this is harmless.
Stimulant laxatives work by increasing rhythmic muscle contractions (peristalsis) in the colon. Thus, they may induce abdominal discomfort and even cramping abdominal pain, ii as you might expect.
There are other side-effects of stimulant laxatives. If you have any of the following symptoms, stop taking them and call your doctor immediately:
  • Bloody stools
  • Severe cramping
  • Pain
  • Weakness
  • Dizziness
  • Unusual tiredness
  • Rectal bleeding
  • Unrelieved constipation
Overuse and abuse of stimulant laxatives can cause diarrhea and potassium deficiency, which can lead to muscle weakness and heart function disorders.

Safety Issues Affecting Stimulant Laxatives


Are stimulant laxatives dangerous?

Yes. Although anthraquinone stimulant laxatives are generally considered harmless because of their natural origin, several health problems may arise from their prolonged use, including electrolyte imbalance, particularly potassium deficiency, cathartic colon,iii melanosis coli,iv and increased risk of colorectal cancer.v
Let’s look at the concerns regarding the safety of aloe as an example.

Safety of aloe a concern

Aloe, a popular houseplant, has a long history as a multipurpose folk remedy. Because aloe is well-known as a gently external treatment for minor burns and skin irritations, it’s easy to assume that it would be safe for use internally as well. But this is not necessarily true. Even though aloe vera is a plant, it contains anthroquinones (aloines A+B, aloe-emodin) which produce a laxative effect by increasing colonic peristalsis and intestinal water content. In plain English, this means that aloe causes faster and stronger contractions of the colon which may produce violent abdominal cramps, painful spasms, and diarrhea, especially at higher doses.
All anthroquinone-containing stimulant laxatives (not just aloe, but senna and cascara sagrada as well) can cause melanosis coli, cathartic colon, and possibly increase the risk of colorectal cancer. In fact, genotoxicity studies show that aloe-containing laxatives pose cancer risks to humans even when used as directed!
And if this isn’t bad enough, chronic use of aloe can also lead to serious medical consequences such as potassium deficiency, which can lead to muscle weakness and heart function disorders, steatorrhea, gastroenteropathy, osteomalacia, and vitamin and mineral deficiencies. In addition, aloe may interact negatively with a number of pharmaceuticals, including thiazide diuretics. Even after discontinuing the use of laxatives, changes in the colon may only partially return to normal because of permanent drug-induced nerve damage to the colon.
What’s really scary about aloe is that it’s a very common ingredient in all sorts of liquid vitamin, energy boost drinks, and these product labels won’t note that aloe is a laxative.
Aloe is even specifically marketed to people with Irritable Bowel Syndrome or chronic constipation as a “digestive aid”, “soothing to the bowel”, with an emphasis on the fact that it’s an all-natural plant ingredient, which again just hides the fact that it is without doubt a harsh stimulant laxative.
It’s possible to find aloe from which the anthraquinones have been removed. If this is the case, the label should specifically say so, or something to the effect that “diarrhea-causing ingredients”, “aloin and aloe emodin” have been removed from the product.

What Is Cathartic Colon?

Cathartic colon is a historic term for the anatomic alteration of the colon secondary to chronic stimulant laxative use.
Physicians generally warn against the use of stimulant laxatives due to concern the colon resulting in a “sluggish” colon.
Studies have shown that chronic (>3 times/week for 1 year or longer) use of anthraquinone glycosides is associated with destruction of nerves within the colon, suggesting that chronic use causes the colonic tissues to get worn out over time and not be able to expel stool due to long-term overstimulation.vi, vii Both oral (sodium phosphate and anthraquinones) and rectal (bisacodyl) administration of anthraquinones have been reported to cause colon damage.viii,ix Thus, all attempts should be made to move to bulk-forming laxatives and refrain from chronic use of stimulant laxatives.
Signs and symptoms of cathartic colon include chronic constipation, bloating, and a feeling of fullness, abdominal pain, and incomplete fecal evacuation.

Melanosis coli


What is Melanosis coli?

Melanosis Coli is asscoiated with the long term use of stimulant laxatives
Melanosis coli in the above picture is the dark circular looking area. This picture of melanosis coli was apparently taken from the wikipedia commons, where it's license for use can be found.
A common finding reported with chronic use of anthraquinone laxatives is increased pigmentation of the intestinal mucosa called melanosis coli. Melanosis coli usually develops 9 to 12 months after the daily use of anthroquinone-containing laxatives, and is diagnostic of laxative abuse.
While this has been determined to be a benign condition that decreases over time with discontinuation of stimulant laxatives,x, xi it often alters the ability to diagnose other colon problems.
Melanosis coli has been observed more frequently in patients with colorectal cancer although the significance of this finding is unclear.xii

Do Stimulant Laxatives Cause Colorectal Cancer?

There is no evidence to support the idea that anthroquinone stimulant laxatives cause colorectal cancer.xiii
However, more individuals with colorectal cancer display signs of stimulant laxative abuse than individuals without colorectal cancer. xiv
In a prospective study of 1095 patients, the incidence of melanosis coli was 18.6% for patients with colorectal cancer. As discussed earlier, melanosis coli is a fairly reliable marker of chronic stimulant laxative abuse (>9 to 12 months).xv Thus, a significant number of patients with colorectal cancer were chronically using stimulant laxatives. In fact, all patients with melanosis coli acknowledged abuse of anthraquinones for between 10 and 30 years.

How Long Can Stimulant Laxatives Be Used?

Stimulant laxatives are traditionally advocated for short-term use (< 2 weeks) because they can damage the colon, cause melanosis coli and cause laxative dependence (see below).
But most warnings against over use of stimulant laxatives are, I think, aimed at people who might use them occasionally without knowing why they are constipated and end up using them more and more without ever getting checked out. Then, if one day what you have is a bowel obstruction or colon cancer, you might have put off seeing a doctor and instead relied upon the laxatives for symptom control for much too long.
That said, if you know that your gut is in good condition, you should know that it is common practice in pain management centers to recommend stimulant laxatives for DAILY use in patients who are on long-term opiates for pain control. Opiates slow down peristaltic activity so even if your stool is softer, that won’t necessarily help it to come out any easier (that’s where a stimulant laxative comes in).
Many patients who were on this regimen, who no longer needed opiates, returned to normal regularity without a problem.
Anthraquinones (20-30 mg sennosides daily) were found to be safe when administered daily to elderly patients with chronic constipation for 6 months.
In short, don’t be unduly concerned that you have had to use a stimulant laxative a few times in the past few weeks. Nevertheless, all attempts should be made to move to bulk-forming laxatives to avoid potential dangers.

How To Take Stimulant Laxatives


When to take stimulant laxatives?

Anthraquinones work within 6 to 12 hours so you should take them at night for an effect the next morning.

How much stimulant laxatives do you take?


Over-the-counter stimulant laxatives are deemed safe and effective when administered in amounts of 20 to 30 mg of sennosides per day.xvi Individual dosages should be the smallest amount possible to achieve the desired effectiveness. Look for products which specify the anthraquinone content whenever possible.
With products whose active components are not listed on the label, be conservative in use. You can always take more if you need it, but you can never take less once you have consumed a dose.
In order to evaluate the dosage of various herbal preparations, it is necessary to know the content of anthroquinones in the crude dried herbs and prepared teas.
Senna teas labeled as laxatives typically contain 7-10 mg of sennosides per cup; a dieter’s tea contains 19 mg/cup.

For how long can you take stimulant laxatives?

Limiting the daily intake of anthraquinones to 20-30 mg and limiting duration of use to less than 9 months may be reasonable to avoid the adverse health consequences related to melanosis coli.
Melanosis coli is usually found after a minimum of 9-12 months of stimulant laxative use.xvii
If after this course of therapy, constipation cannot be relieved by fiber supplementation then stimulant laxatives can be used again after an interval of a few weeks while relying on osmotic laxatives (e.g., lactulose; 10 gm twice daily) as a substitute.
After a break in the use of anthraquinones for several weeks, the colon will return to normal and a course of stimulant laxative therapy can be safely repeated if necessary.

Are Stimulant Laxatives Addictive?

Yes. In Germany, about 80% of people chronically abuse anthroquinone-containing stimulant laxatives.xviii
Since stimulant laxatives do not enter the brain, there is no pharmacologic basis for addiction. However, there are people abusing stimulant laxatives and taking exaggerated, diarrhea-promoting doses for extended periods of time in the belief that it contributes to weight loss or from a false belief that frequent bowel movements are necessary.

What Is and What Causes Laxative Dependence?

After using a stimulant laxative, it may be several days before a spontaneous bowel movement occurs. You will probably assume that you are constipated and a vicious cycle develops in which you become dependent on the daily use of a stimulant to induce defection.
Chronic use of laxatives is often said to result in habituation, that is, the reduction or even disappearance of a laxative response, and tolerance, the need to increase the laxative dose in order to maintain the desired response. In other words, where one laxative dose produced results, now two, then three doses a day are required.
Laxative dependence may be caused, at least in part, from the destruction of nerves in the colon, dulling the natural responses that stimulate peristalsis. That is, stimulated peristalsis begins to replace natural peristalsis. The link between the use of stimulant laxatives and colon nerve damage or other structural changes has been established in people with chronic constipation who use them routinely. xix
However, laxative dependence may simply be a psychological dependence.

What Should I Do If I Am Dependent On Stimulant Laxatives?


STOP TAKING STIMULANT LAXATIVES!

  • Stopping laxatives may be done gradually or by going “cold turkey” (stopping in one day).
  • Changing to products containing psyllium twice a day may help if you gradually withdraw from laxatives.
  • Also, drink lots of water (6-8 glasses a day) and eat salad with extra ingredients like canned kidney beans or green beans.
  • Dried prunes are good too. Just don’t eat too many of them.
  • Vitamin supplementation and maybe some acidophollis or probiotics to help reestablish your intestinal flora may also be good since your body has been depleted of many nutrients.
  • Withdrawal symptoms may include nausea, constipation, bloating or gas. Some people even report feeling “uncomfortable and depressed”. These symptoms will stop as your body recovers and learns how to regulate itself again.

Recommendations for using laxatives

  • Bulk laxatives are the safest laxative for most individuals and should be considered first in the way of treatment for constipation if lifestyle options do not give adequate relief. Consider psyllium (5g twice a day).
  • If you don’t have a response to bulk laxatives, try an osmotic laxative such as lactulose, or polyethylene glycol. The dose should be adjusted until soft stools are attained.
  • Stimulant laxatives should be reserved for individuals with severe constipation who don’t respond to fiber or osmotic laxatives, for example, individuals receiving opioids for pain management.
  • If you must take a stimulant laxative, limit the daily intake of anthraquinones to 20-30 mg and the duration of continuous therapy to less than 9 months.
  • Remember that herbal stimulant laxatives are not reviewed or approved by the US Food and Drug Administration, and that many questions regarding their efficacy and safety profiles remain unanswered.
  • Stimulant laxatives are contraindicated in cases of bowel obstruction, acute intestinal inflammation and abdominal pain of unknown origin.
  • They should not be used in children under 12 or in pregnant or nursing mothers.
  • If you suffer from long-term constipation, see your physician to rule out other gastrointestinal disorders such as defecatory disorders, fecal impaction and colorectal cancer.

References Used for this article on stimulant laxatives

i Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003; 1360-8.
ii Shelton MG. Standardized senna in the management of constipation in the peurperium. S Afr Med J 1980; 57: 78-80.
iii Sik JJ, Ehrenpreis ED, Gonzalez L, Kaye M, Breno S, Wexner S, Zaitman DBS, Secrest K. Alterations in colonic anatomy induced by chronic stimulant laxatives: The cathartic colon revisited. J Clin Gastroent 1998; 26: 283-286.
ivSpeare GS. Melanosiscoli. Experimental observations on its production and elimination in twenty-three cases. Am J Surg 1951; 82: 631-7.
v Siegers C-P, von Hertzberg-Lottin E, Otte M, Schneider B. Anthranoid laxative abuse – a risk for colorectal cancer? Gut 1993; 1099-1101.
vi Riemann JF, Schmidt H, Zimmermann W. The fine structure of colonic submucosal nerves in patients with chronic laxative abuse. Scand J Gastroenterol 1980; 15: 761-8.
vii Riemann F, Schmidt H. Ultrastructural changes in the gut automonic nervous system following laxative abuse and in other conditions. Scand J Gastroenterol 1982; 71: 11-24.
viii Meisel JL, Bergman D, Graney D, et al. Human rectal mucosa: Proctoscopic and morphological changes caused by laxatives. Gastroenterology, 1977; 72: 1274-1279.
ix Riecken EO, Zeitz M, Emde C, et al., The effect of an anthraquinone laxative on colonic nerve tissue: a controlled trial in constipated women. Z Gastroenterol 1990; 28: 660-664.
xSpeare GS. Melanosiscoli. Experimental observations on its production and elimination in twenty-three cases. Am J Surg 1951; 82: 631-7.
xi Willems M, van Buuren HR, de Krijger R. Anthranoid self medication causing rapid development of melanosis coli. Neth J Med 2003; 61: 22-4.
xii Siegers C-P, von Hertzberg-Lottin E, Otte M, Schneider B. Anthranoid laxative abuse – a risk for colorectal cancer? Gut 1993; 1099-1101.
xiii Borrelli R, Aviello G, Capasso R, Capasso F. Senna: a laxative devoid of carcinogenic effects. Arch Toxicol 2006; 81: 873.
xiv Siegers C-P, von Hertzberg-Lottin E, Otte M, Schneider B. Anthranoid laxative abuse – a risk for colorectal cancer? Gut 1993; 1099-1101.
xv Speare GS. Melanosis coli: experimental observations on its production and elimination in 23 cases. Am J Surg 1951; 81: 631-7.
xvi Loscutoff S. Adverse reactions cause the department of health services to require a label notice on foods and dietary supplements containing ingredients with stimulant laxatives effects. California Morbidity, 1998 (September): 1-2.
xvii Siegers CP et al. Anthranoid laxative abuse- a risk factor for colorectal cancer? Gut 1993; 34: 1099-1101.
xviii Van Gorkom BAP, De Vries EGE, Karrenbeld A, Kleibeuker JH. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment Pharmacol Ther 1999; 13: 443-452.
xix Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: “Idiopathic slow transit constipation”. Gut 1986; 27: 41-8.

Research and write by Dr. Annette Kirchgessner, a medical university Professor in a Dept of Gastroenterology, with a Phd (Neuroscience), minor editing by Donald Urquhart.



SENNAE FOLIUM 20 - Constipation 3

SENNAE FOLIUM 20 - Constipation 3


Senna Leaf – Working Two Ways In Treating Constipation

Most of the time, people would rely on natural products to make sure to get good results.  This will also ensure they’ll avoid several negative effects in their body.  One of the products people obtain these days are those that can take care of constant constipation or colon cleansing.  There are several individuals who would choose products that contain senna leaf to keep them from experiencing this condition.

If you’re not familiar with senna leaf, it’s found naturally in the tropics area and is included with the division of angiosperms and can be used in taking care of constipation.  Many people have already claimed its effectiveness on this condition but you may not have an idea how it works to achieve this aim.  The following are the ways how this leaf is able to achieve this effect.
  • The first way on how it can prevent constipation is how it can stimulate the digestive tract in letting the food pass smoothly or properly in it.  Remember that the main reason why people experience constipation is the food doesn’t pass properly along the digestive tract.  This will cause people to not experience the need to go to the bathroom for several days.  This results to bloating and autointoxification once the wastes have not been flushed out of the body.  BY properly allowing food passage long your digestive tract, your body will also flush out a good amount of waste products from your body.  This results to cleaner digestive tract and healthier body.
  • The second way of how it can help the body from experiencing constipation is proper promotion of peristaltic movement.  Most of the time, too much wastes will result to improper digestive functions including less peristaltic movement.  Without it, your body will not have its bowel movements and flush out waste products.  As long as the body has the right peristaltic movement, it can help in removing waste products coming from the body and improve your health.

Looking at this approach, you can say that it’s a good way of promoting good colon health by preventing constipation with the help of a natural ingredient.  You’ll now find this ingredient present in tea form so you can start drinking it and bring back proper digestive functions to its healthy state.  You can look for them online and start comparing to ensure you’ll get the best ones in the market and ensure its effect.

In conclusion, senna leaf has the ability to be a natural laxative for your body.  By working using these two procedures, you’ll find your body getting relief from chronic constipation and even result to having a healthier body by being free from toxins.  This will help you get your digestive tract at its best functions.




SENNAE FOLIUM 19 - Side Effect

SENNAE FOLIUM 19 - Side Effect


Potential Senna Leaf Side Effects You Must Know

Natural products are among the top things people are looking for these days.  Basically, they want to avoid the negative effects caused by medical components made from laboratories.  This is particularly for products in maintaining digestive health like in the colon.  Senna leaf is among the natural products most people choose to have for their colon cleansing products.
Senna leaf is a leaf coming from a plant within the angiosperm group and typically found within the tropic areas.  This ingredient has the ability to promote proper food flow within the digestive tract while acting a natural laxative for it.  By searching online, a lot of individuals have already claimed how effective it is for them.
But regardless of how effective it is, there are not that satisfied with it as they experience various effects in addition to flushing out waste from the body.  Basically, they consider this as a negative effect but they are just the sign of it working for the body.  The following are some of these effects so you’ll have an idea what they are and be ready for it.
  • Immediate need to go to the bathroom.  Most of the time, there are lots of individuals who may want to clean their body from wastes and get relief from constipation.  But many of them are overwhelmed with how fast products with senna work in their body.  While others need to wait for a day or a minimum of 12 hours, this leaf can induce effect within the first 10 hours after intake.
  • There are several studies that indicate that products with this ingredient can make a people have problems in terms of laxative dependence.  This is the situation where a person would not experience bowel or peristaltic movement without taking in any laxatives.  Most of the time, people experience this by taking in this leaf ingredient with other laxatives.  As long as it’s taken alone, people will not feel this negative effect.
  • The last negative effect people may experience is too much gas production on their digestive tract.  Typically, senna has components that can serve as irritants on the digestive tract and cause gas production.  Although this may look like a bad thing, it’s still a sign that the product is working n your body and it won’t be long before you can start feeling its positive effect in the body.
Overall, senna leaf is something that will work for you in terms of keeping a healthy colon and preventing constipation.  As long as you know these effects, you can say that it’s a sign of them working in your body.  This is also a good way for you to be ready with these effects and just continue using the product or get experts advice in using them.



The Side Effects of Senna Leaf

The Side Effects of Senna Leaf
The Side Effects of Senna Leaf

Senna, also known as cassia, is a flowering plant that tends to grow in warm climates. Its primary medicinal use is as a laxative, and it's effective enough to be a main ingredient in several over-the-counter laxative products. Senna is considered to be generally safe, with the common side effects being mild. However, the long-term use or misuse of senna can cause serious side effects that are important to know about.

Gastrointestinal Discomfort

According to the "PDR for Herbal Medicines," when senna is used as directed, the most common complaint is gastrointestinal discomfort. This occurs due to the drug's purgative effect. These side effects include stomach cramps, bloating, gas and diarrhea. Some of these can be minimized by reducing the dose taken, but if they become serious, immediately cease taking senna and contact your doctor.

Electrolyte Abnormalities

Long-term use of senna can lead to electrolyte imbalances, including low potassium. Low levels of potassium can cause a number of serious health problems, including muscle weakness, confusion, inhibition of intestinal motility and cardiac arrhythmia.

Finger Clubbing

Finger clubbing is a side effect typically seen in senna misuse due to anorexia. It's caused by long-term and high-dose usage not intended to relieve constipation, but rather to promote dangerous weight loss. A study published in the April 1981 issue of The Lancet found that the finger clubbing was reversible with the cessation of senna intake and a restoration of body mass, but several letters published in the Medical Journal of Australia in response to a 2008 article titled "Anorexia Nervosa and Senna Misuse" question the reversibility of finger clubbing due to senna abuse.

Hypersensitivity

The "PDR for Herbal Medicines" explains that occupational hypersensitivity is a rare side effect to senna. The resulting hypersensitivity manifests as asthma, rhinoconjunctivitis and allergy.

Cathartic Colon

A study published in the June 1998 issue of the Journal of Clinical Gastroenterology found that chronic use of stimulant laxatives such as senna resulted in an anatomic alteration of the colon in which there was a loss of haustral folds, suggesting "neuronal injury or damage to colonic longitudinal musculature." Chronic use was defined as three times per week for over a year.

References





SENNAE FOLIUM 18 - Monograph 6

SENNAE FOLIUM 18 - Monograph 6



Senna

Generic Name: senna (SEN nah)
Brand Names: Black Draught, Dr Caldwell Laxative, Ex-Lax Chocolated, Ex-Lax Maximum Relief Formula, Ex-Lax Regular Strength Pills, Fletchers Castoria, Innerclean, Pedia-Lax, Perdiem Overnight, Senexon, Senna, Senna Lax, Senna Smooth, Senna Soft, Senna-gen, Senokot, Senokot Extra, SenokotXTRA, SenoSol, SenoSol-X

What is Senna (senna)?

Senna is also known as Cassia senna, tinnevelly senna, India senna, Alexandrian senna, and Khartoum senna.
Senna has been used in alternative medicine as an aid to treat constipation.
Not all uses for senna have been approved by the FDA. Senna should not be used in place of medication prescribed for you by your doctor.
Senna is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.
Senna may also be used for other purposes not listed in this product guide.

What is the most important information I should know about Senna (senna)?

Not all uses for senna have been approved by the FDA. Senna should not be used in place of medication prescribed for you by your doctor.
Senna is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.
Use senna as directed on the label, or as your healthcare provider has prescribed. Do not use this product in larger amounts or for longer than recommended.
Call your healthcare provider if your symptoms do not improve, or if they get worse while using senna. Do not use this product for longer than 1 week without the advice of a healthcare provider.

What should I discuss with my health care provider before taking Senna (senna)?

Ask a doctor, pharmacist, herbalist, or other healthcare provider if it is safe for you to use this product if you have:
  • a bowel disorder such as Crohn's disease or ulcerative colitis;
  • heart disease; or
  • stomach pain, nausea, or vomiting.
Before using senna, talk to your doctor, pharmacist, herbalist, or other healthcare provider. You may not be able to use senna if you have any other medical conditions, allergies, or if you take other medicines or herbal/health supplements.
Do not take senna without first talking to your doctor if you are pregnant or could become pregnant. Do not take senna without first talking to your doctor if you are breast-feeding a baby. Some forms of senna are made for use by children. Do not give any herbal/health supplement to a child without the advice of a doctor.

How should I take Senna (senna)?

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.
If you choose to use senna, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.
Senna is usually taken before bed to produce a bowel movement 6 to 12 hours later when you wake up.
Do not use different forms (such as tablets and liquid) of senna at the same time unless your healthcare provider tells you to. Call your healthcare provider if your symptoms do not improve, or if they get worse while using senna. Do not use this product for longer than 1 week without the advice of a healthcare provider. Store senna at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Senna (senna)?

Follow your healthcare provider's instructions about any restrictions on food, beverages, or activity.

Senna (senna) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your healthcare provider at once if you have a serious side effect such as:
  • severe stomach pain, severe diarrhea, watery diarrhea;
  • weight loss;
  • worsening constipation after you stop taking senna;
  • enlargement of your fingers and toes;
  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or
  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
  • stomach cramps, bloating, gas, mild diarrhea;
  • numbness or tingly feeling;
  • joint pain; or
  • discolored urine.
This is not a complete list of side effects and others may occur. Tell your doctor, pharmacist, herbalist, or other healthcare provider about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

See also: Senna side effects (in more detail)

What other drugs will affect Senna (senna)?

Do not take senna without the advice of a healthcare provider if you are using any of the following medications:
  • digoxin (Lanoxin);
  • a diuretic (water pill); or
  • a blood thinner such as warfarin (Coumadin).
This list is not complete and other drugs may interact with senna. Tell your healthcare provider about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.


Compare Senna with other medications


Where can I get more information?

  • Consult with a licensed healthcare professional before using any herbal/health supplement. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments.

SENNAE FOLIUM 17 - Sennoside 10

SENNAE FOLIUM 17 - Sennoside 10


Senna

Pronunciation: (SEN-ah)
Class: Laxative Trade Names:
Agoral
- Liquid 25 mg

Trade Names:
Black Draught
- Granules 20 mg/5 mL
- Tablets 6 mg

Trade Names:
ex•lax
- Tablets 15 mg

Trade Names:
ex•lax chocolate
- Tablets 15 mg

Trade Names:
Fletcher Castoria
- Liquid 33.3 mg/mL

Trade Names:
Senexon
- Tablets 8.5 mg

Trade Names:
Senna-Gen
- Tablets 8.6 mg

Trade Names:
Senokot
- Granules 15 mg/5 mL
- Syrup 8.8 mg/5 mL
- Tablets 8.6 mg

Trade Names:
SenokotXTRA
- Tablets 17 mg

Senna Laxative Pills Extra Strength Peristaltic Stimulant (Canada)
Senna Laxative Pills Regular Strength Peristaltic Stimulant (Canada)
Senna Tablets Peristaltic Stimulant (Canada)

Pharmacology

Directly acts on intestinal mucosa by altering water and electrolyte secretion, inducing peristalsis and defecation.

Indications and Usage

Short-term treatment of constipation; preoperative and preradiographic bowel evacuation for procedures involving GI tract.

Contraindications

Nausea, vomiting, or other symptoms of appendicitis; acute surgical abdomen; fecal impaction; intestinal obstruction; undiagnosed abdominal pain.

Dosage and Administration

Adults
PO 2 tablets, 5 mL of granules or 10 to 15 mL of syrup, usually at bedtime (max, 15 mL twice daily of syrup).
PR 1 suppository at bedtime; may repeat in 2 h.
 Children 6 to 12 y of age
PO 1 tablet or 2.5 mL granules, or 5 to 7.5 mL of syrup once daily, usually at bedtime (max, 7.5 mL twice daily of syrup).
PR ½ suppository at bedtime.
 2 to younger than 6 y
PO 2.5 to 3.75 mL of syrup once daily, usually at bedtime (max, 3.75 mL twice daily of syrup).

General Advice

  • Administer at bedtime on empty stomach.
  • Shake liquid solution before administering.
  • Dissolve granules before administering.
  • Give oral dosages with full glass of water or juice.
  • Administer suppository with patient lying on left side.

Storage/Stability

Store between 59° and 86° F.

Drug Interactions

None well documented.

Adverse Reactions


Cardiovascular

Palpitations.

CNS

Dizziness, fainting.

GI

Abdominal cramping, bloating, excessive bowel activity (eg, griping, diarrhea, nausea, vomiting), flatulence, perianal irritation.

Miscellaneous

Sweating, weakness.

Precautions

Monitor

Assess bowel function, including normal frequency, type, last bowel movement, bowel sounds, abdominal distention.

Pregnancy

Category C .

Lactation

Undetermined.

Abuse/dependency

Long-term use may lead to laxative dependency, which may result in fluid and electrolyte imbalances, steatorrhea, osteomalacia, and vitamin and mineral deficiencies. Cathartic colon, a poorly functioning colon, results from long-term abuse. Pathologic presentation may resemble ulcerative colitis.

Discoloration of acidic urine

May result in yellow-brown urine.

Discoloration of alkaline urine

May result in pink to red urine.

Fluid and electrolyte imbalance

Excessive laxative use may lead to significant fluid and electrolyte imbalance.

Melanosis Coli

Darkened pigmentation of colonic mucosa may occur after long-term use, usually resolving within 5 to 11 mo of discontinuation.

Rectal bleeding or failure to respond


May indicate serious condition requiring further attention.

Overdosage


Symptoms

Gripping pain, diarrhea.

Patient Information

  • Explain potential hazards (eg, dependence) associated with long-term laxative use.
  • Advise that senna may result in discolored yellow-brown or reddish urine.
  • Explain that bowel patterns are very individual.
  • Identify measures to improve bowel function (ie, fluids, activity, dietary bulk).
  • Caution against taking laxatives in presence of acute abdominal pain or in presence of nausea or vomiting.
Copyright © 2009 Wolters Kluwer Health.


SENNAE FOLIUM 16 - Sennoside 9 - Monograph

SENNAE FOLIUM 16 - Sennoside 9 - Monograph


Senna

Class: Cathartics and Laxatives
ATC Class: A06AB06
VA Class: GA204
CAS Number: 8013-11-4
Brands: Black Draught, Dr. Caldwell, Dr. Edwards’ Olive, Evac-U-Gen, Ex-Lax, Fletcher’s, Perdiem, Peri-Colace, Senexon, Senna-S, Senokot, Senokot S

Introduction

Stimulant laxative; hydroxymethylanthraquinone derivative occurring naturally in plants as glycosides.a

Uses for Senna


Constipation

Used to relieve occasional constipation.b
Mildest of the stimulant laxatives; less pronounced laxative effect than bisacodyl or the violent purgation produced by castor oil.b
Use of stimulant laxatives for simple constipation is seldom necessary or desirable.b
If a stimulant laxative is used, senna derivatives may be preferred.b
Used to treat constipation that occurs following prolonged bed rest or hospitalization.b
Has been used to treat constipation during pregnancy or the puerperium; bulk-forming laxatives or stool softeners preferred.b
Because senna may be distributed into milk, other laxatives usually are preferred for postpartum constipation.b
Also has been used to treat constipation resulting from diminished colonic motor response in geriatric patients but, because this type of constipation frequently is due to psychological or physical laxative dependence, bulk-forming laxatives preferred.b
Used to treat constipation occurring secondary to idiopathic slowing of transit time, to constipating drugs, or to irritable bowel or spastic colon syndrome.b
Also has been used to treat constipation in patients with neurologic constipation.b

Colonic Evacuation

Used orally to empty the bowel prior to surgery or radiologic, proctoscopic, or endoscopic (e.g., sigmoidoscopic, proctoscopic) procedures.b
Usually supplemented with administration of rectal evacuants (e.g., saline, stimulant, or soapsuds enemas) immediately before radiologic procedures.b

Senna Dosage and Administration


Administration


Oral Administration

Administer orally, in conjunction with adequate fluid intake.b
May be administered 1–2 times daily; however, usually administered as a single dose at bedtime.a

Oral Solution
Shake well before use.c d

Tablets
Swallow tablets with a glass of water;f h i do not crush, break, or chew.h i

Chewable Tablets or Pieces
Chew tablets or allow to dissolve in mouth before swallowing.e
Chew piece(s) before swallowing.g

Dosage

Available as sennosides, standardized senna concentrate, and standardized senna fruit extract; dosage expressed in terms of sennosides.a
Administer as infrequently as possible at the lowest effective dosage level.b Do not use for >1 week unless directed by prescriber.c d
Senna fluidextract: 33.3 mg/mL senna concentrate contains 3 mg sennosides A & B per mL.a m

Pediatric Patients


Constipation
Stimulant laxatives generally avoided in children <6 years of age.b

Oral (Standardized Senna Concentrate)
Children 2–6 years of age: 4.3 mg once daily; maximum 8.6 mg twice daily.j
Children 6–11 years of age: Usually, 8.6–15 mg 1–2 times daily.f g h i j May increase to a maximum 17.2 mg twice daily.j
Alternatively, for children 6–11 years of age: 25 mg (1 maximum strength tablet) 1–2 times daily.i
Alternatively, for children ≥6 years of age: 10 mg as chewable tablet 1–2 times daily.e
Children ≥12 years of age: Usually, 17.2–30 mg 1–2 times daily.e f h j May increase to a maximum 34.4 mg twice daily.j
Alternatively, for children ≥12 years of age: 50 mg (2 maximum strength tablets) 1–2 times daily.i

Oral (Senna Fluidextract Oral Solution)
Children 2–5 years of age: 15–30 mg (5–10 mL) 1–2 times daily.c Do not give concentrate containing alcohol to children <6 years of age unless otherwise directed by prescriber.d
Children 6–15 years of age: 30–45 mg (10–15 mL) 1–2 times daily.c
Children ≥12 years of age: Alternatively, 45–90 mg (15–30 mL) of oral solution (with alcohol) may be administered before or after meals or at bedtime.d May repeat in 6–8 hours if needed.d

Oral (Standardized Senna Fruit Extract Oral Solution)
Children 2–5 years of age: 4.4–6.6 mg (2.5–3.75 mL) once daily.n May increase to a maximum 6.6 mg (3.75 mL) twice daily.n
Children 6–11 years of age: 8.8–13.2 mg (5–7.5 mL) 1–2 times daily.n May increase to a maximum 13.2 mg (7.5 mL) twice daily.n
Children ≥12 years of age: 17.6–26.4 mg (10–15 mL) once daily.n May increase to a maximum 26.4 mg (15 mL) twice daily.n
Oral (Sennosides and Docusate Fixed Combination)
Children 2–5 years of age: 4.3 mg of sennosides and 25 mg of docusate sodium once daily.k May increase to a maximum 8.6 mg of sennosides and 50 mg of docusate sodium twice daily.k
Children 6–11 years of age: 8.6 mg of sennosides and 50 mg of docusate sodium once daily.k May increase to a maximum 17.2 mg of sennosides and 100 mg of docusate sodium twice daily.k
Children ≥12 years of age: 17.2 mg of sennosides and 100 mg of docusate sodium once daily.k May increase to a maximum 34.4 mg of sennosides and 200 mg of docusate sodium twice daily.k

Adults


Constipation

Oral (Standardized Senna Concentrate)
Usually, 17.2–30 mg 1–2 times daily.e f g h j May increase to a maximum 34.4 mg twice daily.j
Alternatively, 50 mg (2 maximum strength tablets) 1–2 times daily.i

Oral (Senna Fluidextract Oral Solution)
45–90 mg (15–30 mL) before or after meals or at bedtime.d May repeat in 6–8 hours if needed.d

Oral (Standardized Senna Fruit Extract Oral Solution)
17.6–26.4 mg (10–15 mL) once daily.n May increase to a maximum 26.4 mg (15 mL) twice daily.n

Oral (Sennosides and Docusate Fixed Combination)
17.2 mg of sennosides and 100 mg of docusate sodium once daily.k May increase to a maximum 34.4 mg of sennosides and 200 mg of docusate sodium twice daily.k

Colonic Evacuation
To prepare for colonic surgery or radiologic, sigmoidoscopic, or proctoscopic procedures, patient should receive a residue-free diet 1 day before the surgery or procedure.a Castor oil may be administered 16 hours before surgery or procedure; and a cleansing rectal enema (e.g., tap water, soap suds, saline laxative, bisacodyl tannex enema) administered on the day of surgery or procedure.a

Oral (Standardized Senna Fruit Extract or Standardized Senna Concentrate)
05–157.5 mg as a single dose 12–14 hours before surgery or procedure.a

Prescribing Limits


Pediatric Patients


Constipation
Do not use for >1 week unless directed by prescriber.c d

Oral (Standardized Senna Concentrate)
Children 2–6 years of age: Maximum 8.6 mg twice daily.j
Children 6–11 years of age: Maximum 17.2 mg twice daily.j
Alternatively, for children 6–11 years of age: Maximum 25 mg (1 maximum strength tablet) 2 times daily.i
Children ≥12 years of age: Maximum 34.4 mg twice daily.j
Alternatively, for children ≥12 years of age: 50 mg (2 maximum strength tablets) 2 times daily.i

Oral (Standardized Senna Fruit Extract Oral Solution)
Children ≥12 years of age: Maximum 26.4 mg (15 mL) twice daily.n

Oral (Sennosides and Docusate Fixed Combination)
Children 2–5 years of age: Maximum 8.6 mg of sennosides and 50 mg of docusate sodium twice daily.k
Children 6–11 years of age: Maximum 17.2 mg of sennosides and 100 mg of docusate sodium twice daily.k
Children ≥12 years of age: Maximum 34.4 mg of sennosides and 200 mg of docusate sodium twice daily.k

Adults


Constipation
Do not use for >1 week unless directed by prescriber.c d

Oral (Standardized Senna Concentrate)
Maximum 34.4 mg twice daily.j

Oral (Standardized Senna Fruit Extract Oral Solution)
Maximum 26.4 mg (15 mL) twice daily.n

Oral (Sennosides and Docusate Fixed Combination)
Maximum 34.4 mg of sennosides and 200 mg of docusate sodium twice daily.k

Special Populations

No special population dosage recommendations at this time.


Cautions for Senna


Contraindications

  • Acute abdominal pain, nausea, vomiting,b c d f j k or other symptoms of appendicitis or undiagnosed abdominal pain.b
  • Intestinal obstruction.b

Warnings/Precautions


Warnings


Laxative Dependence
Habit-forming.b
Potentially serious toxicity with chronic use.b (See Chronic Use or Overdosage under Cautions.)

Chronic Use or Overdosage of Laxatives
Chronic use or overdosage of laxatives may produce persistent diarrhea, hypokalemia, loss of essential nutritional factors, and dehydration.b
Laxative dependence, chronic constipation, and loss of normal bowel function may occur during long-term use.b
Electrolyte disturbances (including hypokalemia, hypocalcemia, metabolic acidosis or alkalosis), abdominal pain, diarrhea, malabsorption, weight loss, and protein-losing enteropathy may occur.b
Electrolyte disturbances may produce vomiting and muscle weakness; rarely, osteomalacia, secondary aldosteronism, and tetany.b
Chronic use may cause pathologic changes including structural damage to the myenteric plexus, severe and permanent interference with colonic motility, and hypertrophy of the muscularis mucosae.b
“Cathartic colon” with atony and dilation of the colon, especially of the right side, has occurred with habitual use (often for several years); often resembles ulcerative colitis.b

Change in Bowel Habits
If a sudden change in bowel habits occurs that last >2 weeks, consult a clinician before using.c e h i g j k

General Precautions


Discoloration of Urine and Colonic Mucosa
May discolor colonic mucosa (melanosis coli); innocuous and reversible.b
May discolor urine pink to red or brown to black.b

Diabetes Mellitus
Standardized senna fruit extract contains large amounts of sugar; consider caloric value in patients with diabetes mellitus.b

Use of Fixed Combinations
When senna is used in fixed combination with docusate sodium, consider the cautions, precautions, and contraindications associated with docusate sodium.

Specific Populations


Pregnancy
Category C.l

Lactation
May be distributed into milk.a b Unlikely to appear in sufficient amounts to affect nursing infants.a b
AAP considers senna compatible with breast-feeding.l

Pediatric Use
Safety and efficacy not established in children <2 years of age.c Avoid use of laxatives in infants and children.b

Common Adverse Effects

Abdominal discomfort, nausea, mild cramps, griping, faintness.b

Interactions for Senna


GI Drug Absorption

By increasing intestinal motility, can potentially decrease transit time of concomitantly administered oral drugs and thereby decrease their absorption.b

Specific Drugs and Laboratory Tests

Drugs and Laboratory Tests Interaction
Phenolsulfonphthalein (PSP) Discolors urine; possible apparent increase in urinary excretion of PSPb
Test for estrogen (Kober procedure) Possible false-positive resultsb
Test for urinary urobilinogen Possible false-positive resultsb

Senna Pharmacokinetics


Absorption


Bioavailability

Minimal absorption following oral administration.a

Onset

Following oral administration, laxation usually occurs within 6–12 hours; may take 24 hours.a c d e f g h i j k

Distribution


Extent

Distribution not fully characterized; may be distributed into bile, saliva, and colonic mucosa.a

Elimination


Metabolism

Absorbed drug metabolized in the liver.a

Elimination Route

Absorbed drug and its metabolites eliminated in feces via biliary excretion and/or in urine.a

Stability


Storage


Oral


Tablets and Chewable Pieces
20–25°C (may be exposed to 15–30°C);f g h i j protect from moisture.f

Solution
Tight, light-resistant container at ≤40°C.a

ActionsActions

  • Stimulant laxative; primary active cathartic principles are the stereoisomeric glucosides, sennosides A and B.a
  • Precise mechanism of action not known.b
  • Commonly thought that the stimulant laxatives induce defecation by stimulating propulsive peristaltic activity of the intestine through local irritation of the mucosa or through a more selective action on the intramural nerve plexus of intestinal smooth muscle, thus increasing motility.b
  • More recent evidence shows that stimulant laxatives alter fluid and electrolyte absorption, producing net intestinal fluid accumulation and laxation.b
  • Increases concentrations of cyclic 3′,5′-adenosine monophosphate (cAMP) in colonic mucosal cells and may alter the permeability of these cells and mediate active ion secretion, producing net fluid accumulation and laxative action.b
  • Mainly promotes evacuation of the colon.b

Advice to Patients

  • Importance of informing clinicians before use if abdominal pain, nausea, or vomiting is present or if there has been a sudden change in bowel habits that persists over a period of 2 weeks.b c d e f g h i k
  • Importance of discontinuing use and informing clinician if a bowel movement does not occur or rectal bleeding occurs after use.b c d e f g h i j k
  • Importance of not using laxative products for a period longer than 1 week unless directed by a clinician.c d f g h i j k
  • Importance of taking with a glass of water.f h i
  • Advise about risk of laxative abuse and potential serious consequences.b (See Chronic Use or Overdosage under Cautions.)
  • Importance of advising clinicians of preexisting diabetes mellitus since some preparations contain sugar (e.g., standardized senna fruit extract).b
  • Advise patients of a potential discoloration in urine.b
  • Importance of taking 2 hours before or 2 hours after taking other medications.f g h i
  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses, including intestinal obstruction.b f g h i
  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.c d e f g h i j k
  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Senna Leaf
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Powder*      
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Senna Concentrate, Standardized
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets, chewable 10 mg Sennosides Black Draught Lee
      Evac-U-Gen Lee
  Pieces, chewable 15 mg Sennosides Ex-Lax Chocolated Novartis
  Tablets 8.6 mg Sennosides* Dr. Edwards’ Olive Oakhurst
      Senexon Watson
      Senna-Gen Teva
      Sennatural G&W
      Senokot Purdue Frederick
    15 mg Sennosides Ex-Lax Regular Strength Novartis
      Perdiem Novartis
    17 mg Sennosides SenokotXTRA Purdue Frederick
    25 mg Sennosides Ex-Lax Maximum Strength Novartis
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Senna Concentrate, Standardized Combinations
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets* 8.6 mg Sennosides with Docusate Sodium 50 mg Peri-Colace Purdue
      Senna-S Teva
      Senokot S Purdue Frederick
Senna Fluidextract
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Solution 3 mg Sennosides per mL (33.3 mg Senna Concentrate per mL) Dr. Caldwell Senna Laxative (with alcohol 4.9%) Denison
      Fletcher’s (with parabens; alcohol-free) Mentholatum Company
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Senna Fruit Extract, Standardized
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Solution* 8.8 mg Sennosides per 5 mL Senexon Liquid (with parabens) Watson

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions January 01, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

a. AHFS drug information 2007. McEvoy GK, ed. Anthraquinones. Bethesda, MD: American Society of Health-System Pharmacists; 2007:2923-4.
b. AHFS drug information 2007. McEvoy GK, ed. Cathartics and laxatives general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2007:2919-23.
c. The Mentholatum Co., Inc. Fletcher’s laxative for kids patient information. Orchard Park, NY. Undated.
d. Denison. Dr. Caldwell senna laxative patient information. From website: . Accessed 2007 May 28.
e. Lee Pharmaceuticals, Inc. Black draught laxative tablets patient information. From website: . Accessed 2007 June 24.
f. Novartis Consumer Health, Inc. Perdiem overnight relief patient information. From website: . Accessed 2007 May 28.
h. Novartis Consumer Health, Inc. ex-lax regular strength patient information. From website: . Accessed 2007 May 28.
g. Novartis Consumer Health, Inc. ex-lax regular strength chocolate patient information. From website: . Accessed 2007 May 28.
i. Novartis Consumer Health, Inc. ex-lax maximum strength patient information. From website: . Accessed 2007 May 28.
j. Purdue Products L.P. Senokot tablets patient information. From website: . Accessed 2007 May 28.
k. Purdue Products L.P. Senokot-S tablets patient information. From website: . Accessed 2007 May 28.
l. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 7th ed. Phildelphia, PA: Lippincott Williams & Wilkins; 2005:1452-3.
m. Esford J (The Mentholatum Co., Inc., Orchard Park, NY): Personal communication; 2007 June 27.
n. Rugby Laboratories. Senexon Liquid patient information. Duluth, GA: 2005 Sept.