II. Indications
III. Mechanism
- Simulant Laxative (Anthraquinone)
- Cascara is derived from the dried aged bark (Cascara Sagrada) of buckthorn (Frangula purshiana or Rhamnus purshiana)
- Cascara extracts include the anthranol glycosides, emodin (anthraquinone) and Casanthranol (cascarosides)
- Casanthranol directly stimulates intestinal wall Muscle Contractions
IV. Precautions
- Avoid chronic use of Stimulant Laxatives (see adverse effects below)
- Cascara is listed for historical purposes and has been replaced by other Laxatives in the U.S.
V. Medications
- Cascara Sagrada aromatic fluid extract
- Cascara Sagrada fluid extract
- Caution! Five times the potency of aromatic fluid extract
VI. Dosing: Constipation
- Dosing is for Cascara aromatic fluid extract (not the much more potent fluid extract)
- Adult
- Take 5 ml aromatic fluid extract at bedtime as needed for Constipation
- Child (2 to 12 years)
- Give 2.5 ml orally at bedtime as needed for Constipation
VII. Pharmacokinetics
- Onset of activity within 6-12 hours
VIII. Adverse Effects: Long-Term (Laxative abuse)
- See Stimulant Laxative
- Avoid prolonged use (habit forming)!
- Colonic denervation and atony (Cathartic colon)
- Decreased motility of right colon with secondary worsening Constipation
- Associated with Anthraquinone Laxatives
- Results from myenteric plexus injury
-
Electrolyte and nutritional disturbance
- Hypokalemia
- Sodium overload
- Protein-losing Enteropathy
-
Melanosis coli
- Benign darkening of colonic mucosa
- Macrophage deposition in lamina propria
IX. Safety
- Pregnancy Category C
- Safe in Lactation
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia