III. Mechanism
- Senna is an extract from the dried leaflets of the plant Cassia angustifolia (or Cassia acutifolia)
- Dried senna extract contains dimeric glycosides activated to monoanthrones in the bowel by colonizing Bacteria
- Monoanthrones directly act at enteric cells, nerves and Muscles to stimulate large, migrating contractions of the colon
- Monoanthrones also stimulate water and Electrolyte secretion into the bowel
- Monoanthrones induce low grade inflammation with chronic use (as with other Stimulant Laxatives)
IV. Precautions
- Avoid chronic use of Stimulant Laxatives (see adverse effects below)
V. Medications
- Senna Extract (Senokot)
- Various trade names including Senokot and Ex-Lax
- Ex-Lax was previously formulated with Phenolphthalein (off U.S. market as of 2009)
- Syrup: 8.8 mg sennosides per 5 ml liquid
- Liquid 33 mg senna concentrate (1.5 mg sennosides) per ml (Fletcher's Castoria)
- Tablets 8.6, 15, 17 and 25 mg
- Chewable Tablets: 10 and 15 mg
- Various trade names including Senokot and Ex-Lax
- Combinations with senna and Docusate
- Senekot-S
- Peri-Colace (previously contained Cascara)
VI. Dosing: Senna Extract (Senokot)
- Adult (and age >=12 years)
- Syrup: Take 10 to 15 ml (17.6 to 26.4 mg) orally at bedtime OR
- Tablet (8.6 mg): Take 2 to 3 tablets orally at bedtime
- Child: Senna Syrup (8.8 mg per 5 ml)
- Syrup may be mixed with juice, milk or ice cream
- Age 2-6 years: 2.5 to 3.75 ml (4.4 to 6,6 mg) orally at bedtime
- Age 6-12 years: 5 to 7.5 ml (8.8 to 13.2 mg) orally at bedtime
VII. Pharmacokinetics
- Onset of activity within 6-12 hours
- Duration up to 24 hours
VIII. Adverse Effects: Short-Term
- Nausea
- Vomiting
- Abdominal Pain
- Hepatitis (case reports)
IX. Adverse Effects: Long-term use (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
X. Safety
- Pregnancy Category C
- Safe in Lactation
XI. Resources
- Senna Tablets (DailyMed)
XII. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2023) Management of Constipation, Presc Lett, #390108
Images: Related links to external sites (from Bing)
Related Studies
| senna (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SENNA 8.6 MG TABLET | Generic OTC | $0.02 each |
| SENNA 8.8 MG/5 ML LIQUID | Generic OTC | $0.04 per ml |
| SENNA 8.8 MG/5 ML SYRUP | Generic OTC | $0.04 per ml |
| SENNA LAX 8.6 MG TABLET | Generic OTC | $0.02 each |
| SENNA LAXATIVE 8.6 MG TABLET | Generic OTC | $0.02 each |
| SENNA PLUS 8.6-50 MG SOFTGEL | Generic OTC | $0.06 each |
| SENNA PLUS 8.6-50 MG TABLET | Generic OTC | $0.03 each |
| SENNA PLUS TABLET | Generic OTC | $0.03 each |
| SENNA-LAX 8.6 MG TABLET | Generic OTC | $0.02 each |
| SENNA-S 8.6-50 MG TABLET | Generic OTC | $0.04 each |
| SENNA-S TABLET | Generic OTC | $0.03 each |
| SENNA-TIME 8.6 MG TABLET | Generic OTC | $0.02 each |
| SENNA-TIME S TABLET | Generic OTC | $0.03 each |
| senokot (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SENOKOT 8.6 MG TABLET | Generic OTC | $0.02 each |
| SENOKOT EXTRA STR 17.2 MG TAB | OTC | $0.39 each |
| SENOKOT-S TABLET | Generic OTC | $0.03 each |