II. Indications

III. Mechanism

  1. Simulant Laxative (Anthraquinone)
  2. Cascara is derived from the dried aged bark (Cascara Sagrada) of buckthorn (Frangula purshiana or Rhamnus purshiana)
  3. Cascara extracts include the anthranol glycosides, emodin (anthraquinone) and Casanthranol (cascarosides)
  4. Casanthranol directly stimulates intestinal wall Muscle Contractions

IV. Precautions

  1. Avoid chronic use of Stimulant Laxatives (see adverse effects below)
  2. Cascara is listed for historical purposes and has been replaced by other Laxatives in the U.S.

V. Medications

  1. Cascara Sagrada aromatic fluid extract
  2. Cascara Sagrada fluid extract
    1. Caution! Five times the potency of aromatic fluid extract

VI. Dosing: Constipation

  1. Dosing is for Cascara aromatic fluid extract (not the much more potent fluid extract)
  2. Adult
    1. Take 5 ml aromatic fluid extract at bedtime as needed for Constipation
  3. Child (2 to 12 years)
    1. Give 2.5 ml orally at bedtime as needed for Constipation

VII. Pharmacokinetics

  1. Onset of activity within 6-12 hours

VIII. Adverse Effects: Long-Term (Laxative abuse)

  1. See Stimulant Laxative
  2. Avoid prolonged use (habit forming)!
  3. Colonic denervation and atony (Cathartic colon)
    1. Decreased motility of right colon with secondary worsening Constipation
    2. Associated with Anthraquinone Laxatives
    3. Results from myenteric plexus injury
  4. Electrolyte and nutritional disturbance
    1. Hypokalemia
    2. Sodium overload
    3. Protein-losing Enteropathy
  5. Melanosis coli
    1. Benign darkening of colonic mucosa
    2. Macrophage deposition in lamina propria

IX. Safety

  1. Pregnancy Category C
  2. Safe in Lactation

X. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Ontology: Cascara sagrada (C0205704)

Definition (MSH) Dried aged bark of a buckthorn, Frangula purshiana (FRANGULA), that contains the anthraquinone EMODIN and cascarosides. It is used as a laxative (CATHARTICS).
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D002362
SnomedCT 23888001, 387128007
English Cascara, Cascara sagrada, Sacred Bark, cascara sagrada, laxatives cascara sagrada, cascara sagrada (medication), Cascara Sagrada Fluid Extract, cascara sagrada fluid extract, Cascara Sagrada, CASCARA SAGRADA FLUID EXTRACT, CASCARA SAGRADA @ @ FLUID EXTRACT, Cascara [Chemical/Ingredient], cascara sagrada extract, cascara, Cascara (product), Cascara (substance), CASCARA SAGRADA ORAL FLUID EXTRACT, CASCARA SAGRADA@@ORAL@FLUID EXTRACT, CASCARA SAGRADA, CASCARA SAGRADA EXTRACT
Portuguese Cáscara
Swedish Sagrada
Czech kaskara
Finnish Sagradankuori
Italian Cascara sagrada, Cascara
Russian KAZANTRANOL, KASKARA, CASANTHRANOL, КАЗАНТРАНОЛ, КАСКАРА
Japanese カスカラ, カスカラサグラダ, カサントラノール
French Écorce sacrée, Cascara
Polish Kaskara
Spanish cáscara (producto), cáscara (sustancia), cáscara sagrada, cáscara, Cáscara
German Cascara

Ontology: Casanthranol (C0205705)

Definition (NCI) A concentrated mixture of anthranol glycosides from cascara sagrada (dried bark of Rhamnus p.) and used as a laxative in constipation and various medical conditions, stimulant laxative Casanthranol encourages bowel movements by acting on the intestinal wall to increase muscle contractions. (NCI04)
Definition (MSH) A concentrated mixture of anthranol glycosides derived from cascara sagrada.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002362
SnomedCT 116530002, 400300006
LNC LP171651-5
English casanthranol, casanthranol (medication), laxatives casanthranol, Casanthranol [Chemical/Ingredient], Casanthranol (product), Casanthranol (substance), Casanthranol, CASANTHRANOL
Portuguese Casantranol
Spanish Casantranol, casantranol (producto), casantranol (sustancia), casantranol
German Casanthranol
French Casanthranol
Italian Casanthranol