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 |
Ontology: Senna Extract (C0036656)
Definition (NCI) | An extract made from the dried leaflets on the pods of Cassia angustifolia or Cassia acutifolia with cathartic activity. Dimeric glycosides in dried senna extract are converted to the active monoanthrones by bacterial action in the colon. Through direct effects on enterocytes, enteric neurons, and muscle, monoanthrones produce giant migrating colonic contractions in addition to water and electrolyte secretion. As do other stimulant laxatives, monoanthrones may induce a limited low-grade inflammation in the colon through activation of prostaglandin/cyclic AMP and nitric oxide/cyclic GMP pathways and perhaps inhibition of Na+, K+-ATPase. |
Definition (MSH) | Preparations of Cassia senna and C. angustifolia (see SENNA PLANT). They contain sennosides, which are anthraquinone type CATHARTICS and are used in many different preparations as laxatives. |
Definition (PDQ) | An extract made from the dried leaflets on the pods of Cassia angustifolia or Cassia acutifolia with laxative properties. Dimeric glycosides in dried senna extract are converted to the active monoanthrones by bacterial action in the colon. Through direct effects on enterocytes, enteric neurons, and muscle, monoanthrones produce giant migrating colonic contractions in addition to water and electrolyte secretion. As do other stimulant laxatives, monoanthrones may induce a limited low-grade inflammation in the colon through activation of prostaglandin/cyclic AMP and nitric oxide/cyclic GMP pathways and perhaps inhibition of Na+, K+-ATPase. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=480408&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=480408&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C61324" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D012676 |
Swedish | Sennaextrakt |
English | senna extract, Senna Extract [Chemical/Ingredient], Senna Extract, Extract, Senna, SENNA EXTRACT |
Czech | senna - extrakt |
Finnish | Sennauute |
Russian | SENNY EKSTRAKT, СЕННЫ ЭКСТРАКТ |
Japanese | セノコット, ヨーデルS, ヨーヤクール, アジャストA, センナエキス |
Polish | Wyciąg z senesu |
Portuguese | Extrato de Sene, Extrato de Cene, Extrato de Cássia, Extrato de Sena |
French | Extrait de séné |
German | Senna-Extrakt |
Italian | Estratto di Senna |
Spanish | Extracto de Senna |
Ontology: Peri-Colace (C0307257)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
English | Peri-Colace, peri colace, peri-colace, Peri-Colace (obsolete) |
Ontology: Senokot (C0699932)
Definition (NCI) | A standardized, concentrated preparation, by Purdue, containing the anthraquinone glycosides sennosides extracted from senna leaves with laxative activity. Sennosides act on and irritate the lining of the intestine wall, thereby causing increased intestinal muscle contractions leading to vigorous bowel movement. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C002839 |
English | Senokot, senokot |
Ontology: Ex-Lax (C0720319)
Definition (NCI) | A commercial preparation, by Novartis, with laxative activity. Ex-Lax contains anthraquinone glycosides sennosides, extracted from senna leaves. Sennosides irritate the lining of the intestine wall, thereby causing increased intestinal muscle contractions that lead to vigorous bowel movement and relief constipation. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D020113 |
English | ex-lax, ex lax, Ex-Lax, Manesco Brand of Phenolphthalein, Novartis Brand of Phenolphthalein |