III. Mechanism

  1. Senna is an extract from the dried leaflets of the plant Cassia angustifolia (or Cassia acutifolia)
  2. Dried senna extract contains dimeric glycosides activated to monoanthrones in the bowel by colonizing Bacteria
  3. Monoanthrones directly act at enteric cells, nerves and Muscles to stimulate large, migrating contractions of the colon
  4. Monoanthrones also stimulate water and Electrolyte secretion into the bowel
  5. Monoanthrones induce low grade inflammation with chronic use (as with other Stimulant Laxatives)

IV. Precautions

  1. Avoid chronic use of Stimulant Laxatives (see adverse effects below)

V. Medications

  1. Senna Extract (Senokot)
    1. Various trade names including Senokot and Ex-Lax
      1. Ex-Lax was previously formulated with Phenolphthalein (off U.S. market as of 2009)
    2. Syrup: 8.8 mg sennosides per 5 ml liquid
    3. Liquid 33 mg senna concentrate (1.5 mg sennosides) per ml (Fletcher's Castoria)
    4. Tablets 8.6, 15, 17 and 25 mg
    5. Chewable Tablets: 10 and 15 mg
  2. Combinations with senna and Docusate
    1. Senekot-S
    2. Peri-Colace (previously contained Cascara)

VI. Dosing: Senna Extract (Senokot)

  1. Adult (and age >=12 years)
    1. Syrup: Take 10 to 15 ml (17.6 to 26.4 mg) orally at bedtime OR
    2. Tablet (8.6 mg): Take 2 to 3 tablets orally at bedtime
  2. Child: Senna Syrup (8.8 mg per 5 ml)
    1. Syrup may be mixed with juice, milk or ice cream
    2. Age 2-6 years: 2.5 to 3.75 ml (4.4 to 6,6 mg) orally at bedtime
    3. Age 6-12 years: 5 to 7.5 ml (8.8 to 13.2 mg) orally at bedtime

VII. Pharmacokinetics

  1. Onset of activity within 6-12 hours
  2. Duration up to 24 hours

VIII. Adverse Effects: Short-Term

  1. Nausea
  2. Vomiting
  3. Abdominal Pain
  4. Hepatitis (case reports)

IX. Adverse Effects: Long-term use (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

X. Safety

  1. Pregnancy Category C
  2. Safe in Lactation

XII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2023) Management of Constipation, Presc Lett, #390108

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

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