Senna glycoside

Generic Name: Senna glycoside

Senna is an herb. The leaves and the fruit of the plant are used to make medicine.

Senna is an FDA-approved over-the-counter (OTC) laxative. A prescription is not required to purchase senna. It is used to treat constipation and also to clear the bowel before diagnostic tests such as colonoscopy.

Senna is also used for irritable bowel syndrome (IBS), anal or rectal surgery, tears in the lining of the anus (anal fissures), hemorrhoids, and weight loss.

Senna fruit seems to be gentler than senna leaf. This has led the American Herbal Products Association (AHPA) to warn against long-term use of senna leaf, but not senna fruit. The AHPA recommends that senna leaf products be labeled, "Do not use this product if you have abdominal pain or diarrhea. Consult a healthcare provider prior to use if you are pregnant or nursing. Discontinue use in the event of diarrhea or watery stools. Do not exceed recommended dose. Not for long-term use."

No health feed found.

Mechanism of Action: Anthraquinone derivatives are relatively mild laxatives. Action was generally considered to result from direct stimulation of smooth muscle of the colon. More recently, changes in fluid balance and electrolyte absorption are believed to be contributing factors. Senna can alter permeability of cell walls in the colon because it increases cyclic 3',5'-adenosine monophosphate, which also regulates active ion secretion. The result is increased fluid accumulation in the colon and a laxative action.

Senna is used for the short-term treatment of symptomatic constipation. It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.

Senna is LIKELY SAFE for most adults and children over age 2 when taken by mouth, short-term. Senna is an FDA-approved nonprescription medicine. Senna can cause some side effects including stomach discomfort, cramps, and diarrhea.

Senna is POSSIBLY UNSAFE when taken by mouth long-term or in high doses. Don't use senna for more than two weeks. Longer use can cause the bowels to stop functioning normally and might cause dependence on laxatives. Long-term use can also change the amount or balance of some chemicals in the blood (electrolytes) that can cause heart function disorders, muscle weakness, liver damage, and other harmful effects.

Heart disease: Senna can cause electrolyte disturbances and might make heart disease worse.

Oral dosage (tablets)

Adults, Adolescents and Children >= 12 years

1 to 2 tablets (8.6 to 17.2 mg sennosides) PO twice daily. Max dose: 4 tablets (34.4 mg sennosides) PO twice daily.

Children 6—11 years

1 tablet (8.6 mg sennosides) PO at bedtime. Max: 2 tablets (17.2 mg sennosides) PO twice daily.

Children 2—5 years

1/2 tablet (4.3 mg sennosides) PO once daily at bedtime. Max: 1 tablet (8.6 mg sennosides) PO twice daily.

Oral dosage (solution or syrup containing 8.8 mg sennosides per 5 ml)

NOTE: Concentrations of liquid products may vary.

Adults, Adolescents and Children >= 12 years

10 to 15 mL (17.6 to 26.4 mg sennosides) PO at bedtime. Max: 15 mL PO twice daily.

Children 6—11 years

5 to 7.5 ml (8.8 to 13.2 mg sennosides) PO at bedtime. Max: 7.5 mL PO twice daily.

Children 2—5 years

2.5 to 3.75 mL (4.4 to 6.6 mg sennosides) PO at bedtime. Max: 3.75 mL PO twice daily.

Oral dosage (Oral pediatric drops, e.g., Little Remedies for Tummys Stimulant Laxative Drops containing 8.8 mg sennosides per ml)

Children 6—11 years

1 to 1.5 mL (8.8 to 13.2 mg sennosides/dose) PO at bedtime. Max: 1.5 mL PO twice daily.

Children 2—5 years

0.5  to 0.75 mL (4.4 to 6.6 mg sennosides/dose) PO at bedtime. Max: 0.75 mL PO twice daily.

Oral dosage (Capsules)

Adults, Adolescents, and Children 12 years and older

4 capsules twice daily with a full glass of water.

Children age 6 to 11 years

2 capsules twice daily with a full glass of water.

Maximum Dosage

Adults

1496 mg/day PO of standardized senna extract.

Elderly

1496 mg/day PO of standardized senna extract.

Adolescents

15—18 years: 1496 mg/day PO of standardized senna extract.
13—15 years: 872 mg/day PO of standardized senna extract.

Children

6—12 years: 872 mg/day PO of standardized senna extract.
1—5 years: 436 mg/day PO of standardized senna extract.

Infants

1—12 months: 218 mg/day PO of standardized senna extract.

 

Acetaminophen; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Atropine; Difenoxin: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects. 
Atropine; Diphenoxylate: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects. 
Brompheniramine; Guaifenesin; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Brompheniramine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Bumetanide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. 
Carbinoxamine; Hydrocodone; Phenylephrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Carbinoxamine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Chlorpheniramine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Chlorpheniramine; Hydrocodone; Phenylephrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Chlorpheniramine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Dichlorphenamide: (Moderate) Use dichlorphenamide and senna together with caution. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Measure potassium concentrations at baseline and periodically during dichlorphenamide treatment. If hypokalemia occurs or persists, consider reducing the dichlorphenamide dose or discontinuing dichlorphenamide therapy. 
Diphenhydramine; Hydrocodone; Phenylephrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Droperidol: (Moderate) Caution is advised when using droperidol in combination with laxatives, which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. 
Ethacrynic Acid: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. 
Fosfomycin: (Moderate) Laxatives increase gastrointestinal motility and may decrease the systemic absorption of fosfomycin when the drugs are coadministered. 
Furosemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. 
Guaifenesin; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Hydrocodone; Ibuprofen: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Hydrocodone; Phenylephrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Hydrocodone; Potassium Guaiacolsulfonate: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as senna, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. 
Lactulose: (Major) In general, other laxatives, such as senna, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved. (Major) In general, other laxatives, such as sennosides, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved. 
Loop diuretics: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. 
Torsemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. 

Take Senna exactly as instructed by the doctor. The single dose of this medicine is usually taken at bedtime. Do not take larger amounts than prescribed. Seek emergency medical treatment in case of any severe side effects.

General Information

Senna is contraindicated for long-term use; with chronic therapy, the drug produces laxative dependency and an irreversible impairment of bowel function.

Abdominal pain, appendicitis, diarrhea, electrolyte imbalance, fecal impaction, GI bleeding, GI obstruction, hemorrhoids, vomiting

Senna is contraindicated in patients with diarrhea, loose stools, abdominal pain, GI obstruction, or hemorrhoids. Patients should discontinue use if they experience rectal GI bleeding or if they fail to have a bowel movement after senna administration; these may be signs of a more serious condition. Advise patients to consult their healthcare professional before taking this medication if they have nausea and vomiting or if they notice a change in their bowel habits that lasts for more than two weeks. Administration can worsen fecal impaction; fluid or electrolyte imbalance; or appendicitis.

Children

Senna should be used with caution in children at the recommended doses and for a limited period. Manufacturers' recommendations should be observed.

Diabetes mellitus

Standardized senna fruit extract contains large amounts of sugar and should be used with caution in patients with diabetes mellitus.

Pregnancy

In general, avoid stimulant laxatives such as senna when possible during pregnancy as some of the stimulant laxatives may induce premature labor.  Systemic absorption of the sennosides is minimal and there have been no reports of teratogenicity or an increased risk of congenital anomalies due to senna use in humans ; however, the indiscriminate use of sennosides may cause maternal dehydration and alter electrolyte and nutritional status; the intermittent use of senna should be limited to use under the advice of a qualified health care professional and after safer agents have failed to produce intended results. The safest first-line treatments to use for constipation during pregnancy are those that are not absorbed systemically (e.g., fiber, bulk-forming laxatives, stool softeners) in order to minimize drug exposure to the fetus.

Breast-feeding

Senna is generally considered compatible for use in breast-feeding (American Academy of Pediatrics). Senna is not excreted into human milk, but it is a prodrug which is metabolized in vivo to the sennosides. Sennosides are glucosides of rhein, and the sennosides are essentially undetectable in human milk. Rhein appears to be excreted only in very small amounts. There is a lack of reported adverse events in nursing infants whose mothers ingested sennosides during lactation. Agents that are non-absorbed or poorly absorbed (e.g., bulk-forming laxatives or stool softeners) are often the preferred drugs for first-line use in the lactating female when such therapy is necessary. Other agents that may be considered based on lack of systemic effect or lack of reported adverse effects in nursing infants include psyllium, magnesium hydroxide, docusate salts, and bisacodyl. 

Geriatric

The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of medications in residents (e.g., geriatric adults) of long-term care facilities. The OBRA guidelines caution that laxatives may cause flatulence, bloating, and abdominal pain.

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