Laxatives, anthraquinone

The two most important diphenylmethanes are phenolphthalein and bisacodyl. Senna and cascara are the sources of anthraquinone laxatives. However, although still available in some countries phenolphthalein is now removed from most markets because of concerns over carcinogenicity. As recent as 2006 the United States Food and Drug Administration (FDA) has categorized castor oil as generally recognized as safe and effective (GRASE) for over-the-counter use as a laxative. On the other hand, in 2002 cascara was banned by the FDA. 

It is an anthraquinone laxative. It is not active as such but after oral intake when it reaches colon the bacteria liberate anthrones, which is the active form. Active form acts on myenteric plexus to increase peristalsis. It also inhibits salt and water absorption in colon. 

Dantron and senna are the only anthraquinone laxatives in current use. 

For most persons with acnte constipation, infrequent use (less than every few weeks) of laxative products is acceptable. Acute constipation may be relieved by the nse of a tap-water enema or a glycerin suppository if neither is effective, the use of oral sorbitol, low doses of diphenylmethane or anthraquinone laxatives, or saline laxatives (e.g., milk of magnesia) may provide relief. If laxative treatment is required for longer than 1 week, the person should be advised to consult a physician to determine if there is an underlying cause of constipation that reqnires treatment with other modalities. 

For acute constipation in most age groups, a tap-water enema or glycerin suppository may be helpful. Occasional use of milk of magnesia or an anthraquinone laxative in low doses is justified as well. 

Melanosis coli is observed in 12-31% of unselected constipated patients. A causal relationship between melanosis coli and use of anthraquinone laxatives has been shown in animals and humans. Sennosides produce melanosis coli after 4—13 mo of use, which disappears 5-11 mo after cessation of sennoside use. Melanosis coli begins abruptly at the ileocolonic junction and may extend to the dentate line. The intensity is highest in the cecum and becomes less intense in the aboral direction, and may increase again in the rectum, with a prevalence of 1-8% on proctoscopy. The pigment has not been definitively identified, but it is probably lipofuscin. Even if melanosis coli cannot be seen... 

Anthraquinone laxatives can produce giant migrating colonic contractions and induce water and electrolyte secretion. They are poorly absorbed in the small bowel, but because they require activation in the colon, the laxative effect is not noted until 6 to 12 hours after ingestion. Active compounds are absorbed to a variable degree from the colon and excreted in the bile, saliva, milk, and urine. 

A study in IS patients taking azapropazone 300 mg three times daily found that antacids (dihydroxyaluminium sodium carbonate, aluminium magnesium silicate), bisacodyl or anthraquinone laxatives only caused a minor (S to 7%) reduction in azapropazone plasma levels. No special precautions would seem to be needed if any of these drugs are given together with azapropazone. Consider also NSAIDs Miscellaneous + Antacids , p.l42. 

Quinidine plasma levels can be reduced by the anthraquinone laxative senna. 

A study in 7 patients with cardiac arrhythmias taking quinidine bisulfate 500 mg every 12 hours found that the anthraquinone laxative senna (Liquedepur) redueed plasma quinidine levels, measured 12 hours after the last dose of quinidine, by about 25%. This might be of clinical importance in patients whose plasma levels are barely adequate to control their arrhythmia. 

Long-term use of senna and other anthraquinone laxatives may cause pseudomelanosis coli, a brownish pigmentation of the colon. Although pseudomelanosis coli has been... 

A prospective cohort study of the risk of anthraquinone laxatives use for the development of colorectal neoplasms indicated no statistically significant risk of anthranoid use for the development of colorectal adenomas or carcinomas. Macroscopic and high-grade microscopic melanosis coli were not significant risk factors for the development of adenomas or carcinomas (Nusko et al. 2000). 

Gastrointestinal A 74-year-old woman developed severe melanosis coli of the whole colon after using anthraquinone laxatives over many decades [72 ]. Endoscopy showed marked black pigmentation of the colonic mucosa, which was confirmed by histology as widespread lipofuscin granulation. Several adenomatous lesions were found, although no colorectal cancer was detected. 

Abendroth A, Klein R, Schlaak J, Metz KA, Dobos GJ, Langhorst J. Impressive picture of a melanosis coli after chronic anthraquinone laxative use—is there an increased risk for colorectal cancer Z Gastroenterol 2009 47 579-82. 

Phenolphthalein, like anthraquinones and other irritant phenolic compounds, is a stimulant laxative Colonic peristalsis is increased by stimulation of sensory nerve endings in the mucosa of the intestine. Phenolphthalein also enhances entrance of water and salts into the bowel... 

Stimulant laxatives increase intestinal motility thereby decreasing absorption of water and electrolytes. Included in this group are diphenylmethane derivatives and anthraquinones. 

Constipation bulk-forming laxatives by increasing faecal mass tend to soften stools and relieve constipation, and have value in a range of symptomatic problems associated with anal fissure, haemorrhoids, and with ileostomy and colostomy dysfunction. Faecal softeners, lactulose and macrogols (polyethylene glycol) retain fluid in the bowel. Stimulant laxatives, such as the anthraquinone, senna, and bisacodyl, increase motility and can cause colic verdoses can cause diarrhea and electrolyte depletion. Chronic treatment for constipation is seldom needed, but may be in children with a tendency to faecal impaction, specialist advice should be sought. 

Anthraquinone derivatives (e.g., cascara, aloe, senna, and rhubarb) are among the oldest laxatives known. They act on the colon rather than on the ileum and produce evacuation 8 to 10 hours after administration. This makes them particularly suitable for dosage overnight. Cascara sagrada is one of the mildest of the anthraquinone-containing laxatives. 

Brand Name(s) Ex-Lax, Senexon, Senna-Gen, Sennatural, Senokot, X-Prep Chemical Class Anthraquinone derivative... 

Anthraquinone glycosides are coloured substances, and are the active components in a number of crude drugs, especially with laxative and purgative properties. Anthraquinone aglycone increases peristaltic action of large intestine. A number of over the counter laxative preparations contain anthraquinone glycosides. The use of anthraquinone drugs, however,... 

Cassia angustifolia Vahl. Fan Xie Ye (leaflet) Sennosides, aloe-emodin, dianthrone glucoside, rhein monoglucoside, rhein, kaempferin, myricyl alcohol, anthraquinone derivative.33-510 Purgative, laxative, cathartic. 

Polygonum bistorta L. Cao He Che (Snakeweed, bistort) (stem, root) Iodine, oxalic acids, coumarins, hydroxycinnamic acids, ether oil, hydroxybenzoic acids, hydrocyanic acids, anthocyanidines, carotenes, anthraquinones, phytosterines, monoterpene, sesquiterpene glucoside, caffeic acid, quercimeritrin, avicularin, gallic acid, protocatechuic acid 50.221.222,223,224 Diuretic, laxative, hemostatic, antifebrile. 

Rheum officinale Baill. R. koreanum Nakai R. palmatum L. R. tanguticum Maxim R. undulatum L. Tai Huang (Rhubarb) (rhizome) Anthraquinones, chrysophanol, emodin, physcion, aloe-emodin, rhein, chrysophenol, rheum tannic acid, gallic acid, calechin, bianthraquinonyl, sennosides (R. undulatum also contains rhaponticin).1 33 236,510 This herb may be toxic. Potent laxative, antibacterial, anthelmintic, anticancer, stimulate the large intestine and increase the movement of luminal contents toward the anus, resulting in defecation. Antispasmodic, choleretic, hemostatic, diuretic, lower blood pressure, lower cholesterol level. 

N.A. Anthraquinone, beta-sitosterol, rhein, dianthrone glucosides, sennosides A, B, naphthalene glycosides, aloe-emodin, mucilage.99 100 510 511 Laxative, stimulant, anticancer, cathartic. 

N.A. Cinnamic acid, gallic acid, emodin, rhein, rhein anthrones, catechin, anthraquinone compounds, tannin, calcium oxalate.99-100-107-510-511 Treat diarrhea, stimulate appetite, chronic constipation, laxative, cathartic. 

N.A. Oxalates, anthraquinone (chrysophanol, emodin, physcion), phenol, physcion, tannic acid.100 102 118 Antiseptic, laxative, rheumatic pains. 

N.A. Anthraquinones, nepodin, emodin, chrysophanol, tannins, oxalates, volatile oil.99 Mild laxative, stimulates bile flow, as a cleansing. 

N.A. Anthraquinones, tannins, chebulic acid, resin.99 Laxative, astringent, improve bowel regularity. 

The family, characteristic of Arabia and South Africa with some species in other parts of Africa and Madagascar, has been separated from the Liliaceac. Species have been introduced elsewhere. Several have been used as a source of laxative anthraquinones and as a component of cosmetic preparations. Aloe is one of the oldest drugs. 

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