Laxative senna

The most common route of exposure is ingestion of any part of the plant. The seeds are the most poisonous part of the plant. Laxatives (senna, cascara) are derived from these plants and are taken either orally or rectally. 

Brusick, D. and Mengs, U. (1997) Assessment of the genotoxic risk from laxative senna products. Environ. Mol. Mutagen. 29, 1-9. 

The client is prescribed the stimulant laxative senna (Senokot) for constipation. The client calls the clinic and reports yellow-green-colored feces. Which action should the clinic nurse implement ... 

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. 

Irritant or stimulant laxatives increase peristalsis by direct action on the intestine. An example of an irritant laxative is cascara sagrada and senna (Senokot). 

Slow-transit constipation can be treated with chronic administration of osmotic laxatives. Tegaserod maleate 6 mg orally twice daily is an acceptable treatment. Senna, bisacodyl, and other stimulants should be used only when the others fail to deliver the desired effect. 

Senna (ExLax, Senokot) 1 7.2 mg orally as needed Second-line agent after bulk laxatives... 

For most nonhospitalized persons with acute constipation, the infrequent use (less than every few weeks) of most laxative products is acceptable however, before more potent laxative or cathartics are used, relatively simple measures may be tried. For example, acute constipation may be relieved by the use of a tap-water enema or a glycerin suppository if neither is effective, the use of oral sorbitol, low doses of bisacodyl or senna, or saline laxatives (e.g., milk of magnesia) may provide relief. 

Senokot-S Laxative, stool softener Tab Docusate 50 mg. Senna 187 mg 1-2tabqhs prn... 

One of the main side-effects of opioid analgesics, such as codeine and tramadol, is constipation. Amitriptyline (tricyclic antidepressant) and orphenadrine tend to have antimuscarinic properties, resulting in side-effects such as constipation. Senna is a stimulant laxative indicated in constipation. 

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. 

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... 

IV. Stimulant laxatives Bisacodyl, senna, phenolphthalein, danthron, sodium picosulphate, castor oil... 

Danthron (1,8 dihydroxyanthraquinone) derivatives occur in senna, cascara, rhubarb. They are highly effective, and the main side effect is excessive laxative effect and abdominal pain. Danthron reparations shouid oniy be used in older patients and the terminally ill because of the risk of lepatotoxicity. 

Aloe, senna, and cascara occur naturally in plants. These laxatives are poorly absorbed and after hydrolysis in the colon, produce a bowel movement in 6-12 hours when given orally and within 2 hours when given rectally. Chronic use leads to a characteristic brown pigmentation of the colon known as melanosis coli. There has been some concern that these agents may be carcinogenic, but epidemiologic studies do not suggest a relation to colorectal cancer. 

Oral Powder for oral solution, makes 2L or 4L Senna (Senokot, Ex Lax, others)... 

Stimulant laxatives Bisacodyl, 5-15 mg daily. Senna, dosage varies, consult product labeling Correctol, Dulcolax, Ex-Lax, Senokot, various generic Stimulant laxative actions include direct irritation of intestinal mucosa or stimulation of the myenteric plexus, resulting in peristalsis. These agents may also cause alteration of fluid and electrolyte absorption, resulting in luminal fluid accumulation and bowel evacuation. 

N.A. Cassia senna L. Anthraquinone, beta-sitosterol, rhein, dianthrone glucosides, sennosides A, sennosides B, naphthalene glycosides, aloe-emodine, mucilage.99 100 Laxative, stimulant, cathartic, anticancer, cathartic. 

Senna was used as a laxative in the past and continues to be used for this purpose today. Senna is stated to possess cathartic properties (the leaf more than the fruit) and has been used traditionally for treating constipation (see Chapter 12). 

Irritant agents used in the treatment of constipation include cascara sagrada, castor oil, senna, rhubarb, phenolphthalein, and acetphenolisatin. Phenolphthalein is a constituent of many over-the-counter preparations, including Corrected , Ex-Lax , and Feen-A-Mint . Most of these agents, with the exception of castor oil, are slow in their onset of action (24 h). 

LAXATIVES Gently loosen the bowels.—Cascara Sagrada, Dandelion, Feverfew, Golden Seal, Mountain Flax, Psyllium, Senna, Turkey Rhubarb. 

Incompatibilities of metoclopramide depend on drug concentration, pH, and temperature. It is incompatible with cephalosporins, chloramphenicol, sodium bicarbonate, doxorubicin, cisplatin, and cyclophosphamide. Caution should be exercised with simultaneous administration of metoclopramide with lithium, sym-pathomimetics, antidepressants, bromocriptine, and carbamazepine. Omperazole interacts with tolbutamide, clarithromycin, and phenytoin. Coadministration of rantidine and cisapride increases the plasma concentration of rantidine. Abuse of senna laxative has been reported and may cause hepatitis.176-178... 

In August 1997, the maker of Ex-Lax (which contained phenolphthalein), the nation s top-selling overnight laxative (1996 sales of 41 million), pulled three versions of the product off store shelves. The laxative had been in use since 1906. Replacement products containing senna as the active ingredient were made available several months later. The premise for forcing phenolphthalein removal was based on tests in rodents that developed a variety of tumors when fed the chemical in doses 50 to 100 times those recommended for humans. 

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