Senna, absorption

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. 

Furthermore, plants containing anthranoids, including senna (Cassia senna) and cascara (.Rhamnus purshiana), and soluble fibers, including guar gum and psyllium, can decrease the absorption of drugs (Fugh-Berman, 2000 Table 4.1). 

The anthraquinone group of laxatives includes senna, danthron, cascara, rhubarb and aloes. In the small intestine soluble anthraquinone derivates are liberated and absorbed. These are excreted into the colon and act there, along with those that have escaped absorption, probably after being chemically changed by bacterial action. 

Herbal medicines or teas often contain senna, which may produce diarrhea. In patients with disease persistence following dietary modification, loperamide may be used for episodic management of urgent diarrhea, or in situations in which the patient wishes to avoid the possibility of an acute onset of symptoms. This drug decreases intestinal transit, enhances water and electrolyte absorption, and strengthens rectal sphincter tone. Some patients may require continuous therapy, and careful dosage titration can usually be undertaken to prevent the development of constipation. Cholestyramine may be useful in patients with diarrhea related to idiopathic bile acid malabsorption or following cholecystectomy. ... 

The primary active ingredients of cascara sagrada include cascarosides A, B, C, and D, but barbaloin, chrysaloin, chryophanol, emodin, and aloe-emodin are also present (Tyler, 1994 Anonymous, 1996). The anthrone glucofrangulin is present in the cortex of the European species Rhamni frangula (De Witte, 1993). As with senna and aloe constituents, these anthrones produce an active secretion of water and electrolytes within the lumen of the small intestine. In addition, the anthrones inhibit absorption of water and electrolytes from the large intestine. This causes an increase in the volume of bowel contents, and strengthens the dilatation pressure in the intestine to stimulate peristalsis (Anonymous, 1996). 

May lower the absorption of these drugs (guar gum, senna)... 

Use of stimulant laxatives, such as senna or sickle-pod senna, may reduce the gastrointestinal transit time and thus reduce the absorption of orally administered drugs (Brinker 2001 De Smet 1993). 

Anthraquinones have cathartic properties and inhibit water and electrolyte absorption. The principal agents in this group are sagrada from Rhamnus purshiana, senna, and danthron. Dermatitis of the anal area has been described and found to be due to the formation of an irritant anthraquinone (Doepfmer 1954 Ippen 1959 Bergstrom and Holst 1972). Two cases of exanthema have been reported in Sweden. 

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