Aulne Noir, Bitter Bark, Bois Noir, Bois à Poudre, Borzène, Bourgène, Buckthorn, California Buckthorn, Cáscara, Cascara Sagrada, Chittem Bark, Dogwood Bark, Écorce Sacrée, Frangula purshiana, Nerprun, Pastel Bourd, Purshiana Bark, Rhamni Purshianae Cortex, Rhamnus purshiana, Rhubarbe des Paysans, Sacred Bark, Sagrada Bark, Yellow Bark.
Cascara is a shrub. The dried bark is used to make medicine.
Cascara used to be approved by the federal Food and Drug Administration (FDA) as an over-the-counter (OTC) drug for constipation. However, over the years, concerns were raised about cascara's safety and effectiveness. The FDA gave manufacturers the chance to submit safety and effectiveness information to answer these concerns. But the companies decided the cost of conducting safety and effectiveness studies would likely be more than the profit they could expect from sales of cascara. So they didn't comply with the request. As a result, the FDA notified manufacturers to remove or reformulate all OTC laxative products containing cascara from the U.S. market by November 5, 2002. Today, you can buy cascara as a “dietary supplement,” but not as a drug. “Dietary supplements” don't have to meet the standards that the FDA applies to OTC or prescription drugs.
Cascara is used as a laxative for constipation, as well as a treatment for gallstones, liver ailments, and cancer. Some people use it as a “bitter tonic.”
In foods and beverages, a bitterless extract of cascara is sometimes used as a flavoring agent.
In manufacturing, cascara is used in the processing of some sunscreens.
How does it work?
Cascara contains chemicals that stimulate the bowel and have a laxative effect.
Possibly Effective for...
- Constipation. Cascara has laxative effects and may help relieve constipation in some people.
Possibly Ineffective for...
- Bowel preparation before colonoscopy. Most research shows that taking cascara along with magnesium sulfate or milk of magnesia does not improve bowel cleansing in people who are undergoing a colonoscopy.
Insufficient Evidence to Rate Effectiveness for...
- Liver disease.
- Other conditions.
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
Cascara is POSSIBLY SAFE for most adults when taken by mouth for less than one week. Side effects include stomach discomfort and cramps.
Cascara is POSSIBLY UNSAFE when used long-term. Don't use cascara for longer than one or two weeks. Long-term use can cause more serious side effects including dehydration; low levels of potassium, sodium, chloride, and other “electrolytes” in the blood; heart problems; muscle weakness; and others.
Children: Cascara is POSSIBLY UNSAFE in children when taken by mouth. Don't give cascara to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.
Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn's disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara.
Digoxin (Lanoxin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects of digoxin (Lanoxin).
Medications for inflammation (Corticosteroids)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Some medications for inflammation can decrease potassium in the body. Cascara is a type of laxative that might also decrease potassium in the body. Taking cascara along with some medications for inflammation might decrease potassium in the body too much.
Medications taken by mouth (Oral drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Cascara is a laxative. Laxatives can decrease how much medicine your body absorbs. Decreasing how much medicine your body absorbs can decrease the effectiveness of your medication.
Stimulant laxativesInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives speed up the bowels. Taking cascara along with other stimulant laxatives could speed up the bowels too much and cause dehydration and low minerals in the body.
Some stimulant laxatives include bisacodyl (Correctol, Dulcolax), castor oil (Purge), senna (Senokot), and others.
Warfarin (Coumadin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Cascara can work as a laxative. In some people cascara can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take excessive amounts of cascara.
Water pills (Diuretic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Cascara is a laxative. Some laxatives can decrease potassium in the body. "Water pills" can also decrease potassium in the body. Taking cascara along with "water pills" might decrease potassium in the body too much.
The following doses have been studied in scientific research:
- As a laxative for constipation: 20-30 mg per day of the active ingredient (hydroxyanthracene derivatives). A typical dose is 1 cup of tea, which is made by steeping 2 grams of finely chopped bark in 150 mL of boiling water for 5-10 minutes, and then straining. The cascara liquid extract is taken in a dose of 2-5 mL three times daily. The appropriate amount of cascara is the smallest dose that is needed to maintain soft stools.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Bertram, P. D. Melanosis coli: a consequence of "alternative therapy" for psoriasis. Am J Gastroenterol 1993;88(6):971. View abstract.
Borkje, B., Pedersen, R., Lund, G. M., Enehaug, J. S., and Berstad, A. Effectiveness and acceptability of three bowel cleansing regimens. Scand J Gastroenterol 1991;26(2):162-166. View abstract.
Borrelli, F., Mereto, E., Capasso, F., Orsi, P., Sini, D., Izzo, A. A., Massa, B., Boggio, M., and Mascolo, N. Effect of bisacodyl and cascara on growth of aberrant crypt foci and malignant tumors in the rat colon. Life Sci 9-7-2001;69(16):1871-1877. View abstract.
Chang, C. J., Ashendel, C. L., Geahlen, R. L., McLaughlin, J. L., and Waters, D. J. Oncogene signal transduction inhibitors from medicinal plants. In Vivo 1996;10(2):185-190.
Chang, L. C., Sheu, H. M., Huang, Y. S., Tsai, T. R., and Kuo, K. W. A novel function of emodin: enhancement of the nucleotide excision repair of UV- and cisplatin-induced DNA damage in human cells. Biochem Pharmacol 1999;58(1):49-57.
Chen, H. C., Hsieh, W. T., Chang, W. C., and Chung, J. G. Aloe-emodin induced in vitro G2/M arrest of cell cycle in human promyelocytic leukemia HL-60 cells. Food Chem Toxicol 2004;42(8):1251-1257.
Chen, Y. C., Shen, S. C., Lee, W. R., Hsu, F. L., Lin, H. Y., Ko, C. H., and Tseng, S. W. Emodin induces apoptosis in human promyeloleukemic HL-60 cells accompanied by activation of caspase 3 cascade but independent of reactive oxygen species production. Biochem Pharmacol 12-15-2002;64(12):1713-1724. View abstract.
de Witte, P. and Lemli, L. The metabolism of anthranoid laxatives. Hepatogastroenterology 1990;37(6):601-605. View abstract.
Fork, F. T., Ekberg, O., Nilsson, G., Rerup, C., and Skinhoj, A. Colon cleansing regimens. A clinical study in 1200 patients. Gastrointest.Radiol. 1982;7(4):383-389. View abstract.
Goel, R. K., Das, Gupta G., Ram, S. N., and Pandey, V. B. Antiulcerogenic and anti-inflammatory effects of emodin, isolated from Rhamnus triquerta wall. Indian J Exp Biol 1991;29(3):230-232. View abstract.
Hangartner, P. J., Munch, R., Meier, J., Ammann, R., and Buhler, H. Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients. Endoscopy 1989;21(6):272-275. View abstract.
Huang, H. C., Chang, J. H., Tung, S. F., Wu, R. T., Foegh, M. L., and Chu, S. H. Immunosuppressive effect of emodin, a free radical generator. Eur J Pharmacol 2-18-1992;211(3):359-364. View abstract.
Huang, H. C., Lee, C. R., Chao, P. D., Chen, C. C., and Chu, S. H. Vasorelaxant effect of emodin, an anthraquinone from a Chinese herb. Eur J Pharmacol 12-3-1991;205(3):289-294. View abstract.
Huang, Q., Shen, H. M., and Ong, C. N. Inhibitory effect of emodin on tumor invasion through suppression of activator protein-1 and nuclear factor-kappaB. Biochem Pharmacol 7-15-2004;68(2):361-371. View abstract.
Izzo, A. A., Mascolo, N., and Capasso, F. Nitric oxide as a modulator of intestinal water and electrolyte transport. Dig Dis Sci 1998;43(8):1605-1620. View abstract.
Jin, Z. H., Ma, D. L., and Lin, X. Z. [Study on effect of emodin on the isolated intestinal smooth muscle of guinea-pigs]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 1994;14(7):429-431. View abstract.
Jung, H. A., Chung, H. Y., Yokozawa, T., Kim, Y. C., Hyun, S. K., and Choi, J. S. Alaternin and emodin with hydroxyl radical inhibitory and/or scavenging activities and hepatoprotective activity on tacrine-induced cytotoxicity in HepG2 cells. Arch Pharm Res 2004;27(9):947-953. View abstract.
Koyama, J., Morita, I., Tagahara, K., Nobukuni, Y., Mukainaka, T., Kuchide, M., Tokuda, H., and Nishino, H. Chemopreventive effects of emodin and cassiamin B in mouse skin carcinogenesis. Cancer Lett 8-28-2002;182(2):135-139. View abstract.
Kuo, P. L., Lin, T. C., and Lin, C. C. The antiproliferative activity of aloe-emodin is through p53-dependent and p21-dependent apoptotic pathway in human hepatoma cell lines. Life Sci 9-6-2002;71(16):1879-1892. View abstract.
Lai, G. H., Zhang, Z., and Sirica, A. E. Celecoxib acts in a cyclooxygenase-2-independent manner and in synergy with emodin to suppress rat cholangiocarcinoma growth in vitro through a mechanism involving enhanced Akt inactivation and increased activation of caspases-9 and -3. Mol.Cancer Ther 2003;2(3):265-271. View abstract.
Lee, H. Z. Effects and mechanisms of emodin on cell death in human lung squamous cell carcinoma. Br J Pharmacol 2001;134(1):11-20. View abstract.
Lee, H. Z. Protein kinase C involvement in aloe-emodin- and emodin-induced apoptosis in lung carcinoma cell. Br J Pharmacol 2001;134(5):1093-1103. View abstract.
Lee, H. Z., Hsu, S. L., Liu, M. C., and Wu, C. H. Effects and mechanisms of aloe-emodin on cell death in human lung squamous cell carcinoma. Eur J Pharmacol 11-23-2001;431(3):287-295. View abstract.
Liu, J. B., Gao, X. G., Lian, T., Zhao, A. Z., and Li, K. Z. [Apoptosis of human hepatoma HepG2 cells induced by emodin in vitro]. Ai.Zheng. 2003;22(12):1280-1283. View abstract.
Marchesi, M., Marcato, M., and Silvestrini, C. [Clinical experience with a preparation containing cascara sagrada and boldo in the therapy of simple constipation in the elderly]. G.Clin.Med. 1982;63(11-12):850-863. View abstract.
Mereto, E., Ghia, M., and Brambilla, G. Evaluation of the potential carcinogenic activity of Senna and Cascara glycosides for the rat colon. Cancer Lett 3-19-1996;101(1):79-83. View abstract.
Mitty, R. D., Wolfe, G. R., and Cosman, M. Initial description of gastric melanosis in a laxative-abusing patient. Am J Gastroenterol 1997;92(4):707-708. View abstract.
Morrow, D. M., Rapaport, M. J., and Strick, R. A. Hypersensitivity to aloe. Arch Dermatol. 1980;116(9):1064-1065. View abstract.
Muller, S. O., Eckert, I., Lutz, W. K., and Stopper, H. Genotoxicity of the laxative drug components emodin, aloe-emodin and danthron in mammalian cells: topoisomerase II mediated? Mutat.Res 12-20-1996;371(3-4):165-173. View abstract.
Novetsky, G. J., Turner, D. A., Ali, A., Raynor, W. J., Jr., and Fordham, E. W. Cleansing the colon in gallium-67 scintigraphy: a prospective comparison of regimens. AJR Am J Roentgenol. 1981;137(5):979-981. View abstract.
Nusko, G., Schneider, B., Schneider, I., Wittekind, C., and Hahn, E. G. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46(5):651-655.
Pecere, T., Gazzola, M. V., Mucignat, C., Parolin, C., Vecchia, F. D., Cavaggioni, A., Basso, G., Diaspro, A., Salvato, B., Carli, M., and Palu, G. Aloe-emodin is a new type of anticancer agent with selective activity against neuroectodermal tumors. Cancer Res 6-1-2000;60(11):2800-2804. View abstract.
Petticrew, M., Watt, I., and Sheldon, T. Systematic review of the effectiveness of laxatives in the elderly. Health Technol Assess. 1997;1(13):i-52. View abstract.
Phillip, J., Schubert, G. E., Thiel, A., and Wolters, U. [Preparation for colonoscopy using Golytely--a sure method? Comparative histological and clinical study between lavage and saline laxatives]. Med Klin (Munich) 7-15-1990;85(7):415-420. View abstract.
Rosengren, J. E. and Aberg, T. Cleansing of the colon without enemas. Radiologe 1975;15(11):421-426. View abstract.
Silberstein, E. B., Fernandez-Ulloa, M., and Hall, J. Are oral cathartics of value in optimizing the gallium scan? Concise communication. J Nucl.Med 1981;22(5):424-427. View abstract.
Stern, F. H. Constipation--an omnipresent symptom: effect of a preparation containing prune concentrate and cascarin. J Am Geriatr Soc 1966;14(11):1153-1155. View abstract.
Sydiskis, R. J., Owen, D. G., Lohr, J. L., Rosler, K. H., and Blomster, R. N. Inactivation of enveloped viruses by anthraquinones extracted from plants. Antimicrob.Agents Chemother. 1991;35(12):2463-2466. View abstract.
Tramonte, S. M., Brand, M. B., Mulrow, C. D., Amato, M. G., O'Keefe, M. E., and Ramirez, G. The treatment of chronic constipation in adults. A systematic review. J Gen.Intern.Med 1997;12(1):15-24. View abstract.
Wang, H. W., Chen, T. L., Yang, P. C., and Ueng, T. H. Induction of cytochromes P450 1A1 and 1B1 by emodin in human lung adenocarcinoma cell line CL5. Drug Metab Dispos. 2001;29(9):1229-1235. View abstract.
Cascara sagrada, aloe laxatives, O-9 contraceptives are category II-FDA. The Tan Sheet May 13, 2002.
Choice of laxatives for constipation. Pharmacist's Letter/Prescriber's Letter 2002;18(6):180614.
Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
Food and Drug Administration, HHS. Status of certain additional over-the counter drug category II and III active ingredients. Final rule. Fed Regist 2002;67:31125-7. View abstract.
Fork FT, Ekberg O, Nilsson G, et al. Colon cleansing regimens. A clinical study in 1200 patients. Gastrointest Radiol 1982;7:383-9. View abstract.
Nadir A, Reddy D, Van Thiel DH. Cascara-sagrada induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol 2000;95:3634-7. View abstract.
Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. View abstract.
Young DS. Effects of Drugs on Clinical Laboratory Tests 4th ed. Washington: AACC Press, 1995.