Other Name(s):

Alexandrian Senna, Alexandrinische Senna, Casse, Cassia acutifolia, Cassia angustifolia, Cassia lanceolata, Cassia senna, Fan Xie Ye, Indian Senna, Khartoum Senna, Sen, Sena Alejandrina, Séné, Séné d'Alexandrie, Séné d'Egypte, Séne d'Inde, Séné de Tinnevelly, Senna alexandrina, Sennae Folium, Sennae Fructus, Sennosides, Tinnevelly Senna, True Senna.


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

Senna is an FDA-approved nonprescription laxative. 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), 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.”

How does it work?

Senna contains many chemicals called sennosides. Sennosides irritate the lining of the bowel, which causes a laxative effect.


Pancreatitis is inflammation of an organ in the abdomen called the pancreas. See Answer

Uses & Effectiveness

Likely Effective for...

  • Constipation. Taking senna by mouth is effective for short-term treatment of constipation. Senna is an FDA-approved nonprescription drug for adults and children ages 2 years and older. However, in children ages 3-15 years, mineral oil and a medication called lactulose might be more effective than taking senna. Senna also appears to be effective for treating constipation when used in combination with psyllium or docusate sodium. In elderly people, senna plus psyllium is more effective than lactulose for treating ongoing constipation. Senna plus docusate sodium is effective for treating constipation in the elderly and in people who have undergone anorectal surgery. Taking senna appears to be as effective as lactulose, psyllium, and docusate for relieving constipation in people taking opioids or loperamide.

Possibly Effective for...

  • Bowel preparation before colonoscopy. Taking senna by mouth is as effective as castor oil and bisocodyl for bowel cleansing. Some evidence suggests that senna is also at least as effective as polyethylene glycol for bowel preparation. However, conflicting evidence exists. It is unclear if taking senna with polyethylene glycol is more effective than taking polyethylene glycol alone. Senna appears to be less effective than sodium phosphate for bowel cleansing. However, taking a combination of senna, sodium picosulfate, and polyethylene glycol appears to be more effective than sodium phosphate for bowel prepration prior to colonoscopy.

Possibly Ineffective for...

  • Diagnostic imaging. Taking senna by mouth does not appear to improve imaging of abdominal organs.

Insufficient Evidence to Rate Effectiveness for...

  • Hemorrhoids.
  • Irritable bowel disease.
  • Losing weight.
  • Other conditions.
More evidence is needed to rate the effectiveness of senna for these uses.

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).

Side Effects

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.


Super Tips to Boost Digestive Health: Bloating, Constipation, and More See Slideshow

Special Precautions & Warnings

Pregnancy and breast-feeding: Senna is POSSIBLY SAFE during pregnancy and breast-feeding when taken by mouth, short-term. It is POSSIBLY UNSAFE when taken by mouth long-term or in high doses. Long-term, frequent use, or use of high doses has been linked to serious side effects including laxative dependence and liver damage.

Although small amounts of senna cross into breast milk, it doesn't seem to be a problem for nursing babies. As long as the mother uses senna in recommended amounts, senna does not cause changes in the frequency or consistency of babies' stools.

Electrolyte disturbances, potassium deficiency: Overuse of senna can make these conditions worse.

Dehydration, diarrhea or loose stools: Senna should not be used in people with dehydration, diarrhea, or loose stools. It can make these conditions worse.

Gastrointestinal (GI) conditions: Senna should not be used by people with abdominal pain (either diagnosed or undiagnosed), intestinal blockage, Crohn's disease, ulcerative colitis, appendicitis, stomach inflammation, anal prolapse, or hemorrhoids.

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


Birth control pills (Contraceptive drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Ethinyl estradiol is a form of estrogen that's in some birth control pills. Senna can decrease how much estradiol the body absorbs. Taking senna along with certain birth control pills might decrease their effectiveness.

Digoxin (Lanoxin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Senna 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).

EstrogensInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Some pills used for hormone replacement therapy contain the chemical estrone. Senna can reduce the amount of estrone in the body. Other pills used for hormone replacement therapy contain the chemical ethinyl estradiol. Senna can decrease how much estradiol the body absorbs. Taking senna might decrease the effects of hormone replacement therapy.

Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.

Warfarin (Coumadin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Senna can work as a laxative. In some people, senna 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 senna.

Water pills (Diuretic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Senna is a laxative. Some laxatives can decrease potassium in the body. "Water pills" can also decrease potassium in the body. Taking senna along with "water pills" might decrease potassium in the body too much.

Some "water pills" that can decrease potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.


The following doses have been studied in scientific research:


Senna is an FDA-approved nonprescription drug.

  • For constipation in adults and children age 12 and over: the usual dose is 17.2 mg daily. Don't take more than 34.4 mg per day.
  • For constipation in children: 8.5 mg daily increased just enough to cause one bowel movement daily has been used.
  • For constipation in elderly people: 17 mg daily has been used.
  • For constipation following pregnancy: 28 mg in 2 divided doses has been used.

FDA Logo

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.


Agra, Y., Sacristan, A., Gonzalez, M., Ferrari, M., Portugues, A., and Calvo, M. J. Efficacy of senna versus lactulose in terminal cancer patients treated with opioids. J Pain Symptom.Manage. 1998;15(1):1-7. View abstract.

Bailey, S. R., Tyrrell, P. N., and Hale, M. A trial to assess the effectiveness of bowel preparation prior to intravenous urography. Clin.Radiol. 1991;44(5):335-337. View abstract.


Beuers, U., Spengler, U., and Pape, G. R. Hepatitis after chronic abuse of senna. Lancet 2-9-1991;337(8737):372-373. 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.

Bossi, S., Arsenio, L., Bodria, P., Magnati, G., Trovato, R., and Strata, A. [Clinical study of a new preparation from plantago seeds and senna pods]. Acta Biomed.Ateneo.Parmense. 1986;57(5-6):179-186. View abstract.

Bronder, E., Klimpel, A., Helmert, U., Greiser, E., Molzahn, M., and Pommer, W. [Analgesics and laxatives as risk factors for cancer in the efferent urinary tract--results of the Berlin Urothelial Carcinoma Study]. Soz.Praventivmed. 1999;44(3):117-125. View abstract.

Brouwers, J. R., van Ouwerkerk, W. P., de Boer, S. M., and Thoman, L. A controlled trial of senna preparations and other laxatives used for bowel cleansing prior to radiological examination. Pharmacology 1980;20 Suppl 1:58-64. View abstract.

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

Buhmann, S., Kirchhoff, C., Wielage, C., Fischer, T., Mussack, T., Reiser, M., and Lienemann, A. [Visualization and quantification of large bowel motility with functional cine-MRI]. Rofo 2005;177(1):35-40. View abstract.

Buhmann, S., Kirchhoff, C., Wielage, C., Mussack, T., Reiser, M. F., and Lienemann, A. Assessment of large bowel motility by cine magnetic resonance imaging using two different prokinetic agents: a feasibility study. Invest Radiol. 2005;40(11):689-694. View abstract.

Burlefinger, R. J. and Schmitt, W. [Letter to the Journal of Gastroenterology. Comment on the article "Senna or bisacodyl before lavage preparation for colonoscopy: prospective randomized comparative study", by D. J. Ziegenhagen, E. Zehnter, W. Tacke, T. H. Gheorghiu, W. Kruis]. Z.Gastroenterol. 1992;30(5):376. View abstract.

Calore, E. E., Cavaliere, M. J., Haraguchi, M., Gorniak, S. L., Dagli, M. L., Raspantini, P. C., and Perez Calore, N. M. Experimental mitochondrial myopathy induced by chronic intoxication by Senna occidentalis seeds. J Neurol.Sci. 2-27-1997;146(1):1-6. View abstract.

Chilton, A. P., O'Sullivan, M., Cox, M. A., Loft, D. E., and Nwokolo, C. U. A blinded, randomized comparison of a novel, low-dose, triple regimen with fleet phospho-soda: a study of colon cleanliness, speed and success of colonoscopy. Endoscopy 2000;32(1):37-41. View abstract.

Chomnawang, M. T., Surassmo, S., Nukoolkarn, V. S., and Gritsanapan, W. Effect of Garcinia mangostana on inflammation caused by Propionibacterium acnes. Fitoterapia 2007;78(6):401-408. View abstract.

Connolly, P., Hughes, I. W., and Ryan, G. Comparison of "Duphalac" and "irritant" laxatives during and after treatment of chronic constipation: a preliminary study. Curr Med Res Opin. 1974;2(10):620-625. View abstract.

Corman, M. L. Management of postoperative constipation in anorectal surgery. Dis.Colon Rectum 1979;22(3):149-151. View abstract.

Crossner, C. G., Birkhed, D., and Edwardsson, S. [The cariologic aspects of two laxatives--Senna (Fikonsirap) and Duphalac]. Tandlakartidningen. 3-15-1982;74(6):284-288. View abstract.

de Witte, P. and Lemli, L. The metabolism of anthranoid laxatives. Hepatogastroenterology 1990;37(6):601-605. View abstract.

de Witte, P. Metabolism and pharmacokinetics of anthranoids. Pharmacology 1993;47 Suppl 1:86-97. View abstract.

De, Salvo L., Borgonovo, G., Ansaldo, G. L., Varaldo, E., Floris, F., Assalino, M., and Gianiorio, F. The bowel cleansing for colonoscopy. A randomized trial comparing three methods. Ann.Ital.Chir 2006;77(2):143-146. View abstract.

Fernandez, Seara J., Pascual, Rubin P., Pato Rodriguez, M. A., Pereira Jorge, J. A., Dominguez Alvarez, L. M., Landeiro, Aller E., Tesouro, Rodriguez, I, Gonzalez Simon, M. C., Mendez Veloso, M. C., and Pena, Perez L. [Comparative study of the efficacy and tolerance of 2 types of colon cleansing]. Rev.Esp.Enferm.Dig. 1995;87(11):785-791. View abstract.

Fireman, Z., Rozen, P., Fine, N., and Chetrit, A. Reproducibility studies and effects of bowel preparations on measurements of rectal epithelial proliferation. Cancer Lett. 1989;45(1):59-64. View abstract.

First International Symposium on Senna. May 22-23, 1987, Rottach-Egern (FRG). Proceedings. Pharmacology 1988;36 Suppl 1:1-240. View abstract.

Gattuso, J. M. and Kamm, M. A. Adverse effects of drugs used in the management of constipation and diarrhoea. Drug Saf 1994;10(1):47-65. View abstract.

Glatzel, H. [Results of long-term therapy of 1059 babitually constipated patients using a standardized senna preparation]. Z.Allgemeinmed. 5-10-1972;48(13):654-656. View abstract.

Goppel, M. and Franz, G. Stability control of senna leaves and senna extracts. Planta Med 2004;70(5):432-436. View abstract.

Gould, S. R. and Williams, C. B. Castor oil or senna preparation before colonoscopy for inactive chronic ulcerative colitis. Gastrointest.Endosc. 1982;28(1):6-8. View abstract.

Greenhalf, J. O. and Leonard, H. S. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner 1973;210(256):259-263. View abstract.

Greiner, A. C. and Warwick, W. E. The use of sennosides A and B in the treatment of constipation in a mental institution. Appl.Ther 1965;7(12):1096-1098. View abstract.

Guo, H., Huang, Y., Xi, Z., Song, Y., Guo, Y., and Na, Y. Is bowel preparation before excretory urography necessary? A prospective, randomized, controlled trial. J Urol. 2006;175(2):665-668. 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.

Hardcastle, J. D. and Wilkins, J. L. The action of sennosides and related compounds on human colon and rectum. Gut 1970;11(12):1038-1042. View abstract.

Heldwein, W., Sommerlatte, T., Hasford, J., Lehnert, P., Littig, G., and Muller-Lissner, S. Evaluation of the usefulness of dimethicone and/or senna extract in improving the visualization of abdominal organs. J Clin.Ultrasound 1987;15(7):455-458. View abstract.

Hensel, A., Deters, A. M., Muller, G., Stark, T., Wittschier, N., and Hofmann, T. Occurrence of N-phenylpropenoyl-L-amino acid amides in different herbal drugs and their influence on human keratinocytes, on human liver cells and on adhesion of Helicobacter pylori to the human stomach. Planta Med. 2007;73(2):142-150. View abstract.

Hietala, P., Lainonen, H., and Marvola, M. New aspects on the metabolism of the sennosides. Pharmacology 1988;36 Suppl 1:138-143. View abstract.

Ip, S. W., Weng, Y. S., Lin, S. Y., Mei, Dueyang, Tang, N. Y., Su, C. C., and Chung, J. G. The role of Ca+2 on rhein-induced apoptosis in human cervical cancer Ca Ski cells. Anticancer Res 2007;27(1A):379-389. 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.

Kaspi, T., Royds, R. B., and Turner, P. Qualitative determination of senna in urine. Lancet 5-27-1978;1(8074):1162. View abstract.

Kinnunen, O. and Salokannel, J. The carry-over effect on the bowel habit in elderly long-term patients of long-term bulk-forming products containing stimulant laxative. Acta Med Scand. 1987;222(5):477-479. View abstract.

Kobashi, K., Nishimura, T., Kusaka, M., Hattori, M., and Namba, T. Metabolism of sennosides by human intestinal bacteria. Planta Med 1980;40(3):225-236. View abstract.

Kositchaiwat, S., Suwanthanmma, W., Suvikapakornkul, R., Tiewthanom, V., Rerkpatanakit, P., and Tinkornrusmee, C. Comparative study of two bowel preparation regimens for colonoscopy: senna tablets vs sodium phosphate solution. World J Gastroenterol. 9-14-2006;12(34):5536-5539. View abstract.

Krumbiegel G and Schulz HU. Rhein and aloe-emodin kinetics from senna laxatives in man. Pharmacology 1993;47(suppl 1):120-124. View abstract.

Labenz, J., Hopmann, G., Leverkus, F., and Borsch, G. [Bowel cleansing prior to colonoscopy. A prospective, randomized, blind comparative study]. Med Klin.(Munich) 10-15-1990;85(10):581-585. View abstract.

Lazarus, H., Fitzmartin, R. D., and Goldenheim, P. D. A multi-investigator clinical evaluation of oral controlled-release morphine (MS Contin tablets) administered to cancer patients. Hosp.J 1990;6(4):1-15. View abstract.

Lemli, J. [Mechanism of action of sennosides]. Bull.Acad.Natl.Med 1995;179(8):1605-1611. View abstract.

Lemli, J. [Senna: chemistry and pharmacology]. Verh.K.Acad.Geneeskd.Belg. 1986;48(1):51-62. View abstract.

Lemli, J. [The mechanism of action of sennosides]. Ann.Gastroenterol.Hepatol.(Paris) 1996;32(2):109-112. View abstract.

Lemli, J. Metabolism of sennosides--an overview. Pharmacology 1988;36 Suppl 1:126-128. View abstract.

Lemli, J. Senna--an old drug in modern research. Pharmacology 1988;36 Suppl 1:3-6. View abstract.

Leng-Peschlow, E. Acceleration of large intestine transit time in rats by sennosides and related compounds. J Pharm.Pharmacol. 1986;38(5):369-373. View abstract.

Leng-Peschlow, E. Dual effect of orally administered sennosides on large intestine transit and fluid absorption in the rat. J Pharm.Pharmacol. 1986;38(8):606-610. View abstract.

Leng-Peschlow, E. Inhibition of intestinal water and electrolyte absorption by senna derivatives in rats. J Pharm.Pharmacol. 1980;32(5):330-335. View abstract.

Levine, D., Goode, A. W., and Wingate, D. L. Purgative abuse associated with reversible cachexia, hypogammaglobulinaemia, and finger clubbing. Lancet 4-25-1981;1(8226):919-920. View abstract.

Lewis, S. and Cochrane, S. Alteration of sulfate and hydrogen metabolism in the human colon by changing intestinal transit rate. Am J Gastroenterol. 2007;102(3):624-633. View abstract.

Lewis, S. J. and Heaton, K. W. Increasing butyrate concentration in the distal colon by accelerating intestinal transit. Gut 1997;41(2):245-251. View abstract.

Lewis, S. J. and Heaton, K. W. Stool form scale as a useful guide to intestinal transit time. Scand.J Gastroenterol. 1997;32(9):920-924. View abstract.

Lewis, S. J., Heaton, K. W., Oakey, R. E., and McGarrigle, H. H. Lower serum oestrogen concentrations associated with faster intestinal transit. Br.J Cancer 1997;76(3):395-400. View abstract.

Lewis, S. J., Oakey, R. E., and Heaton, K. W. Intestinal absorption of oestrogen: the effect of altering transit-time. Eur.J Gastroenterol.Hepatol. 1998;10(1):33-39. View abstract.

Lewis, S., Bolton, C., and Heaton, K. Lack of influence of intestinal transit on oxidative status in premenopausal women. Eur.J Clin.Nutr. 1996;50(8):565-568. View abstract.

Lim, A. K., Hooke, D. H., and Kerr, P. G. Anorexia nervosa and senna misuse: nephrocalcinosis, digital clubbing and hypertrophic osteoarthropathy. Med J Aust. 1-21-2008;188(2):121-122. View abstract.

Maddi, V. I. Regulation of bowel function by a laxative/stool softener preparation in aged nursing home patients. J Am Geriatr.Soc. 1979;27(10):464-468. View abstract.

Maguire, L. C., Yon, J. L., and Miller, E. Prevention of narcotic-induced constipation. N.Engl.J Med 12-31-1981;305(27):1651. View abstract.

Malmquist, J., Ericsson, B., Hulten-Nosslin, M. B., Jeppsson, J. O., and Ljungberg, O. Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient. Postgrad.Med J 1980;56(662):862-864. View abstract.

Marcus, S. N. and Heaton, K. W. Intestinal transit, deoxycholic acid and the cholesterol saturation of bile--three inter-related factors. Gut 1986;27(5):550-558. View abstract.

Marvola, M., Koponen, A., Hiltunen, R., and Hieltala, P. The effect of raw material purity on the acute toxicity and laxative effect of sennosides. J Pharm.Pharmacol. 1981;33(2):108-109. View abstract.

McLaughlin, A. F. Anorexia nervosa and senna misuse: nephrocalcinosis, digital clubbing and hypertrophic osteoarthropathy. Med J Aust. 9-15-2008;189(6):348. View abstract.

Mengs, U. and Rudolph, R. L. Light and electron-microscopic changes in the colon of the guinea pig after treatment with anthranoid and non-anthranoid laxatives. Pharmacology 1993;47 Suppl 1:172-177. View abstract.

Mengs, U. Reproductive toxicological investigations with sennosides. Arzneimittelforschung. 1986;36(9):1355-1358. View abstract.

Mengs, U. Toxic effects of sennosides in laboratory animals and in vitro. Pharmacology 1988;36 Suppl 1:180-187. View abstract.

Mengs, U., Grimminger, W., Krumbiegel, G., Schuler, D., Silber, W., and Volkner, W. No clastogenic activity of a senna extract in the mouse micronucleus assay. Mutat.Res 8-18-1999;444(2):421-426. 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.

Miles, C. L., Fellowes, D., Goodman, M. L., and Wilkinson, S. Laxatives for the management of constipation in palliative care patients. Cochrane.Database.Syst.Rev. 2006;(4):CD003448. View abstract.

Milner, P., Belai, A., Tomlinson, A., Hoyle, C. H., Sarner, S., and Burnstock, G. Effects of long-term laxative treatment on neuropeptides in rat mesenteric vessels and caecum. J Pharm.Pharmacol. 1992;44(9):777-779. View abstract.

Mishalany, H. Seven years' experience with idiopathic unremitting chronic constipation. J Pediatr.Surg. 1989;24(4):360-362. View abstract.

Mitchell, J. M., Mengs, U., McPherson, S., Zijlstra, J., Dettmar, P., Gregson, R., and Tigner, J. C. An oral carcinogenicity and toxicity study of senna (Tinnevelly senna fruits) in the rat. Arch.Toxicol. 2006;80(1):34-44. View abstract.

Modes of action of senna. Pharmacology 1992;44 Suppl 1:16-19. View abstract.

Nazif, N. M., Rady, M. R., and el-Nasr, M. M. Stimulation of anthraquinone production in suspension cultures of Cassia acutifolia by salt stress. Fitoterapia 2000;71(1):34-40. View abstract.

Otero, R., Nunez, V., Barona, J., Fonnegra, R., Jimenez, S. L., Osorio, R. G., Saldarriaga, M., and Diaz, A. Snakebites and ethnobotany in the northwest region of Colombia. Part III: neutralization of the haemorrhagic effect of Bothrops atrox venom. J.Ethnopharmacol. 2000;73(1-2):233-241. View abstract.

Padumanonda, T. and Gritsanapan, W. Barakol contents in fresh and cooked Senna siamea leaves. Southeast Asian J Trop.Med Public Health 2006;37(2):388-393. View abstract.

Padumanonda, T., Suntornsuk, L., and Gritsanapan, W. Quantitative analysis of barakol content in Senna siamea leaves and flowers by TLC-densitometry. Med Princ.Pract. 2007;16(1):47-52. View abstract.

Patanwala, A. E., Abarca, J., Huckleberry, Y., and Erstad, B. L. Pharmacologic management of constipation in the critically ill patient. Pharmacotherapy 2006;26(7):896-902. View abstract.

Pers, M. and Pers, B. A crossover comparative study with two bulk laxatives. J Int.Med Res 1983;11(1):51-53. View abstract.

Pockros, P. J. and Foroozan, P. Golytely lavage versus a standard colonoscopy preparation. Effect on normal colonic mucosal histology. Gastroenterology 1985;88(2):545-548. View abstract.

Putalun, W., Pimmeuangkao, S., De-Eknamkul, W., Tanaka, H., and Shoyama, Y. Sennosides A and B production by hairy roots of Senna alata (L.) Roxb. Z.Naturforsch.C. 2006;61(5-6):367-371. View abstract.

Radaelli, F., Meucci, G., Imperiali, G., Spinzi, G., Strocchi, E., Terruzzi, V., and Minoli, G. High-dose senna compared with conventional PEG-ES lavage as bowel preparation for elective colonoscopy: a prospective, randomized, investigator-blinded trial. Am J Gastroenterol. 2005;100(12):2674-2680. View abstract.

Raimondi, F., Santoro, P., Maiuri, L., Londei, M., Annunziata, S., Ciccimarra, F., and Rubino, A. Reactive nitrogen species modulate the effects of rhein, an active component of senna laxatives, on human epithelium in vitro. J Pediatr.Gastroenterol.Nutr. 2002;34(5):529-534. View abstract.

Ramkumar, D. and Rao, S. S. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100(4):936-971. View abstract.

Rogers, H. J., House, F. R., Morrison, P. J., and Bradbrook, I. D. Comparison of the effect of drugs upon some commonly used measures of bowel transit time. Br.J Clin.Pharmacol. 1978;6(6):493-497. View abstract.

Sanders, R. C. and Wright, F. W. Colonic preparation: a controlled trial of Dulcodos, Dulcolax and Senokot DX. Br.J Radiol. 1970;43(508):245-247. View abstract.

Sansores-Peraza, P., Rosado-Vallado, M., Brito-Loeza, W., Mena-Rejon, G. J., and Quijano, L. Cassine, an antimicrobial alkaloid from Senna racemosa. Fitoterapia 2000;71(6):690-692. View abstract.

Senna and damage of the nerve plexus of the intestinal wall. Pharmacology 1992;44 Suppl 1:26-29. View abstract.

Senna and habituation. Pharmacology 1992;44 Suppl 1:30-32. View abstract.

Site of senna action. Pharmacology 1992;44 Suppl 1:10-15. View abstract.

Slanger, A. Comparative study of a standardized senna liquid and castor oil in preparing patients for radiographic examination of the colon. Dis.Colon Rectum 1979;22(5):356-359. View abstract.

Sogni, P., Chaussade, S., Akue-Gohe, K., Nepveux, P., Homerin, M., Couturier, D., and Guerre, J. [Comparative effects of ricinoleic acid and senna on orocecal and oroanal transit time in healthy subjects. Application of the salacylazosulfapyridine method]. Gastroenterol.Clin.Biol 1992;16(1):21-24. View abstract.

Sonmez, A., Yilmaz, M. I., Mas, R., Ozcan, A., Celasun, B., Dogru, T., Taslipinar, A., and Kocar, I. H. Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation. Acta Gastroenterol.Belg. 2005;68(3):385-387. View abstract.

Soyuncu, S., Cete, Y., and Nokay, A. E. Portal vein thrombosis related to Cassia angustifolia. Clin.Toxicol.(Phila) 2008;46(8):774-777. View abstract.

Sriphong, L., Sotanaphun, U., Limsirichaikul, S., Wetwitayaklung, P., Chaichantipyuth, C., and Pummangura, S. Cytotoxic alkaloids from the flowers of Senna spectabilis. Planta Med 2003;69(11):1054-1056. View abstract.

Staumont, G., Frexinos, J., Fioramonti, J., and Bueno, L. Sennosides and human colonic motility. Pharmacology 1988;36 Suppl 1:49-56. View abstract.

Stickel, F. and Schuppan, D. Herbal medicine in the treatment of liver diseases. Dig.Liver Dis. 2007;39(4):293-304. View abstract.

Sykes, N. P. A volunteer model for the comparison of laxatives in opioid-related constipation. J Pain Symptom.Manage. 1996;11(6):363-369. View abstract.

Taylor, S. A., Slater, A., Burling, D. N., Tam, E., Greenhalgh, R., Gartner, L., Scarth, J., Pearce, R., Bassett, P., and Halligan, S. CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur.Radiol. 2008;18(1):32-42. View abstract.

Tshikalange, T. E., Meyer, J. J., and Hussein, A. A. Antimicrobial activity, toxicity and the isolation of a bioactive compound from plants used to treat sexually transmitted diseases. J Ethnopharmacol. 1-15-2005;96(3):515-519. View abstract.

Unal, S., Dogan, U. B., Ozturk, Z., and Cindoruk, M. A randomized prospective trial comparing 45 and 90-ml oral sodium phosphate with X-Prep in the preparation of patients for colonoscopy. Acta Gastroenterol.Belg. 1998;61(3):281-284. View abstract.

Valverde, A., Hay, J. M., Fingerhut, A., Boudet, M. J., Petroni, R., Pouliquen, X., Msika, S., and Flamant, Y. Senna vs polyethylene glycol for mechanical preparation the evening before elective colonic or rectal resection: a multicenter controlled trial. French Association for Surgical Research. Arch.Surg. 1999;134(5):514-519. View abstract.

van der Jagt, E. J., Thijn, C. J., and Taverne, P. P. Colon cleansing prior to roentgenologic examination. A double blind comparative study. J Belge Radiol. 1986;69(3):167-170. View abstract.

van Gorkom, B. A., Karrenbeld, A., Limburg, A. J., and Kleibeuker, J. H. The effect of sennosides on colonic mucosal histology and bowel preparation. Z.Gastroenterol. 1998;36(1):13-18. View abstract.

van Gorkom, B. A., Karrenbeld, A., van Der, Sluis T., Koudstaal, J., de Vries, E. G., and Kleibeuker, J. H. Influence of a highly purified senna extract on colonic epithelium. Digestion 2000;61(2):113-120. View abstract.

Waltenberger, B., Avula, B., Ganzera, M., Khan, I. A., Stuppner, H., and Khan, S. I. Transport of sennosides and sennidines from Cassia angustifolia and Cassia senna across Caco-2 monolayers--an in vitro model for intestinal absorption. Phytomedicine. 2008;15(5):373-377. View abstract.

Wildgrube, H. J. and Lauer, H. [Combination intestinal lavage: a conservative procedure for colonoscopy]. Bildgebung 1991;58(2):63-66. View abstract.

Wilkins, J. L. and Hardcastle, J. D. The mechanism by which senna glycosides and related compounds stimulate peristalsis in the human colon. Br.J Surg. 1970;57(11):864. View abstract.

Yang, B. and Ni, H. K. Diagnosis and treatment of spontaneous colonic perforation: analysis of 10 cases. World J Gastroenterol. 7-28-2008;14(28):4569-4572. View abstract.

Ziegenhagen, D. J., Zehnter, E., Tacke, W., and Kruis, W. Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial. Gastrointest.Endosc. 1991;37(5):547-549. View abstract.

Ziegenhagen, D. J., Zehnter, E., Tacke, W., Gheorghiu, T., and Kruis, W. Senna vs. bisacodyl in addition to Golytely lavage for colonoscopy preparation--a prospective randomized trial. Z.Gastroenterol. 1992;30(1):17-19. View abstract.

[No authors listed] Senna in the puerperium. Pharmacology 1992;44:23-5. View abstract.

American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-89. View abstract.

Arezzo A. Prospective randomized trial comparing bowel cleaning preparations for colonoscopy. Surg Laparosc Endosc Percutan Tech. 2000;10:215-7. View abstract.

Duncan AS. Standardized senna as a laxative in the puerperium; a clinical assessment. Br Med J 1957;1:439-41. View abstract.

Ewe K, Ueberschaer B, Press AG. Influence of senna, fibre, and fibre + senna on colonic transit in loperamide-induced constipation. Pharmacology 1993;47:242-8. View abstract.

Faber P, Strenge-Hesse A. Relevance of rhein excretion into breast milk. Pharmacology 1988;36 Suppl 1:212-20. View abstract.

Faber P, Strenge-Hesse A. Senna-containing laxatives: excretion in the breast milk? Geburtshilfe Frauenheilkd 1989;49:958-62. View abstract.

Godding EW. Laxatives and the special role of senna. Pharmacology 1988;36:230-6. View abstract.

Hagemann TM. Gastrointestinal medications and breastfeeding. J Hum Lact 1998;14:259-62. View abstract.

Joo JS, Ehrenpreis ED, Gonzalez L, et al. Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. J Clin Gastroenterol 1998;26:283-6. View abstract.

Kinnunen O, Winblad I, Koistinen P, Salokannel J. Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacology 1993;47:253-5. View abstract.

Kittisupamongkol W, Nilaratanakul V, Kulwichit W. Near-fatal bleeding, senna, and the opposite of lettuce. Lancet 2008;371:784. View abstract.

Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver disease--benefits and dangers. Aliment Pharmacol Ther 2001;15:1239-52. View abstract.

MacLennan WJ, Pooler AFWM. A comparison of sodium picosulphate ("Laxoberal") with standardised senna ("Senokot") in geriatric patients. Curr Med Res Opin. 1974;2:641-7. View abstract.

Marlett JA, Li BU, Patrow CJ, Bass P. Comparative laxation of psyllium with and without senna in an ambulatory constipated population. Am J Gastroenterol 1987;82:333-7. 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.

Passmore AP, Davies KW, Flanagan PG, et al. A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology 1993;47:249-52. View abstract.

Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ 1993;307:769-71. View abstract.

Perkin JM. Constipation in childhood: a controlled comparison between lactulose and standardized senna. Curr Med Res Opin 1977;4:540-3. View abstract.

Prather CM. Pregnancy-related constipation. Curr Gastroenterol Rep 2004;6:402-4. View abstract.

Prior J, White I. Tetany and clubbing in patient who ingested large quantities of senna. Lancet 1978;2:947. View abstract.

Ramesh PR, Kumar KS, Rajagopal MR, et al. Managing morphine-induced constipation: a controlled comparison of an Ayurvedic formulation and senna. J Pain Symptom Manage 1998;16:240-4. View abstract.

Senokot Package Labeling. Purdue Products L.P. 2007.

Seybold U, Landauer N, Hillebrand S, Goebel FD. Senna-induced hepatitis in a poor metabolizer. Ann Intern Med 2004;141:650-1. View abstract.

Shelton MG. Standardized senna in the management of constipation in the puerperium: A clinical trial. S Afr Med J 1980;57:78-80. View abstract.

Sondheimer JM, Gervaise EP. Lubricant versus laxative in the treatment of chronic functional constipation of children: a comparative study. J Pediatr Gastroenterol Nutr 1982;1:223-6. View abstract.

van Os FH. Anthraquinone derivatives in vegetable laxatives. Pharmacology 1976;14:7-17. View abstract.

Vanderperren B, Rizzo M, Angenot L, et al. Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides. Ann Pharmacother 2005;39:1353-7. View abstract.

Werthmann WM Jr, Krees SV. Quantitative excretion of Senokot in human breast milk. Med Ann Dist Columbia 1973;42:4-5. View abstract.

Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9. View abstract.

Young DS. Effects of Drugs on Clinical Laboratory Tests 4th ed. Washington: AACC Press, 1995.

Health Solutions From Our Sponsors