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ALIMENTARY TRACT AND METABOLISM › DRUGS FOR CONSTIPATION › DRUGS FOR CONSTIPATION › Contact laxatives
cascara
A06AB07
Forms & Strengths
- Aromatic Cascara Sagrada Fluidextract: 1 g/mL
- Cascara Sagrada Tablets: 325 mg
- Crude bark preparations
Adult Dosing
- Fluidextract: 1 mL orally once daily as needed at bedtime
- Aromatic fluidextract: 2 to 5 mL orally once daily as needed
- Tablets (325 mg): 1 to 2 tablets orally once daily at bedtime
- Limit short-term use to no longer than 1 week
Pediatric Dosing
- Children < 2 years: Safety and efficacy not established
- Children 2-11 years: 0.25 to 0.5 mL fluidextract or fraction of adult dose, cautiously and short-term
- Children ≥ 12 years: Same as adult dosing
Indications
- Short-term relief of occasional constipation
- Evacuation of bowel prior to diagnostic or endoscopic procedures
Mechanism of Action
- Anthraquinone glycosides (emodin, aloin) are hydrolyzed by colonic bacteria
- Stimulates peristaltic activity of the colon via direct action on the intestinal mucosa and nerve plexus
- Inables net absorption of water and electrolytes, increasing luminal fluid accumulation
Contraindications
- Hypersensitivity to cascara sagrada or anthraquinones
- Intestinal obstruction, ileus, or bowel perforation
- Acute surgical abdomen (e.g., appendicitis)
- Inflammatory bowel disease (e.g., Crohn disease, ulcerative colitis)
- Undiagnosed abdominal pain, nausea, or vomiting
- Severe dehydration or electrolyte depletion
Adverse Reactions
- Abdominal cramps, colic, and griping
- Nausea and diarrhea
- Electrolyte disturbances (hypokalemia, hypocalcemia) with chronic use
- Melanosis coli (benign pigmentation of the colonic mucosa with prolonged use)
- Cathartic colon (atonic colon dysfunction with chronic abuse)
- Urgent need for defecation, urine discoloration (yellow-brown to red-pink)
Drug Interactions
- Cardiac glycosides (digoxin): Risk of toxicity due to cascara-induced hypokalemia
- Diuretics (thiazides, loop diuretics): Increased risk of severe potassium depletion
- Oral medications: Decreased absorption due to accelerated transit time through the GI tract
- Anticoagulants (warfarin): Altered absorption of fat-soluble vitamins or unpredictable INR changes
Curated Content: Needs Vetting Before Put to Clinical Use