Senna glycoside
| Clinical data | |
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| Trade names | Ex-Lax, Senokot, and others[1] |
| AHFS/Drugs.com | Monograph |
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| Routes of administration | By mouth (PO), rectal (PR) |
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| Legal status | |
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| Pharmacokinetic data | |
| Onset of action | Minutes (PR), 6 to 12 hours (PO)[2] |
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Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1] The medication is taken by mouth or via the rectum.[1][3] It typically begins working in minutes when given by rectum and within twelve hours when given by mouth.[2] It is a weaker laxative than bisacodyl or castor oil.[1]
Common side effects of senna glycoside include abdominal cramps.[2] It is not recommended for long term use as it may result in poor bowel function or electrolyte problems. While no harms have been found for use while breastfeeding, such use is not typically recommended. It is not typically recommended in children. May change urine to a somewhat reddish color. Senna derivatives are a type of stimulant laxative and are of the anthraquinone type. While its mechanism of action is not entirely clear, senna is thought to act by increasing fluid secretion within and contraction of the large intestine.[1]
It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[4] It is available as a generic medication and is relatively cheap.[1][3] The wholesale cost in the developing world is about 0.01 USD per pill.[5] Sennosides come from the group of plants Senna.[2] In plant form it has been used at least since the 700s CE.[6]
Medical uses
Senna is used for the short-term treatment of symptomatic constipation. It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[7][8]
Administration
It should be taken once daily at bedtime.[8][9] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories act within 2 hours.[10]
Contraindications
According to Commission E, the German equivalent of the U.S. Food and Drug Administration, senna is contraindicated in cases of intestinal obstruction, acute intestinal inflammation (e.g., Crohn's disease), ulcerative colitis, appendicitis, and abdominal pain of unknown origin.[7]
Senna is considered contraindicated in people with a documented allergy to anthraquinones. Such allergies are rare and typically limited to dermatological reactions of redness and itching.[7]
Adverse effects
Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[7] Regular use of senna products can lead to a characteristic brown pigmentation of the internal colonic wall seen on colonoscopy. This abnormal pigmentation is known as melanosis coli.[10]
Interactions
Can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[11]
Mechanism of action
The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[12]
Pharmacology
They are anthraquinone derivatives and dimeric glycosides.
Society and culture
Formulations
Senna is an over-the-counter medication available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers as various brand names.[8]
Brand names
Ex-Lax Maximum Strength, Ex-Lax, Geri-kot, GoodSense Senna Laxative, Natural Senna Laxative, Perdiem Overnight Relief, Senexon, Senna Lax, Senna Laxative, Senna Maximum Strength, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot To Go, Senokot XTRA, Senokot, Kayam churna.[7]
References
- ^ a b c d e f g American Society of Health-System Pharmacists (January 1, 2008). "Senna". Drugs.com. Retrieved 11 August 2015.
- ^ a b Hamilton, Richard J. (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685.
- ^ "19th WHO Model List of Essential Medicines" (PDF). World Health Organization. April 2015. Retrieved 17 December 2015.
- ^ "Senna". International Drug Price Indicator Guide. Retrieved 11 August 2015.
- ^ Khare, C.P. (2004). Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 133. ISBN 9783642186592.
- ^ a b c d e Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
- ^ a b c Drugs.com http://www.drugs.com/ppa/senna.html
- ^ Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
- ^ a b McQuaid KR. Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In: Katzung BG, Masters SB, Trevor AJ. eds. Basic & Clinical Pharmacology, 12e. New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=388&Sectionid=45764290. Accessed April 18, 2014.
- ^ [1]
- ^ Sharkey KA, Wallace JL. Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. New York, NY: McGraw-Hill; 2011. http://accessmedicine.mhmedical.com/content.aspx?bookid=374&Sectionid=41266256. Accessed April 18, 2014.