Senna glycoside

Senna glycoside
Names
Trade namesEx-Lax, Senokot, and others[1]
Clinical data
Pregnancy
category
  • AU: N[2]
  • US: N (Not classified yet)[2]
Routes of
use		By mouth (PO), rectal (PR)
Onset of actionMinutes (PR), 6 to 12 hours (PO)[3]
Defined daily dosenot established[4]
External links
AHFS/Drugs.comMonograph
US NLMSenna glycoside
MedlinePlusa601112
Legal
License data
Legal status
  • US: OTC / Rx-only
Chemical and physical data
FormulaC42H38O20[5]
Molar mass862.75 g·mol−1

Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][6] The medication is taken by mouth or via the rectum.[1][7] It typically begins working in minutes when given by rectum and within twelve hours when given by mouth.[3] It is a weaker laxative than bisacodyl or castor oil.[1]

Common side effects of senna glycoside include abdominal cramps.[3] It is not recommended for long-term use, as it may result in poor bowel function or electrolyte problems.[1] While no harm has been found to result from use while breastfeeding, such use is not typically recommended.[1] It is not typically recommended in children.[1] Senna may change urine to a somewhat reddish color.[1] Senna derivatives are a type of stimulant laxative and are of the anthraquinone type.[1] 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.[8] It is available as a generic medication and is relatively inexpensive.[1][7] The wholesale cost in the developing world is about 0.01 USD per pill.[9] Sennosides come from the group of plants Senna.[3] In plant form, it has been used at least since the 700s CE.[10] In 2017, it was the 287th most commonly prescribed medication in the United States, with more than one million prescriptions.[11][12] It is sold under a number of brand names including Ex-Lax and Senokot.[1]

Medical uses

Senna is used for episodic and chronic constipation though there is a lack of high-quality evidence to support its use for these purposes.[6] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[13][14] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories act within two hours.[15]

Dosage

The defined daily dose is not established.[4] In the United States the adult dose is 15 to 17.2 mg once to twice per day.[16][17] The dose in children 2 to 6 years old is 4.3 mg once to twice per day and in children 6 to 12 years old is 8.6 mg once to twice per day.[16]

If used once daily it is recommended at bedtime.[14][18]

Contraindications

According to Commission E 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.[13]

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.[13]

Side effects

Side effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[13] 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.[15]

Interactions

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[19]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[20]

Pharmacology

They are anthraquinone derivatives and dimeric glycosides.

Society and culture

Cost

The wholesale cost in the developing world is about 0.01 USD per pill.[9]In 2017, it was the 287th most commonly prescribed medication in the United States, with more than one million prescriptions.[11][12]

  • Sennosides costs (US)
  • Sennosides prescriptions (US)

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.[14]

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, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot To Go, Senokot XTRA, Senokot, Kayam churna.[13]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 American Society of Health-System Pharmacists (1 January 2008). "Senna". Drugs.com. Archived from the original on 6 September 2015. Retrieved 11 August 2015.
  2. 1 2 "Senna Use During Pregnancy". Drugs.com. 12 June 2019. Archived from the original on 12 January 2020. Retrieved 12 January 2020.
  3. 1 2 3 4 Navti, Phyllis (2010). Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. p. 337. ISBN 9780199559824. Archived from the original on 5 March 2016.
  4. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 1 July 2021. Retrieved 22 September 2020.
  5. ↑ "Senna(Powdered)". PubChem. Archived from the original on 1 December 2017. Retrieved 21 May 2017.
  6. 1 2 Wald, A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91. doi:10.1001/jama.2015.16994. PMID 26757467.
  7. 1 2 Hamilton, Richard J. (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. Archived from the original on 5 March 2016.
  8. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  9. 1 2 "Senna". International Drug Price Indicator Guide. Archived from the original on 22 January 2018. Retrieved 11 August 2015.
  10. ↑ 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. Archived from the original on 5 March 2016.
  11. 1 2 "The Top 300 of 2020". ClinCalc. Archived from the original on 18 March 2020. Retrieved 11 April 2020.
  12. 1 2 "Sennosides - Drug Usage Statistics". ClinCalc. Archived from the original on 8 July 2020. Retrieved 11 April 2020.
  13. 1 2 3 4 5 Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  14. 1 2 3 Drugs.com "Archived copy". Archived from the original on 19 April 2014. Retrieved 17 April 2014.{{cite web}}: CS1 maint: archived copy as title (link)
  15. 1 2 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. "Archived copy". Archived from the original on 19 April 2014. Retrieved 18 April 2014.{{cite web}}: CS1 maint: archived copy as title (link). Accessed April 18, 2014.
  16. 1 2 "Senna - WikEM". www.wikem.org. Archived from the original on 20 October 2020. Retrieved 5 August 2020.
  17. ↑ "Senokot, ExLax Regular Strength (senna) dosing, indications, interactions, adverse effects, and more". reference.medscape.com. Archived from the original on 27 April 2021. Retrieved 22 March 2021.
  18. ↑ Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  19. ↑ "Senna: MedlinePlus Supplements". Archived from the original on 6 April 2015.
  20. ↑ 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. "Archived copy". Archived from the original on 19 April 2014. Retrieved 18 April 2014.{{cite web}}: CS1 maint: archived copy as title (link). Accessed April 18, 2014.
Identifiers:
  • "Senna". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 12 January 2020. Retrieved 12 January 2020.
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