Senna glycoside

Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][5] The medication is taken by mouth or via the rectum.[1][6] It typically begins working in around 30 minutes when given by rectum and within twelve hours when given by mouth.[3] It is a weaker laxative than bisacodyl and castor oil.[1]

Senna glycoside
Clinical data
Trade namesEx-Lax, Senokot, and others[1]
AHFS/Drugs.comMonograph
MedlinePlusa601112
License data
Pregnancy
category
Routes of
administration		By mouth (PO), rectal (PR)
ATC code
Legal status
Legal status
Pharmacokinetic data
Onset of actionMinutes (by rectum), 6 to 12 hours (by mouth)[3]
Identifiers
  • 9-[2-carboxy-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracen-9-yl]-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracene-2-carboxylic acid
CAS Number
PubChem CID
DrugBank
ChemSpider
KEGG
Chemical and physical data
FormulaC42H38O20[4]
Molar mass862.746 g·mol−1
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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.[7] It is available as a generic medication.[1][6] Sennosides come from the group of plants Senna.[3] In plant form, it has been used at least since the 700s CE.[8] In 2020, it was the 291st most commonly prescribed medication in the United States, with more than 1 million prescriptions.[9][10] 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.[5] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[11][12]

Administration

It should be taken once daily at bedtime.[12][13] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories can act within minutes or take up to two hours.[14]

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.[11]

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.[11]

Adverse effects

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[11] 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.[14]

Interactions

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[15]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[16]

Pharmacology

They are anthraquinone derivatives and dimeric glycosides.[17]

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 and sold under various brand names.[12]

Kayam churna is a traditional Indian laxative that contains senna leaves.

Brand names

Ex-Lax, Geri-kot, Perdiem Overnight Relief, Senexon, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot.[11]

References
  1. 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. "Senna Use During Pregnancy". Drugs.com. 12 June 2019. Retrieved 12 January 2020.
  3. Navti P (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. "Senna(Powdered)". PubChem. U.S. National Library of Medicine.
  5. Wald A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91. doi:10.1001/jama.2015.16994. PMID 26757467.
  6. Hamilton RJ (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. Archived from the original on 5 March 2016.
  7. 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.
  8. Khare CP (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.
  9. "The Top 300 of 2020". ClinCalc. Retrieved 7 October 2022.
  10. "Sennosides - Drug Usage Statistics". ClinCalc. Retrieved 7 October 2022.
  11. Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.
  12. Drugs.com "Senna (Professional Patient Advice)". Archived from the original on 19 April 2014. Retrieved 17 April 2014.
  13. Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.
  14. McQuaid KR (2012). "Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases.". In Katzung BG, Masters SB, Trevor AJ (eds.). Basic & Clinical Pharmacology (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
  15. "Senna: MedlinePlus Supplements". Archived from the original on 6 April 2015.
  16. Sharkey KA, Wallace JL (2011). "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 (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
  17. Franz G (October 1993). "The senna drug and its chemistry". Pharmacology. 47 Suppl 1 (Suppl. 1): 2–6. doi:10.1159/000139654. PMID 8234429.
  • "Senna". Drug Information Portal. U.S. National Library of Medicine.
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