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Cascara

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Cascara, Cascara Sagrada, Casanthranol

  • See Also
  1. Stimulant Laxative
  2. Senna
  3. Bisacodyl
  4. Laxative
  5. Constipation
  6. Functional Constipation
  7. Pediatric Constipation
  • Indications
  1. Functional Constipation
  • Mechanism
  1. Simulant Laxative (Anthraquinone)
  2. Cascara is derived from the dried aged bark (Cascara Sagrada) of buckthorn (Frangula purshiana or Rhamnus purshiana)
  3. Cascara extracts include the anthranol glycosides, emodin (anthraquinone) and Casanthranol (cascarosides)
  4. Casanthranol directly stimulates intestinal wall Muscle Contractions
  • Precautions
  1. Avoid chronic use of Stimulant Laxatives (see adverse effects below)
  2. Cascara is listed for historical purposes and has been replaced by other Laxatives in the U.S.
  • Medications
  1. Cascara Sagrada aromatic fluid extract
  2. Cascara Sagrada fluid extract
    1. Caution! Five times the potency of aromatic fluid extract
  1. Dosing is for Cascara aromatic fluid extract (not the much more potent fluid extract)
  2. Adult
    1. Take 5 ml aromatic fluid extract at bedtime as needed for Constipation
  3. Child (2 to 12 years)
    1. Give 2.5 ml orally at bedtime as needed for Constipation
  • Pharmacokinetics
  1. Onset of activity within 6-12 hours
  • Adverse Effects
  • Long-Term (Laxative abuse)
  1. See Stimulant Laxative
  2. Avoid prolonged use (habit forming)!
  3. Colonic denervation and atony (Cathartic colon)
    1. Decreased motility of right colon with secondary worsening Constipation
    2. Associated with Anthraquinone Laxatives
    3. Results from myenteric plexus injury
  4. Electrolyte and nutritional disturbance
    1. Hypokalemia
    2. Sodium overload
    3. Protein-losing Enteropathy
  5. Melanosis coli
    1. Benign darkening of colonic mucosa
    2. Macrophage deposition in lamina propria
  • Safety
  1. Pregnancy Category C
  2. Safe in Lactation
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia