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Senna

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Senna, Senokot, Peri-Colace, Senekot-S, Ex-Lax

  • See Also
  1. Stimulant Laxative
  2. Bisacodyl
  3. Laxative
  4. Constipation
  5. Functional Constipation
  6. Pediatric Constipation
  • Indications
  1. Functional Constipation
  2. Constipation Prophylaxis in Chronic Opioid Use
  • Mechanism
  1. Senna is an extract from the dried leaflets of the plant Cassia angustifolia (or Cassia acutifolia)
  2. Dried senna extract contains dimeric glycosides activated to monoanthrones in the bowel by colonizing Bacteria
  3. Monoanthrones directly act at enteric cells, nerves and Muscles to stimulate large, migrating contractions of the colon
  4. Monoanthrones also stimulate water and Electrolyte secretion into the bowel
  5. Monoanthrones induce low grade inflammation with chronic use (as with other Stimulant Laxatives)
  • Precautions
  1. Avoid chronic use of Stimulant Laxatives (see adverse effects below)
  • Medications
  1. Senna Extract (Senokot)
    1. Various trade names including Senokot and Ex-Lax
      1. Ex-Lax was previously formulated with Phenolphthalein (off U.S. market as of 2009)
    2. Syrup: 8.8 mg sennosides per 5 ml liquid
    3. Liquid 33 mg senna concentrate (1.5 mg sennosides) per ml (Fletcher's Castoria)
    4. Tablets 8.6, 15, 17 and 25 mg
    5. Chewable Tablets: 10 and 15 mg
  2. Combinations with senna and Docusate
    1. Senekot-S
    2. Peri-Colace (previously contained Cascara)
  • Dosing
  • Senna Extract (Senokot)
  1. Adult (and age >=12 years)
    1. Syrup: Take 10 to 15 ml (17.6 to 26.4 mg) orally at bedtime OR
    2. Tablet (8.6 mg): Take 2 to 3 tablets orally at bedtime
  2. Child: Senna Syrup (8.8 mg per 5 ml)
    1. Syrup may be mixed with juice, milk or ice cream
    2. Age 2-6 years: 2.5 to 3.75 ml (4.4 to 6,6 mg) orally at bedtime
    3. Age 6-12 years: 5 to 7.5 ml (8.8 to 13.2 mg) orally at bedtime
  • Pharmacokinetics
  1. Onset of activity within 6-12 hours
  2. Duration up to 24 hours
  • Adverse Effects
  • Short-Term
  1. Nausea
  2. Vomiting
  3. Abdominal Pain
  4. Hepatitis (case reports)
  • Adverse Effects
  • Long-term use (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
  • Resources
  1. Senna Tablets (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=62d07bae-1807-40e8-968c-bae70fed6a9f
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2023) Management of Constipation, Presc Lett, #390108