CASCARA SAGRADA
Aulne Noir, Bitter Bark, Bois Noir, Bois à Poudre, Borzène, Bourgène, Buckthorn, California Buckthorn, Cáscara, Cascara Sagrada, Chittem Bark, Dogwood Bark, Écorce Sacrée, Frangula purshiana, Nerprun, Pastel Bourd, Purshiana Bark, Rhamni Purshianae Cortex, Rhamnus purshiana, Rhubarbe des Paysans, Sacred Bark, Sagrada Bark, Yellow Bark.
Uses & Effectiveness
Possibly Effective for
- Constipation. Cascara sagrada has laxative effects and may help relieve constipation in some people.
Possibly Ineffective for
- Emptying the colon before a colonoscopy. Most research shows that taking cascara sagradaalong with magnesium sulfate or milk of magnesia does not improve bowel cleansing in people who are undergoing a colonoscopy.
Insufficient Evidence for
- Disorders affecting bile flow in the liver such as gallstones.
- Liver disease.
- Cancer.
- Other conditions.
Side Effects & Safety
When taken by mouth: Cascara sagrada is POSSIBLY SAFE for most adults when taken for less than one week. Side effects include stomach discomfort and cramps.Cascara sagrada is POSSIBLY UNSAFE when used for more than one week. This could cause more serious side effects including dehydration; low levels of potassium, sodium, chloride, and other "electrolytes" in the blood; heart problems; muscle weakness; and others.
Special Precautions & Warnings:
Pregnancy and breast-feeding: There isn't enough reliable information to know if cascara sagrada is safe to use when pregnant. Stay on the safe side and avoid use. Cascara sagrada is POSSIBLY UNSAFE when taken by mouth while breast-feeding. Cascara sagrada can cross into breast milk and might cause diarrhea in a nursing infant.Children: Cascara sagrada is POSSIBLY UNSAFE in children when taken by mouth. Don't give cascara sagrada to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.
Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara sagrada.
Interactions
Moderate Interaction
Be cautious with this combination
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Digoxin (Lanoxin) interacts with CASCARA SAGRADA
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects of digoxin (Lanoxin).
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Medications for inflammation (Corticosteroids) interacts with CASCARA SAGRADA
Some medications for inflammation can decrease potassium in the body. Cascara is a type of laxative that might also decrease potassium in the body. Taking cascara along with some medications for inflammation might decrease potassium in the body too much.
Some medications for inflammation include dexamethasone (Decadron), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisone (Deltasone), and others. -
Medications taken by mouth (Oral drugs) interacts with CASCARA SAGRADA
Cascara is a laxative. Laxatives can decrease how much medicine your body absorbs. Decreasing how much medicine your body absorbs can decrease the effectiveness of your medication.
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Stimulant laxatives interacts with CASCARA SAGRADA
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives speed up the bowels. Taking cascara along with other stimulant laxatives could speed up the bowels too much and cause dehydration and low minerals in the body.
Some stimulant laxatives include bisacodyl (Correctol, Dulcolax), castor oil (Purge), senna (Senokot), and others. -
Warfarin (Coumadin) interacts with CASCARA SAGRADA
Cascara can work as a laxative. In some people cascara can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin do not to take excessive amounts of cascara.
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Water pills (Diuretic drugs) interacts with CASCARA SAGRADA
Cascara is a laxative. Some laxatives can decrease potassium in the body. "Water pills" can also decrease potassium in the body. Taking cascara along with "water pills" might decrease potassium in the body too much.
Some "water pills" that can decrease potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Microzide), and others.
Dosing
The appropriate dose of cascara sagrada depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for cascara sagrada. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.
REFERENCES:
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- Lai, G. H., Zhang, Z., and Sirica, A. E. Celecoxib acts in a cyclooxygenase-2-independent manner and in synergy with emodin to suppress rat cholangiocarcinoma growth in vitro through a mechanism involving enhanced Akt inactivation and increased activation of caspases-9 and -3. Mol.Cancer Ther 2003;2(3):265-271. View abstract.
- Lee, H. Z. Effects and mechanisms of emodin on cell death in human lung squamous cell carcinoma. Br J Pharmacol 2001;134(1):11-20. View abstract.
- Lee, H. Z. Protein kinase C involvement in aloe-emodin- and emodin-induced apoptosis in lung carcinoma cell. Br J Pharmacol 2001;134(5):1093-1103. View abstract.
- Lee, H. Z., Hsu, S. L., Liu, M. C., and Wu, C. H. Effects and mechanisms of aloe-emodin on cell death in human lung squamous cell carcinoma. Eur J Pharmacol 11-23-2001;431(3):287-295. View abstract.
- Liu, J. B., Gao, X. G., Lian, T., Zhao, A. Z., and Li, K. Z. [Apoptosis of human hepatoma HepG2 cells induced by emodin in vitro]. Ai.Zheng. 2003;22(12):1280-1283. View abstract.
- Marchesi, M., Marcato, M., and Silvestrini, C. [Clinical experience with a preparation containing cascara sagrada and boldo in the therapy of simple constipation in the elderly]. G.Clin.Med. 1982;63(11-12):850-863. View abstract.
- Mereto, E., Ghia, M., and Brambilla, G. Evaluation of the potential carcinogenic activity of Senna and Cascara glycosides for the rat colon. Cancer Lett 3-19-1996;101(1):79-83. View abstract.
- Muller, S. O., Eckert, I., Lutz, W. K., and Stopper, H. Genotoxicity of the laxative drug components emodin, aloe-emodin and danthron in mammalian cells: topoisomerase II mediated? Mutat.Res 12-20-1996;371(3-4):165-173. View abstract.
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- Rosengren, J. E. and Aberg, T. Cleansing of the colon without enemas. Radiologe 1975;15(11):421-426. View abstract.
- Silberstein, E. B., Fernandez-Ulloa, M., and Hall, J. Are oral cathartics of value in optimizing the gallium scan? Concise communication. J Nucl.Med 1981;22(5):424-427. View abstract.
- Stern, F. H. Constipation--an omnipresent symptom: effect of a preparation containing prune concentrate and cascarin. J Am Geriatr Soc 1966;14(11):1153-1155. View abstract.
- Tramonte, S. M., Brand, M. B., Mulrow, C. D., Amato, M. G., O'Keefe, M. E., and Ramirez, G. The treatment of chronic constipation in adults. A systematic review. J Gen.Intern.Med 1997;12(1):15-24. View abstract.
- Cascara sagrada, aloe laxatives, O-9 contraceptives are category II-FDA. The Tan Sheet May 13, 2002.
- Choice of laxatives for constipation. Pharmacist's Letter/Prescriber's Letter 2002;18(6):180614.
- Cirillo C, Capasso R. Constipation and botanical medicines: an overview. Phytother Res 2015;29(10):1488-93. View abstract.
- Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
- Food and Drug Administration, HHS. Status of certain additional over-the counter drug category II and III active ingredients. Final rule. Fed Regist 2002;67:31125-7. View abstract.
- Nadir A, Reddy D, Van Thiel DH. Cascara-sagrada induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol 2000;95:3634-7. View abstract.
- Nakasone ES, Tokeshi J. A serendipitous find: a case of cholangiocarcinoma identified incidentally after acute liver injury due to cascara sagrada ingestion. Hawaii J Med Public Health 2015;74(6):200-2. View abstract.
- Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. View abstract.
- Young DS. Effects of Drugs on Clinical Laboratory Tests 4th ed. Washington: AACC Press, 1995.
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