Senna: Benefits, Dosage, Contraindications

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Senna is a perennial herbaceous plant of the Fabaceae family, native to Yemen, Somalia, and India. As early as the 9th century, Arab physicians used senna in medicine as a laxative. The leaves and fruits (pods) are used therapeutically. Senna mainly contains sennosides A and B, high molecular weight dianthrone glycosides, representing about 2.5% of active components. These sennosides are prodrugs that are not absorbed by the gastrointestinal tract. They are hydrolyzed by enteric bacteria into active rhein monoanthrones, which increase colon motility. The laxative effect generally manifests between 6 to 10 hours after ingestion of senna, resulting in stool elimination. Senna, according to the monograph of the European Pharmacopoeia, must contain at least 2.5% hydroxyanthracene glycosides calculated as sennoside B, relative to the dried plant. Its use is indicated for short-term treatment of occasional constipation.

Other name(s) 

Senna alexandrina, Cassia angustifolia

Scientific name(s)

cassia angustifolia

Family or group: 

Plants

Active ingredients:

Sennosides


Indications

Rating methodology

EFSA approval.

Several clinical trials (> 2) randomized controlled with double blind, including a significant number of patients (>100) with consistently positive outcomes for the indication.
Several clinical trials (> 2) randomized controlled with double blind, and including a significant number of patients (>100) with positive outcomes for the indication.
One or more randomized studies or multiple cohorts or epidemiological studies with positive outcomes for the indication.
Clinical studies exist but are uncontrolled, with conclusions that may be positive or contradictory.
Lack of clinical studies to date that can demonstrate the indication.


Constipation
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Senna is FDA approved as an over-the-counter medication for short-term treatment of constipation in adults and children from 2 years old. It is generally effective 6 to 10 hours after oral administration. Although senna is often compared to alternatives like mineral oil, lactulose in children, and psyllium, research indicates that senna combined with psyllium is particularly effective in increasing stool moisture more than psyllium alone. In the context of opioid or loperamide-induced constipation, senna is as effective as lactulose, psyllium, and docusate (a laxative). Research among specific populations, such as pediatric cancer patients on opioids, suggests senna may be more effective than docusate, polyethylene glycol, and lactulose in preventing constipation. A small study in middle-aged adults with chronic idiopathic constipation demonstrated that 500 mg of senna taken twice daily for 4 weeks was as effective as 500 mg of magnesium oxide taken three times a day. The EMA and ESCOP recommend short-term use of senna to treat occasional constipation. Senna is generally used at a rate of 15 mg of sennosides, once a day. The maximum dose is 30 mg of sennosides per day.

Posologie

posologieOral: leaf, fruit

posologie15 - 30 mg

formulationstandardized extract


Synergies


Properties


Laxative

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Senna is used as a stimulant laxative due to its sennosides contained in its leaves and fruit. It acts selectively on the nerve plexus of smooth intestinal muscles, increasing colonic motility and accelerating transit. This laxative effect generally occurs between 6 to 10 hours after ingestion. Proposed mechanisms also include modulation of prostaglandins and serotonin in the colon.

Usages associés

Constipation


Safety dosage

Adult from 18 years: 15 mg - 30 mg (standardized extract in sennosides)

In the context of using senna to treat occasional constipation, the recommended dosage for adults and children over 10 years is to take preparations equivalent to 15-30 mg of sennosides once a day, preferably in the evening. Elderly individuals can follow the same dosage as adults.

Child from 10 to 18 years: 15 mg - 30 mg (standardized extract in sennosides)

It is important to note that the use of senna is not recommended for children under 10 years old.

Pregnant women: 15 mg - 30 mg (standardized extract in sennosides)

For pregnant women, the oral and appropriate short-term use of senna is considered safe. However, long-term, frequent, or high-dose use can be potentially dangerous, being associated with severe side effects such as laxative dependency and liver toxicity.

Breastfeeding women: 15 mg - 30 mg (standardized extract in sennosides)

During breastfeeding, the oral and appropriate short-term use of senna is also considered safe. Although small amounts of senna components pass into breast milk, it has been taken during breastfeeding without apparent problems for babies. Senna does not cause changes in the frequency or consistency of infant stools.


Interactions

Médicaments

Estrogens: moderate interaction

Some preliminary clinical data suggest that senna reduces the absorption of estradiol by reducing intestinal transit time.