Dosages (Alexandrian Senna): - 0.5 - 2 g (0.5 - 1 tsp)/cup water (APA); 1 - 2 g fruit (WHO); 3 - 6 alexandrian or 4 - 12 tinnevelly pods steeped in 150 ml warm water 6 - 12 hours (CAN); 0.5 - 2 g dry leaflets (CAN); 1 - 2 g dry leaf (PED; WHO); 1 g dry leaf:5 ml alcohol/5 ml water (PED); 0.5 - 2 ml liquid leaf extract (1:1 in 25% ethanol) (CAN); 20 - 30 mg hydroxyanthracene derivatives/day calculated as sennoside B (KOM); 2 (25 mg) StX extracts 1 - 2 ×/day (APA); 10 - 60 mg sennosides (SKY).
Contraindications, Interactions, and Side Effects (Alexandrian Senna): - Class 2b, 2c, 2d (AHP). Commission E and other sources report interaction of anthranoid laxatives (AEH). Anthranoid-containing laxatives can be habit-forming. Some contain compounds suspected of being cytotoxic, genotoxic, mutagenic, and even tumorigenic. Epidemiological studies in Germany reveal that abusers of anthranoid laxatives have three times higher rate of colon carcinoma. One woman developed clubbing of her digits and hypertropic osteoarthropathy after taking at least three tablets daily for 3 years for weight loss. She also experienced several months of secondary amenorrhea. Of senna leaf, Blumenthal et al. lists abdominal pain of unknown origin, acute intestinal inflammation (e.g., Crohns disease and colitis ulcerosa), and appendicitis as contraindications. Because of the anthraquinones, nonstandardized preparations should be avoided during pregnancy and lactation (CAN). Anthraquinones may be secreted into breast milk (CAN). Should not be used in lactation, pregnancy, or with children under 12 years old (KOM). Occasional cramp-like discomfort of the GI tract may require dosage reduction (KOM). Side effects with chronic abuse: disturbance of electrolyte balance, especially hypokalemia (may be exacerbated by simultaneous administration of corticoadrenal steroids, licorice root, or thiazide diuretics), leading to cardiopathy, muscular weakness especially with concurrent uses of cardiac glycosides, corticosteroids, or diuretics (KOM). Pigmentation of the intestinal mucosae (pseudomelanosis coli) is harmless and usually reverses on discontinuation of the drug. Laxative like this should not be used more than 1 - 2 weeks without medical advice (KOM). CAN report anthraquinones are purgative and irritate GI tract. Also contraindicated in hemorrhoids and nephropathy (CAN), intestinal obstruction, abdominal pain of unknown causes, any enterosis (appendicitis, colitis, Crohns disease, irritable bowel syndrome) hemorrhoids, nephropathy, menstruation (AHP). Do not use more than 8 - 10 days (AHP). Do not use this in case of abdominal pain or diarrhea. Consult a health care provider prior to use in pregnancy or nursing. Discontinue use if diarrhea or watery stools occur. Not for long term use (AHP). Some herbal laxative preparations, such as cascara and senna for example, can cause an increase in the potency of digoxin (Depiro, 1997). Pedersen (1998) cautions against taking the fresh leaf (we have done that in Peru with modest laxative results). Senna causes gripping unless taken in combination with carminative herbs such as ginger, cloves, or various mint species. Although GRAS, senna can be more habit-forming than cascara (PED). Lininger et al. (1998) pronounce it safe for children over the age of six (half the adult dose) (SKY). Id be more cautious.
Extracts (Alexandrian Senna): - Possibly representing a negative case for my synergy proposition, The toxicity of total extracts is greater than that of the individual sennosides. It has been proposed that the laxative and toxic components of senna could be separated (CAN). Elsewhere, I have read that the sennosides are synergetic as far as their laxative action is concerned. But then anomalously, CAN report that sennosides A and B are reported to be most potent with respect to laxative action, but the least toxic compared to other anthraquinone fractions. LD50s of sennosides A & B are 4100 mg/kg ivn mus and of rhein-8-glycoside 400 mg/kg ivn mus. All fractions had LD50 = >5000 mg/kg orl rat.
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