Senna glycoside

Senna glycoside

Clinical data
Trade names	Ex-Lax, Senokot, others[1]
AHFS/Drugs.com	Monograph
MedlinePlus	a601112
License data	US DailyMed: Senna
Pregnancy category	AU: A[2]
Routes of administration	By mouth, rectal
ATC code	A06AB06 (WHO)
Legal status
Legal status	UK: P (Pharmacy medicines) US: OTC In general: Over-the-counter (OTC)
Pharmacokinetic data
Onset of action	Minutes (by rectum), 6 to 12 hours (by mouth)[3]
Identifiers
IUPAC name 9-[2-carboxy-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracen-9-yl]-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracene-2-carboxylic acid
CAS Number	66575-30-2 Y
PubChem CID	5199
DrugBank	DB11365 Y
ChemSpider	65892 N
KEGG	D02171
Chemical and physical data
Formula	C42H38O20[4]
Molar mass	862.746 g·mol−1
NY (what is this?)  (verify)

Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.^[1][5] The medication is taken by mouth or via the rectum.^[1][6] It typically begins working in around 30 minutes when given by rectum and within twelve hours when given by mouth.^[3] It is a weaker laxative than bisacodyl and castor oil.^[1]

Common side effects of senna glycoside include abdominal cramps.^[3] It is not recommended for long-term use, as it may result in poor bowel function or electrolyte problems.^[1] While no harm has been found to result from use while breastfeeding, such use is not typically recommended.^[1] It is not typically recommended in children.^[1] Senna may change urine to a somewhat reddish color.^[1] Senna derivatives are a type of stimulant laxative and are of the anthraquinone type.^[1] While its mechanism of action is not entirely clear, senna is thought to act by increasing fluid secretion within and contraction of the large intestine.^[1]

Sennosides come from the group of plants Senna.^[3] In plant form, it has been used at least since the 700s AD.^[7] It is on the World Health Organization's List of Essential Medicines.^[8] It is available as a generic medication.^[1][6] In 2021, it was the 270th most commonly prescribed medication in the United States, with more than 1 million prescriptions.^[9][10] In 2021, the combination with docusate was the 275th most commonly prescribed medication in the United States, with more than 800,000 prescriptions.^[9][11] It is sold under a number of brand names including Ex-Lax and Senokot.^[1]

Medical uses

Senna is used for episodic and chronic constipation though there is a lack of high-quality evidence to support its use for these purposes.^[5] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.^[12][13]

Administration

Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories can act within minutes or take up to two hours.^[14]

Contraindications

According to Commission E, senna is contraindicated in cases of intestinal obstruction, acute intestinal inflammation (e.g., Crohn's disease), ulcerative colitis, appendicitis, and abdominal pain of unknown origin.^[12]

Senna is considered contraindicated in people with a documented allergy to anthraquinones. Such allergies are rare and typically limited to dermatological reactions of redness and itching.^[12]

Adverse effects

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.^[12]

Regular use of senna products can lead to a characteristic brown pigmentation of the internal colonic wall seen on colonoscopy. This abnormal pigmentation is known as melanosis coli.^[14]

Interactions

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.^[15]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.^[16]

Pharmacology

They are anthraquinone derivatives and dimeric glycosides.^[17]

Society and culture

Formulations

Senna is an over-the-counter medication available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers and sold under various brand names.^[13]

Brand names

Ex-Lax, Geri-kot, Perdiem Overnight Relief, Senexon, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot.^[12]

References

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