Senna glycoside

Short description: Constipation and surgery medication

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| Oral, 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 (orally)[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)
Picture depicting an old Ex-Lax™ carton

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 orally (swallowed 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 orally.[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 2023, it was the 302nd most commonly prescribed medication in the United States, with more than 300,000 prescriptions.[9] In 2023, the combination with docusate was the 242nd most commonly prescribed medication in the United States, with more than 1 million prescriptions.[10][11] It is sold under a number of brand names including Ex-Lax and Senokot.[1]

## Contents

* 1 Medical uses
* 1.1 Administration
* 2 Contraindications
* 3 Adverse effects
* 3.1 Interactions
* 4 Mechanism of action
* 5 Pharmacology
* 6 Society and culture
* 6.1 Formulations
* 6.2 Brand names
* 7 References

## 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 anthraquinones derivatives and dimeric glycosides.[17]

## Society and culture

### Formulations

Senna is an over-the-counter drug 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

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 "Senna". Drugs.com. 1 January 2008. https://www.drugs.com/monograph/senna.html.
2. ↑ "Prescribing medicines in pregnancy database". Australian Government, Department of Health and Aged Care. https://www.tga.gov.au/products/medicines/find-information-about-medicine/prescribing-medicines-pregnancy-database.
3. ↑ 3.0 3.1 3.2 3.3 Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. 2010. p. 337. ISBN 9780199559824. https://books.google.com/books?id=KVicAQAAQBAJ&pg=PA337.
4. ↑ "Senna(Powdered)". PubChem. U.S. National Library of Medicine. https://pubchem.ncbi.nlm.nih.gov/compound/171194.
5. ↑ 5.0 5.1 "Constipation: Advances in Diagnosis and Treatment". JAMA 315 (2): 185–91. January 2016. doi:10.1001/jama.2015.16994. PMID 26757467.
6. ↑ 6.0 6.1 Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. 2010. p. 181. ISBN 9780763777685. https://books.google.com/books?id=Urmh7ylCXnoC&pg=PA181.
7. ↑ Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. 2004. p. 133. ISBN 9783642186592. https://books.google.com/books?id=njLtCAAAQBAJ&pg=PA133.
8. ↑ World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
9. ↑ "Sennosides Drug Usage Statistics, United States, 2013 - 2023". https://clincalc.com/DrugStats/Drugs/Sennosides.
10. ↑ "The Top 300 of 2023". https://clincalc.com/DrugStats/Top300Drugs.aspx.
11. ↑ "Senna; Docusate Drug Usage Statistics, United States, 2013 - 2023". https://clincalc.com/DrugStats/Drugs/SennaDocusate.
12. ↑ 12.0 12.1 12.2 12.3 12.4 Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.
13. ↑ 13.0 13.1 Drugs.com "Senna (Professional Patient Advice)". https://www.drugs.com/ppa/senna.html.
14. ↑ 14.0 14.1 "Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases.". Basic & Clinical Pharmacology (12th ed.). New York, NY: McGraw-Hill. 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=388&Sectionid=45764290. Retrieved 18 April 2014.
15. ↑ "Senna: MedlinePlus Supplements". https://www.medlineplus.gov/druginfo/natural/652.html.
16. ↑ "Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease.". Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York, NY: McGraw-Hill. 2011. http://accessmedicine.mhmedical.com/content.aspx?bookid=374&Sectionid=41266256. Retrieved 18 April 2014.
17. ↑ "The senna drug and its chemistry". Pharmacology 47 (Suppl. 1): 2–6. October 1993. doi:10.1159/000139654. PMID 8234429.

* v
* t
* e

Drugs for constipation (laxatives and cathartics) (A06)

Stool softeners|

* Docusate

Stimulant laxatives|

* Bisacodyl
* Bisoxatin
* Cascara
* Castor oil
* Dantron
* Oxyphenisatine
* Phenolphthalein
* Senna glycosides
* Sodium picosulfate

Bulk-forming laxatives|

* Dietary fiber
* Ethulose
* Ispaghula
* Methylcellulose
* Polycarbophil calcium
* Sterculia
* Triticum

Lubricant laxatives|

* Liquid paraffin
* Mineral oil
* White petrolatum (petroleum jelly)

Osmotic laxatives|

* Lactitol
* Lactulose
* Laminarid
* Magnesium carbonate
* Magnesium citrate
* Magnesium hydroxide (milk of magnesia)
* Magnesium oxide
* Magnesium peroxide
* Magnesium sulfate
* Mannitol
* Pentaerythritol
* Polyethylene glycol (macrogol)
* Sodium phosphate
* Sodium sulfate
* Sodium tartrate
* Sorbitol

Enemas|

* Bisacodyl
* Dantron
* Glycerol
* Oil
* Sodium laurilsulfate
* Sodium lauryl sulfoacetate
* Sodium phosphate
* Sorbitol

Opioid antagonists|

* Naloxone (Oxycodone/naloxone)
* PAMORAs
* Alvimopan
* Axelopran
* Bevenopran
* Methylnaltrexone
* Naldemedine
* Naloxegol

Others|

* Linaclotide
* Lubiprostone
* Oxyphenisatine
* Prucalopride
* Tegaserod
* Ulimorelin

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