Senna glycoside explained

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

Common side effects of senna glycoside include abdominal cramps. 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.[2] In plant form, it has been used at least since the 700s AD.[3] It is on the World Health Organization's List of Essential Medicines.[4] It is available as a generic medication.[1] [5] In 2021, it was the 270th most commonly prescribed medication in the United States, with more than 1million prescriptions.[6] [7] In 2021, the combination with docusate was the 275th most commonly prescribed medication in the United States, with more than 800,000 prescriptions.[8] 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.[9] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[10]

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.[11]

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.

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.

Adverse effects

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

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.[11]

Interactions

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[12]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[13]

Pharmacology

They are anthraquinones derivatives and dimeric glycosides.[14]

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.[10]

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.[15]

Notes and References

  1. Web site: American Society of Health-System Pharmacists. Senna. Drugs.com. 11 August 2015. 1 January 2008. live. https://web.archive.org/web/20150906045617/http://www.drugs.com/monograph/senna.html. 6 September 2015.
  2. Book: Navti P . Pharmacology for pharmacy and the health sciences : a patient-centred approach. 2010. Oxford University Press. Oxford. 9780199559824. 337. live. https://web.archive.org/web/20160305023955/https://books.google.ca/books?id=KVicAQAAQBAJ&pg=PA337. 5 March 2016.
  3. Book: Khare CP . Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. 2004. Springer Berlin Heidelberg. Berlin, Heidelberg. 9783642186592. 133. live. https://web.archive.org/web/20160305030839/https://books.google.ca/books?id=njLtCAAAQBAJ&pg=PA133. 5 March 2016.
  4. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  5. Book: Hamilton RJ . Tarascon pharmacopoeia . 2010 . Jones and Bartlett . Sudbury, Mass. . 9780763777685 . 181 . 2010 . live. https://web.archive.org/web/20160305014932/https://books.google.ca/books?id=Urmh7ylCXnoC&pg=PA181. 5 March 2016.
  6. Web site: The Top 300 of 2021 . ClinCalc . 14 January 2024 . 15 January 2024 . https://web.archive.org/web/20240115223848/https://clincalc.com/DrugStats/Top300Drugs.aspx . live .
  7. Web site: Sennosides - Drug Usage Statistics . ClinCalc . 14 January 2024 . 18 January 2024 . https://web.archive.org/web/20240118071808/https://clincalc.com/DrugStats/Drugs/Sennosides . live .
  8. Web site: Senna; Docusate - Drug Usage Statistics . ClinCalc . 14 January 2024 . 18 January 2024 . https://web.archive.org/web/20240118044824/https://clincalc.com/DrugStats/Drugs/SennaDocusate . live .
  9. Wald A . Constipation: Advances in Diagnosis and Treatment . JAMA . 315 . 2 . 185–91 . January 2016 . 26757467 . 10.1001/jama.2015.16994 . Review .
  10. Drugs.com Web site: Senna (Professional Patient Advice) . 17 April 2014 . live . https://web.archive.org/web/20140419013432/http://www.drugs.com/ppa/senna.html . 19 April 2014 .
  11. Book: McQuaid KR . Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. . Katzung BG, Masters SB, Trevor AJ . Basic & Clinical Pharmacology . 12th . New York, NY . McGraw-Hill . 2012 . 18 April 2014 . live . https://web.archive.org/web/20140419013030/http://accessmedicine.mhmedical.com/content.aspx?bookid=388&Sectionid=45764290 . 19 April 2014 .
  12. Web site: Senna: MedlinePlus Supplements. live. https://web.archive.org/web/20150406045004/http://www.nlm.nih.gov/medlineplus/druginfo/natural/652.html. 6 April 2015.
  13. Book: Sharkey KA, Wallace JL . Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. . Brunton LL, Chabner BA, Knollmann BC . Goodman & Gilman's The Pharmacological Basis of Therapeutics . 12th . New York, NY . McGraw-Hill . 2011 . 18 April 2014 . live . https://web.archive.org/web/20140419013258/http://accessmedicine.mhmedical.com/content.aspx?bookid=374&Sectionid=41266256 . 19 April 2014 .
  14. Franz G . The senna drug and its chemistry . Pharmacology . 47 . Suppl. 1 . 2–6 . October 1993 . 8234429 . 10.1159/000139654 .
  15. Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.

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