Cascara sagrada ( Frangula purshiana) is a shrub native to North America. The bark of the cascara sagrada plant is used to make a dietary supplement. It was previously approved by the US FDA as an over-the-counter (OTC) drug for constipation, but this approval was taken away in 2002 due to a lack of evidence.
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What is Cascara Sagrada?
Cascara sagrada contains chemicals that stimulate the bowel and have a laxative effect. The major constituents are cascarosides that stimulate the large intestine and produce a laxative effect. Cascara also causes water and electrolytes such as sodium and potassium to be expelled with the feces.
Uses and Effectiveness
People use cascara sagrada for constipation, emptying the colon before a colonoscopy, and other conditions. However, there is no good scientific evidence to support these uses.
Constipation: The dried bark used to be FDA approved as an OTC laxative for constipation.
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Emptying the colon before a colonoscopy: Taking cascara sagrada by mouth, along with magnesium sulfate or milk of magnesia, does not improve bowel cleansing in people who are having a colonoscopy and is thus, possibly ineffective for this purpose.
There is interest in using cascara sagrada for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.
Additional Research
Scientists have isolated a compound called aloe-emodin from cascara. Lab studies show that aloe-emodin from cascara has anticancer activity. In laboratory studies, this compound inhibited the growth of tumor cells, but it is unknown if this effect would take place in the human body. In vitro studies suggest anticancer properties, as aloe-emodin induces p53 and p21 expression that results in G1-phase cell cycle arrest. In vitro studies suggest that emodin, one of the constituents, has hepatoprotective, neuroprotective, anti-osteoporotic, and chemopreventive effects. Emodin also enhances the cytotoxic effects of some chemotherapeutic agents. Emodin may play a protective role against osteoporosis.
Cascara is one of the ingredients in the Hoxsey herbal therapy, which is promoted to treat cancer.
Side Effects and Precautions
When taken by mouth: Cascara sagrada is possibly safe when used for less than one week. Side effects include stomach discomfort and cramps. But cascara sagrada is possibly unsafe when used for more than one week. This could cause more serious side effects, including dehydration, low levels of electrolytes, heart problems, muscle weakness, and others.
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Long-term use or overdose of cascara can cause electrolyte imbalances like very low blood levels of potassium, sodium, and chloride.
Special Precautions and Warnings
Pregnancy: There isn't enough reliable information to know if cascara sagrada is safe to use when pregnant. Stay on the safe side and avoid use. Do not use this product if you are pregnant or plan to become pregnant soon.
Breast-feeding: Cascara sagrada is possibly unsafe when taken by mouth while breast-feeding. Cascara sagrada can cross into breast milk and might cause diarrhea in a nursing infant.
Children: Cascara sagrada is possibly unsafe when taken by mouth in children. Don't give cascara sagrada to children. They are more likely than adults to have serious side effects, including dehydration and low potassium levels.
Gastrointestinal (GI) disorders: People with intestinal obstruction, Crohn's disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain should not use cascara sagrada.
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Signs of a very bad reaction: These include wheezing; chest tightness; trouble breathing, swallowing, or talking; fever; rash; hives; itching, discolored, swollen, blistered, or peeling skin; or swelling of face, lips, tongue, or throat.
Signs of fluid loss.
Signs of low potassium.
Interactions
Moderate Interactions
Be cautious with these combinations:
Digoxin: Cascara sagrada is a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects from digoxin.
Drugs for inflammation (corticosteroids): Some medications for inflammation, called corticosteroids, can also decrease potassium levels. Taking these products together might cause potassium levels to drop too low. Take extra care if you are taking drugs for inflammation. Some of these drugs decrease the potassium in your blood.
Other stimulant laxatives: Taking cascara sagrada with other stimulant laxatives might cause more diarrhea and very low potassium levels.
Warfarin: Cascara sagrada can work as a laxative and cause diarrhea in some people. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take large doses of cascara sagrada.
"Water pills" (diuretics): Some laxatives can cause diarrhea and decrease potassium levels. "Water pills" can also decrease potassium levels. Taking cascara sagrada along with "water pills" might make potassium levels drop too low. Take extra care if you are taking drugs called “water pills.” These drugs can decrease the potassium in your blood.
Take extra care if you are taking drugs that help your heart beat stronger or more regular.
Minor Interactions
Be watchful with this combination:
- Medications changed by the liver: Some medications are changed and broken down by the liver. Cascara sagrada might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
P-Glycoprotein (P-Gp)
Emodin inhibits the activity of P-Glycoprotein in vitro and in vivo, and may affect the transport of drugs mediated by this protein.
Dosage
Cascara sagrada used to be approved by the US FDA as an over-the-counter (OTC) drug for constipation, but this approval was taken away in 2002 due to a lack of evidence. Today, you can buy cascara sagrada as a dietary supplement, but not as a drug.
There isn't enough reliable information to know what an appropriate dose of cascara sagrada might be. Natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult a healthcare professional before using.