Authors: Suh Chang,
PharmD , Maria Kostka-Rokosz PharmD,
Lana Dvorkin, PharmD, Julia Whelan MS.
Overview
Fabaceae/Leguminosae family.
Senna is a low branching perennial shrub
and grows to about three feet high.
Senna has compound leaves with narrow
linear-to-oval-shaped dark green leaflets.
In the spring and summer it has yellow
pea-like flowers which are followed
by brown pods which contain brown seeds.
Leaves, fruit and flowers of senna are
used for medicinal purpose.
Historical Uses
Laxative use, antifungal,
decreases fever, cutaneous anti-infective,
antispasmodic, antirheumatic, anti-inflammatory,
Used for treatment of urinary infections
and hemorroids. Purgative and cleansing.
In Africa and Asia the leaves and seed
pod were used to treat anemia, bronchitis,
constipation, jaundice and skin problems.
Distribution
Native to Egypt, Northeastern
Africa and Arabia; so-called "wild
sennas" can be found in eastern
region of North America.
Active Ingredients
Anthroquinones- dianthrone;
Anthracenederivatives
(2.5-3.5%): chief components sennosides
A, A1, B, C and D. Naphthacenederivatives: including 6-hydroxymusizin
glucoside, tinnevellin-6-glucosides.
Laxative effect is due to the action
of sennosides and their active metabolite,
rhein anthrone in the colon. Effect
occurs 8-12 hours after administration.
Proven Scientific Evidence
Surgical Preparation:
In a prospective, randomized, single-blind
controlled study that was published
in Arch Surg, the study compared senna
vs polyethylene glycol for mechanical
preparation before elective colorectal
surgery. In the study 262 patients were
randomly selected to receive senna (one
120mg package diluted in water) and
261 patients were randomly selected
to receive polyethylene glycol (two
59-g packages diluted in 2-3 L of water).
1 The degree of colonic and rectal cleanliness
as judged by the operating surgeon in
the upstream and downstream intestinal
segment was used to measure the main
outcome. Senna was significantly more
efficient in providing intestinal cleanliness
in the upstream (p=0.04) and in both
intestinal segments taken together (p=0.006).
1 The final result of the study was
that senna was better and easier than
polyethylene glycol for mechanical preparation
before colonic or rectal resection.1
Constipation:
A study that was published in Journal
of Pain and Symptom Management, compared
the efficacy of senna versus lactulose
in terminal cancer patients treated
with opioids. The study was a randomized,
open trial, in which one group received
senna and the other lactulose twice
a day. 2 43 patients were randomly
selected to receive senna and 48 patients
received lactulose. Initial daily
doses were 0.4ml (12mg) for senna
and 15ml (10g) for lactulose, with
increments of 0.4ml and 15ml, every
3 days, according to clinical response.
2 Maximum doses were 1.6ml (48mg)
for senna and 60ml (40g) for lactulose.
2 Main outcome of the study were assessed
in terms of the number of 72-hr intervals
without defecation and days with defecation
events. 2 The result of the study
was that there is no significant difference
between the two groups in main outcome
(p=0.85).2
But senna was cost effective compared
to lactulose.2
Dosage Information
Senna is available as a
liquid or solid form of medication exclusively
for oral use and comminuted herb, powder
or dried extracts for tea.
For constipation, adult dose is 2 tablets
(187 mg) at bedtime (maximum of 8 tabs/day)
in children who weigh more than 60lb,
1 tablet at bedtime (maximum of 4 tabs/day).
Toxicities
Senna should not be used
during pregnancy (electrolyte abnormalities
and uterine contractions) and lactation
(anthroquinones cross into breast milk).
Senna can cause abdominal discomfort,
colic and cramps. Questionable mutagenicity.
Chronic use can cause hypokalemia, finger
clubbing, weakness, melanosis coli and
physiological dependence. Interactions:
digoxin, diuretics (theoretical-- may
enhance potassium loss).
Ritual Use
For rituals and amulets.
To assist the earth bound moribund to
pass peacefully.
Where Sold
Conventional senna containing
products can be purchased at pharmacies.
Products containing senna leaves can
be purchased at whole food markets.
1. Valverde A, Hay JM, Fingerhut
A, et al. Senna vs Polyethylene Glycol
for Mechanical Preparation the Evening
Before Elective Colonic or Rectal
Resection. Arch Surg. 1999 May; 134(5):
514-519.
2. Agra Y, Sacristan A, Gonzalez M,
et al. Efficacy of Senna versus Lactulose
in Terminal Cancer Patients Treated
with Opioids. Journal of Pain and
Symptom Management. 1998 Jan; 15(1):1-7.
3. Gruenward J, Brendler T, Jaenicke
C, editors. PDR for Herbal Medicines.
3rd ed. New Jersey: Thompson PDR;
2004.
4. DerMarderosian A, Beutler J, editors.
The Review of Natural Products. 2nd
ed. Missouri: Facts and Comparison;
2002.
5. Jellin JM. Natural Medicines Comprehensive
Database. Pharmacist's letter. Prescriber's
letter. Therapeutic Research Faculty;
Stockton CA.
