senna

Senna is a stimulant laxative medication available over the counter used to treat occasional constipation and bowel movement irregularity in both adults and children. Senna is also used for cleansing the colon before colonoscopy in adults. Senna generally causes bowel movement in about 6 to 12 hours. People also use senna for irritable bowel syndrome (IBS), hemorrhoids, and weight loss, but there is no good scientific evidence to support these uses.

Senna is an herbal laxative made from the leaves or fruits of the plant Senna alexandrina. The fruit is considered to have milder effect than the leaves. Senna contains chemicals known as sennosides that irritate the intestinal lining, which stimulates peristalsis, a series of contractions by which intestines propel their contents, resulting in bowel movement. 

• Do not use senna in the following conditions:
  • Hypersensitivity to senna, sennosides, or any component of the product
  • Gastrointestinal (GI) obstruction or perforation
  • Severe fecal impaction
  • GI or rectal bleeding
  • Symptoms of appendicitis or any other abdominal condition that requires immediate surgical intervention (acute surgical abdomen)
  • Inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease
• Senna dose of 15 mg/kg is potentially toxic to children younger than 6 years
• Over-the-counter use is not recommended in children younger than 2 years
• Some dosage forms of senna may contain benzyl alcohol which has been associated with fatal toxicity in newborn babies; do not administer formulations containing benzyl alcohol derivatives to neonates
• High doses of senna for prolonged periods can cause liver injury

Common side effects of senna include:

• Nausea
• Vomiting
• Abdominal cramps or pain
• Gas (flatulence)
• Urgent and frequent bowel movements
• Diarrhea
• Urine discoloration
• Kidney inflammation (nephritis)
• Rash
• Low potassium level (hypokalemia)
• Melanosis coli, a condition in which the intestinal lining turns dark brown or black, from chronic use
• Finger clubbing (with chronic use)
• Wheezing
• Severe allergic (anaphylactoid) reaction

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Tablet, extended-release

• 8.6 mg
• 15 mg
• 25 mg

Chewable tablet

• 10 mg
• 15 mg

Liquid

• 8.8 mg/5mL

Concentrated oral drops

• 8.8 mg/mL

Syrup

• 8.8 mg/5mL

Senna leaves

• 454g

Adult:

Constipation

• 15 mg orally once daily; not to exceed 70-100 mg/day divided every 12 hours
• Not for use more than 1 week

Senna Leaf Extract

• 362-1056 mg orally once/day

Bowel Preparation (Off-label)

• Various regimens exist that include senna laxative with additional gastric lavage
• Usual dose: 130 mg orally between 2:00 and 4:00 PM in afternoon of the day before the procedure

Pediatric:

Constipation

• Children 2-6 years: 4.3-17.2 mg/day orally; not to exceed 17.2 mg/day
• Children 6-12 years: 6-50 mg/day orally; not to exceed 50 mg/day
• Children over 12 years: 12-100 mg/day orally; not to exceed 100 mg/day
• Not for use more than 1 week

Senna Leaf Extract

• 2-6 years: 166.5-666 mg/day orally
• 6-12 years: 333-999 mg/day orally

• Most laxative overdoses in children are accidental, however, some people may take overdoses of laxatives to try to lose weight.
• Senna overdose may cause severe abdominal pain and/or cramping, persistent nausea, vomiting and diarrhea, and bloody stools. Overdose is treated with symptomatic and supportive care.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Senna has no known severe interactions with other drugs.
• Serious interactions of senna include:
  • sodium sulfate/magnesium sulfate/potassium chloride
  • sodium sulfate/potassium sulfate/magnesium sulfate
  • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
• Moderate Interactions of senna include:
  • deflazacort
  • dichlorphenamide
  • digoxin
  • lily of the valley
• Senna has no known mild interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Constipation during pregnancy should ideally be managed with moderate exercise and dietary intake of fiber and fluid; use senna with caution during pregnancy, can increase the risk for electrolyte imbalances
• Senna is not present in breast milk and is considered compatible with use by breastfeeding women
• Ideally, check with your healthcare provider before taking senna if you are pregnant or breastfeeding

• Senna is generally safe for occasional use in recommended doses in patients older than 2 years
• Avoid chronic use of senna; may lead to laxative dependence and electrolyte imbalance
• Consult with your doctor before taking senna if you have nausea, vomiting, stomach pain or changes in bowel habits that persist for longer than 2 weeks
• Do not use senna for longer than 1 week; if you do not have bowel movement within a week or if you have diarrhea or rectal bleeding, discontinue and seek medical help
• In case of overdose, get medical help or contact Poison Control Center
• Keep senna out of reach of children