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Senna glycoside

Clinical data
Trade names	Ex-Lax, Senokot, others
AHFS/Drugs.com	Monograph
MedlinePlus	a601112
License data	US DailyMed: Senna
Pregnancy category	AU: A
Routes of administration	By mouth, 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 (by mouth)
Identifiers
IUPAC name 9-oxy-9H-anthracen-9-yl]-4-hydroxy-10-oxo-5-oxy-9H-anthracene-2-carboxylic acid
CAS Number	66575-30-2
PubChem CID	5199
DrugBank	DB11365
ChemSpider	65892
KEGG	D02171
Chemical and physical data
Formula	C42H38O20
Molar mass	862.746 g·mol
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Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery. The medication is taken by mouth or via the rectum. 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.

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. While no harm has been found to result from use while breastfeeding, such use is not typically recommended. It is not typically recommended in children. Senna may change urine to a somewhat reddish color. Senna derivatives are a type of stimulant laxative and are of the anthraquinone type. 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.

Sennosides come from the group of plants Senna. In plant form, it has been used at least since the 700s AD. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2022, it was the 280th most commonly prescribed medication in the United States, with more than 600,000 prescriptions. In 2022, the combination with docusate was the 261st most commonly prescribed medication in the United States, with more than 1 million prescriptions. It is sold under a number of brand names including Ex-Lax and Senokot.

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. It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.

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.

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.

Interactions

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

Mechanism of action

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

Pharmacology

They are anthraquinones derivatives and dimeric glycosides.

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.

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.

References

1. ^ American Society of Health-System Pharmacists (1 January 2008). "Senna". Drugs.com. Archived from the original on 6 September 2015. Retrieved 11 August 2015.
2. "Prescribing medicines in pregnancy database". Therapeutic Goods Administration (TGA). Australian Government, Department of Health and Aged Care.
3. ^ Navti P (2010). Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. p. 337. ISBN 9780199559824. Archived from the original on 5 March 2016.
4. "Senna(Powdered)". PubChem. U.S. National Library of Medicine.
5. ^ Wald A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91. doi:10.1001/jama.2015.16994. PMID 26757467.
6. ^ Hamilton RJ (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. Archived from the original on 5 March 2016.
7. Khare CP (2004). Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 133. ISBN 9783642186592. Archived from the original on 5 March 2016.
8. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
9. ^ "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
10. "Sennosides Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
11. "Senna; Docusate Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
12. ^ Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.
13. ^ Drugs.com "Senna (Professional Patient Advice)". Archived from the original on 19 April 2014. Retrieved 17 April 2014.
14. ^ McQuaid KR (2012). "Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases.". In Katzung BG, Masters SB, Trevor AJ (eds.). Basic & Clinical Pharmacology (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
15. "Senna: MedlinePlus Supplements". Archived from the original on 6 April 2015.
16. Sharkey KA, Wallace JL (2011). "Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease.". In Brunton LL, Chabner BA, Knollmann BC (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
17. Franz G (October 1993). "The senna drug and its chemistry". Pharmacology. 47 (Suppl. 1): 2–6. doi:10.1159/000139654. PMID 8234429.

• Medicine

• Anthraquinone glycosides
• Laxatives
• World Health Organization essential medicines