Cascara sagrada is obtained from the dried bark of Rhamni purshianae; the bark must be aged 1 year or heat treated before use. Anthraglycosides, or anthraquinones, which consist primarily of cascarosides A and B, are the active ingredients.

Cascara is referred to as a stimulant laxative. When ingested, the herb causes the secretion of water and electrolytes into the small intestine. In the large intestine, the absorption of these products is inhibited, allowing the contents of the bowel to grow in volume. This increased volume then stimulates peristalsis and advances the bowel contents quickly through the large intestine for evacuation. Cascara may also have antileukemic properties. Historically, cascara has also been used for gallstones, liver ailments, and as a bitter tonic. Cascara sagrada is available as cut bark, powder, and dry extract.

Benefits And Uses of Cascara Sagrada

Cascara sagrada is used mainly as a stimulant laxative to treat constipation; the FDA has approved the herb for this use. It’s also used to make teas, decoctions, elixirs, for cold maceration, and as a sun screen in cosmetic products.

Administration

To treat constipation: 20 to 70 mg of hydroxyanthracene derivatives (calculated as cascaroside A) from the cut bark, powder, or dry extract, taken by mouth every day. Tea prepared by steeping 2 g of finely cut bark in 5 oz of boiling water for 5 to 10 minutes, then straining. Correct dose is the smallest necessary to maintain soft stools.

Side Effects of Cascara Sagrada

Adverse effects of cascara sagrada include abdominal cramping, abdominal discomfort, vomiting, bloody diarrhea albuminuria, hematuria, potassium deficiency, weight loss, and dermatitis. Colic and kidney irritation may result from intake of fresh rind.

Long-term use of cascara may lead to hypokalemia, which may enhance digoxin action. Concomitant use of cascara and laxatives increases the likelihood of diarrhea and fluid or electrolyte disturbances. There is an increased risk of potassium depletion if cascara is used with potassium sparing diuretics and corticosteroids. There is an increased risk of potassium depletion if cascara is used with licorice root.

Those with intestinal obstruction, ulcerative colitis, appendicitis, abdominal pain of unknown origin, diarrhea, or acute intestinal inflammation, such as Crohn’s disease, should avoid use of cascara sagrada. Children younger than age 12 and pregnant or breast-feeding patients should also avoid use.

Clinical Considerations

• Liquid and solid forms of cascara sagrada are for oral use only.
• Effects are generally seen with 6 to 8 hours.
• Tell patients not to be begin using cascara if he’s experiencing abdominal pain or diarrhea.
• Advise patients that cascara isn’t intended for long-term use and that he shouldn’t use it for longer than 10 days without medical advice.
• Long-term use may cause hypokalemia that can lead to cardiac problems and muscle weakness.
• It may also cause lazy bowel, an inabillty to move bowels without a laxative.
• Pseudomelanosis coli, a harmless pigmentation of the intestinal mucosa, may develop; it should reverse when patient stops taking the herb.
• Encourage patients to use milder methods of relieving constipation, including making dietary changes and using bulk forming products , before using stimulant laxative such as cascara.
• Herb may discolor urine, making diagnostic test interpretation more difficult.
• Overdose can cause diarrhea and fluid and electrolyte imblances.
• Caution patient that children younger than age 12 and pregnant and breast-feeding patients shouldn’t use cascara unless under the supervision of a health care provider.
• Advise patient not to use the fresh bark of the cascara plant because it can cause intestinal irritation, spasms, or cramping; bloody diarrhea; or severe vomiting.
• Tell patient to consult his health care provider if discomfort occurs. Discomfort may be resolved by lowering the dose or discontinuing the herb.
• Advise patient not to exceed the recommended dose and to discontinue use in the event of diarrhea or watery stools.
• Use only standardized anthraquinone containing preparations. The effects of nonstandardized preparations are unpredictable.
• Tell patient to remind prescriber and pharmacist of any herbal or dietary supplement that he’s taking when obtaining a new prescription.
• Advise patient to consult his health care provider before using an herbal preparation because a treatment with proven efficacy may be available.

Research summary

Cascara sagrada has been approved by the FDA as an over-the-counter laxative. A few recent studies have shown some antileukemia activity, but these are only in vitro and in mice. For humans, this and other uses of cascar sagrada have not yet been validated scientifically.

Tagged under:albuminuria anthraquinones bloody diarrhea cascara sagrada colic digoxin gallstones Health Flash hematuria hypokalemia maceration potassium deficiency stimulant laxative

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