What is it?
Senna is an FDA-approved over-the-counter (OTC) laxative. A prescription is not required to purchase senna. It is used to treat constipation and also to clear the bowel before diagnostic tests such as colonoscopy.
Senna is also used for irritable bowel syndrome (IBS), anal or rectal surgery, tears in the lining of the anus (anal fissures), hemorrhoids, and weight loss.
Senna fruit seems to be gentler than senna leaf. This has led the American Herbal Products Association (AHPA) to warn against long-term use of senna leaf, but not senna fruit. The AHPA recommends that senna leaf products be labeled, "Do not use this product if you have abdominal pain or diarrhea. Consult a healthcare provider prior to use if you are pregnant or nursing. Discontinue use in the event of diarrhea or watery stools. Do not exceed recommended dose. Not for long-term use."
How effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for SENNA are as follows:
Likely effective for...
- Constipation. Taking senna by mouth is effective for short-term treatment of constipation. Senna is an FDA-approved nonprescription drug for adults and children ages 2 years and older. However, in children ages 3-15 years, mineral oil and a medication called lactulose might be more effective than taking senna. Senna also appears to be effective for treating constipation when used in combination with psyllium or docusate sodium. In elderly people, senna plus psyllium is more effective than lactulose for treating ongoing constipation. Senna plus docusate sodium is effective for treating constipation in the elderly and in people who have undergone anorectal surgery. Taking senna appears to be as effective as lactulose, psyllium, and docusate for relieving constipation in people taking opioids or loperamide.
Possibly effective for...
- Bowel preparation before colonoscopy. Taking senna by mouth is as effective as castor oil and bisocodyl for bowel preparation. Some evidence suggests that senna is also at least as effective as polyethylene glycol for bowel preparation. However, conflicting evidence exists. It is unclear if taking senna with polyethylene glycol is more effective than taking polyethylene glycol alone. Senna appears to be less effective than sodium phosphate for bowel cleansing. However, taking a combination of senna, sodium picosulfate, and polyethylene glycol appears to be more effective than sodium phosphate for bowel preparation prior to colonoscopy.
Possibly ineffective for...
- Diagnostic imaging. Taking senna by mouth does not appear to improve imaging of abdominal organs.
Insufficient evidence to rate effectiveness for...
- Irritable bowel syndrome (IBS).
- Losing weight.
- Surgery of anus or rectum.
- Tears in lining of anus (anal fissures).
- Other conditions.
How does it work?
Are there safety concerns?
Senna is POSSIBLY UNSAFE when taken by mouth long-term or in high doses. Don't use senna for more than two weeks. Longer use can cause the bowels to stop functioning normally and might cause dependence on laxatives. Long-term use can also change the amount or balance of some chemicals in the blood (electrolytes) that can cause heart function disorders, muscle weakness, liver damage, and other harmful effects.
Special precautions & warnings:Pregnancy and breast-feeding: Senna is POSSIBLY SAFE during pregnancy and breast-feeding when taken by mouth, short-term. It is POSSIBLY UNSAFE when taken by mouth long-term or in high doses. Long-term, frequent use, or use of high doses has been linked to serious side effects including laxative dependence and liver damage.
Although small amounts of senna cross into breast milk, it doesn't seem to be a problem for nursing babies. As long as the mother uses senna in recommended amounts, senna does not cause changes in the frequency or consistency of babies' stools.
Electrolyte disturbances, potassium deficiency: Overuse of senna can make these conditions worse.
Dehydration, diarrhea or loose stools: Senna should not be used in people with dehydration, diarrhea, or loose stools. It can make these conditions worse.
Gastrointestinal (GI) conditions: Senna should not be used by people with abdominal pain (either diagnosed or undiagnosed), intestinal blockage, Crohn's disease, ulcerative colitis, appendicitis, stomach inflammation, anal prolapse, or hemorrhoids.
Heart disease: Senna can cause electrolyte disturbances and might make heart disease worse.
Are there interactions with medications?
- Birth control pills (Contraceptive drugs)
- Ethinyl estradiol is a form of estrogen that's in some birth control pills. Senna can decrease how much estradiol the body absorbs. Taking senna along with certain birth control pills might decrease their effectiveness.
- Digoxin (Lanoxin)
- Senna is a type of laxative called a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects of digoxin (Lanoxin).
- Some pills used for hormone replacement therapy contain the chemical estrone. Senna can reduce the amount of estrone in the body. Other pills used for hormone replacement therapy contain the chemical ethinyl estradiol. Senna can decrease how much estradiol the body absorbs. Taking senna might decrease the effects of hormone replacement therapy.
Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.
- Warfarin (Coumadin)
- Senna can work as a laxative. In some people, senna can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take excessive amounts of senna.
- Water pills (Diuretic drugs)
- Senna is a laxative. Some laxatives can decrease potassium in the body. "Water pills" can also decrease potassium in the body. Taking senna along with "water pills" might decrease potassium in the body too much.
Some "water pills" that can decrease potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.
Are there interactions with herbs and supplements?
- There is a concern that using senna along with horsetail might increase the chance that potassium levels in the body might drop too low.
- There is a concern that using senna along with licorice might increase the chance that potassium levels in the body might drop too low.
- Stimulant laxative herbs
- There is a concern that using senna along with stimulant laxative herbs might increase the chance that potassium levels in the body might drop too low. Stimulant laxative herbs include aloe, alder buckthorn, black root, blue flag, butternut bark, colocynth, European buckthorn, fo ti, gamboge, gossypol, greater bindweed, jalap, manna, Mexican scammony root, rhubarb, senna, and yellow dock.
Are there interactions with foods?
- There are no known interactions with foods.
What dose is used?
- For constipation: For general constipation, the usual dose is 17.2 mg daily. Don't take more than 34.4 mg twice daily. In elderly people, 17 mg daily has been used. For constipation following pregnancy, 28 mg in 2 divided doses has been used.
- For bowel preparation: Doses of senna containing 75 mg or sennosides taken the day before colonoscopy, or 120-150 mg taken once or twice the day before colonoscopy, have been used.
- In children age 12 and over, the usual dose is 2 tablets, with 8.6 mg sennosides per tablet, once daily. The maximum dose is 4 tablets (34.4 mg sennosides) twice daily. In children ages 6 to 11 years, the usual dose is 1 tablet (8.6 mg sennosides) daily. The maximum dose is 2 tablets (17.2 mg sennosides) twice daily. In children ages 2 to 5 years, the usual dose is 1/2 tablet (4.3 mg sennosides) daily. The maximum dose is 1 tablet (8.6 mg sennosides) twice daily.
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.
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