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. Using a combination of senna, mannitol, saline solution, and simethicone, before imaging of the bowel with a special capsule that is swallowed, seems to be more effective than using the same regimen without the senna.
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.
- Cogley K, Echevarria A, Correa C, De la Torre-Mondragón L. Contact Burn with Blister Formation in Children Treated with Sennosides. Pediatr Dermatol 2017;34:e85-e88. View abstract.
- Vilanova-Sanchez A, Gasior AC, Toocheck N, et al. Are Senna based laxatives safe when used as long term treatment for constipation in children? J Pediatr Surg 2018;53:722-7. View abstract.
- Chen HB, Lian-Xiang P, Yue H, et al. Randomized controlled trial of 3 days fasting and oral senna, combined with mannitol and simethicone, before capsule endoscopy. Medicine (Baltimore) 2017;96:e8322. View abstract.
- Senokot Package Labeling, Purdue Products, L.P. 2016
- Poyrazoglu OK, Yalniz M. Two low-dose bowel-cleansing regimens: efficacy and safety of senna and sodium phosphorus solution for colonoscopy. Patient Prefer Adherence 2015;9:1325-31.View abstract.
- Yenidogan E, Okan I, Kayaoglu HA, et al. Same-day colonoscopy preparation with Senna alkaloids and bisacodyl tablets: a pilot study. World J Gastroenterol 2014;20:15382-6.View abstract.
- Feudtner C, Freedman J, Kang T, Womer JW, Dai D, Faerber J. Comparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: a multicenter study of clinically detailed administrative data. J Pain Symptom Manage 2014;48:272-80.View abstract.
- National Toxicology Program. Toxicology study of senna (CAS No. 8013-11-4) in C57BL/6NTAC mice and toxicology and carcinogenesis study of senna in genetically modified C3B6.129F1/Tac-Trp53tm1Brd haploinsufficient mice (feed studies). Natl Toxicol Program Genet Modif Model Rep 2012;:1-114.View abstract.
- Unal, S., Dogan, U. B., Ozturk, Z., and Cindoruk, M. A randomized prospective trial comparing 45 and 90-ml oral sodium phosphate with X-Prep in the preparation of patients for colonoscopy. Acta Gastroenterol.Belg. 1998;61:281-284. View abstract.
- van Gorkom, B. A., Karrenbeld, A., Limburg, A. J., and Kleibeuker, J. H. The effect of sennosides on colonic mucosal histology and bowel preparation. Z.Gastroenterol. 1998;36:13-18. View abstract.
- Lewis, S. J., Oakey, R. E., and Heaton, K. W. Intestinal absorption of oestrogen: the effect of altering transit-time. Eur.J Gastroenterol.Hepatol. 1998;10:33-39. View abstract.
- Agra, Y., Sacristan, A., Gonzalez, M., Ferrari, M., Portugues, A., and Calvo, M. J. Efficacy of senna versus lactulose in terminal cancer patients treated with opioids. J Pain Symptom.Manage. 1998;15:1-7. View abstract.
- Lewis, S. J., Heaton, K. W., Oakey, R. E., and McGarrigle, H. H. Lower serum oestrogen concentrations associated with faster intestinal transit. Br.J Cancer 1997;76:395-400. View abstract.
- Brusick, D. and Mengs, U. Assessment of the genotoxic risk from laxative senna products. Environ.Mol.Mutagen. 1997;29:1-9. View abstract.
- Sykes, N. P. A volunteer model for the comparison of laxatives in opioid-related constipation. J Pain Symptom.Manage. 1996;11:363-369. View abstract.
- Maddi, V. I. Regulation of bowel function by a laxative/stool softener preparation in aged nursing home patients. J Am Geriatr.Soc. 1979;27:464-468. View abstract.
- Corman, M. L. Management of postoperative constipation in anorectal surgery. Dis.Colon Rectum 1979;22:149-151. View abstract.
- Fernandez, Seara J., Pascual, Rubin P., Pato Rodriguez, M. A., Pereira Jorge, J. A., Dominguez Alvarez, L. M., Landeiro, Aller E., Tesouro, Rodriguez, I, Gonzalez Simon, M. C., Mendez Veloso, M. C., and Pena, Perez L. [Comparative study of the efficacy and tolerance of 2 types of colon cleansing]. Rev.Esp.Enferm.Dig. 1995;87:785-791. View abstract.
- de Witte, P. Metabolism and pharmacokinetics of anthranoids. Pharmacology 1993;47 Suppl 1:86-97. View abstract.
- Mengs, U. and Rudolph, R. L. Light and electron-microscopic changes in the colon of the guinea pig after treatment with anthranoid and non-anthranoid laxatives. Pharmacology 1993;47 Suppl 1:172-177. View abstract.
- Kaspi, T., Royds, R. B., and Turner, P. Qualitative determination of senna in urine. Lancet 5-27-1978;1:1162. View abstract.
- Gould, S. R. and Williams, C. B. Castor oil or senna preparation before colonoscopy for inactive chronic ulcerative colitis. Gastrointest.Endosc. 1982;28:6-8. View abstract.
- Brouwers, J. R., van Ouwerkerk, W. P., de Boer, S. M., and Thoman, L. A controlled trial of senna preparations and other laxatives used for bowel cleansing prior to radiological examination. Pharmacology 1980;20 Suppl 1:58-64. View abstract.
- Pers, M. and Pers, B. A crossover comparative study with two bulk laxatives. J Int.Med Res 1983;11:51-53. View abstract.
- Greiner, A. C. and Warwick, W. E. The use of sennosides A and B in the treatment of constipation in a mental institution. Appl.Ther 1965;7:1096-1098. View abstract.
- Glatzel, H. [Results of long-term therapy of 1059 babitually constipated patients using a standardized senna preparation]. Z.Allgemeinmed. 5-10-1972;48:654-656. View abstract.
- Sanders, R. C. and Wright, F. W. Colonic preparation: a controlled trial of Dulcodos, Dulcolax and Senokot DX. Br.J Radiol. 1970;43:245-247. View abstract.
- Slanger, A. Comparative study of a standardized senna liquid and castor oil in preparing patients for radiographic examination of the colon. Dis.Colon Rectum 1979;22:356-359. View abstract.
- Connolly, P., Hughes, I. W., and Ryan, G. Comparison of "Duphalac" and "irritant" laxatives during and after treatment of chronic constipation: a preliminary study. Curr Med Res Opin. 1974;2:620-625. View abstract.
- Greenhalf, J. O. and Leonard, H. S. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner 1973;210:259-263. View abstract.
- Pockros, P. J. and Foroozan, P. Golytely lavage versus a standard colonoscopy preparation. Effect on normal colonic mucosal histology. Gastroenterology 1985;88:545-548. View abstract.
- Mengs, U. Reproductive toxicological investigations with sennosides. Arzneimittelforschung. 1986;36:1355-1358. View abstract.
- van der Jagt, E. J., Thijn, C. J., and Taverne, P. P. Colon cleansing prior to roentgenologic examination. A double blind comparative study. J Belge Radiol. 1986;69:167-170. View abstract.
- Mengs, U. Toxic effects of sennosides in laboratory animals and in vitro. Pharmacology 1988;36 Suppl 1:180-187. View abstract.
- Hietala, P., Lainonen, H., and Marvola, M. New aspects on the metabolism of the sennosides. Pharmacology 1988;36 Suppl 1:138-143. View abstract.
- Lemli, J. Metabolism of sennosides--an overview. Pharmacology 1988;36 Suppl 1:126-128. View abstract.
- Lemli, J. Senna--an old drug in modern research. Pharmacology 1988;36 Suppl 1:3-6. View abstract.
- Heldwein, W., Sommerlatte, T., Hasford, J., Lehnert, P., Littig, G., and Muller-Lissner, S. Evaluation of the usefulness of dimethicone and/or senna extract in improving the visualization of abdominal organs. J Clin.Ultrasound 1987;15:455-458. View abstract.
- Kinnunen, O. and Salokannel, J. The carry-over effect on the bowel habit in elderly long-term patients of long-term bulk-forming products containing stimulant laxative. Acta Med Scand. 1987;222:477-479. View abstract.
- Bossi, S., Arsenio, L., Bodria, P., Magnati, G., Trovato, R., and Strata, A. [Clinical study of a new preparation from plantago seeds and senna pods]. Acta Biomed.Ateneo.Parmense. 1986;57(5-6):179-186. View abstract.
- Mishalany, H. Seven years' experience with idiopathic unremitting chronic constipation. J Pediatr.Surg. 1989;24:360-362. View abstract.
- Labenz, J., Hopmann, G., Leverkus, F., and Borsch, G. [Bowel cleansing prior to colonoscopy. A prospective, randomized, blind comparative study]. Med Klin.(Munich) 10-15-1990;85:581-585. View abstract.
- Lazarus, H., Fitzmartin, R. D., and Goldenheim, P. D. A multi-investigator clinical evaluation of oral controlled-release morphine (MS Contin tablets) administered to cancer patients. Hosp.J 1990;6:1-15. View abstract.
- Ziegenhagen, D. J., Zehnter, E., Tacke, W., and Kruis, W. Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial. Gastrointest.Endosc. 1991;37:547-549. View abstract.
- Soyuncu, S., Cete, Y., and Nokay, A. E. Portal vein thrombosis related to Cassia angustifolia. Clin.Toxicol.(Phila) 2008;46:774-777. View abstract.
- Wildgrube, H. J. and Lauer, H. [Combination intestinal lavage: a conservative procedure for colonoscopy]. Bildgebung 1991;58:63-66. View abstract.
- McLaughlin, A. F. Anorexia nervosa and senna misuse: nephrocalcinosis, digital clubbing and hypertrophic osteoarthropathy. Med J Aust. 9-15-2008;189:348. View abstract.
- Bailey, S. R., Tyrrell, P. N., and Hale, M. A trial to assess the effectiveness of bowel preparation prior to intravenous urography. Clin.Radiol. 1991;44:335-337. View abstract.
- De, Salvo L., Borgonovo, G., Ansaldo, G. L., Varaldo, E., Floris, F., Assalino, M., and Gianiorio, F. The bowel cleansing for colonoscopy. A randomized trial comparing three methods. Ann.Ital.Chir 2006;77:143-146. View abstract.
- Miles, C. L., Fellowes, D., Goodman, M. L., and Wilkinson, S. Laxatives for the management of constipation in palliative care patients. Cochrane.Database.Syst.Rev. 2006;:CD003448. View abstract.
- Kositchaiwat, S., Suwanthanmma, W., Suvikapakornkul, R., Tiewthanom, V., Rerkpatanakit, P., and Tinkornrusmee, C. Comparative study of two bowel preparation regimens for colonoscopy: senna tablets vs sodium phosphate solution. World J Gastroenterol. 9-14-2006;12:5536-5539. View abstract.
- Patanwala, A. E., Abarca, J., Huckleberry, Y., and Erstad, B. L. Pharmacologic management of constipation in the critically ill patient. Pharmacotherapy 2006;26:896-902. View abstract.
- Beuers, U., Spengler, U., and Pape, G. R. Hepatitis after chronic abuse of senna. Lancet 2-9-1991;337:372-373. View abstract.
- Guo, H., Huang, Y., Xi, Z., Song, Y., Guo, Y., and Na, Y. Is bowel preparation before excretory urography necessary? A prospective, randomized, controlled trial. J Urol. 2006;175:665-668. View abstract.
- Radaelli, F., Meucci, G., Imperiali, G., Spinzi, G., Strocchi, E., Terruzzi, V., and Minoli, G. High-dose senna compared with conventional PEG-ES lavage as bowel preparation for elective colonoscopy: a prospective, randomized, investigator-blinded trial. Am J Gastroenterol. 2005;100:2674-2680. View abstract.
- Burlefinger, R. J. and Schmitt, W. [Letter to the Journal of Gastroenterology. Comment on the article "Senna or bisacodyl before lavage preparation for colonoscopy: prospective randomized comparative study", by D. J. Ziegenhagen, E. Zehnter, W. Tacke, T. H. Gheorghiu, W. Kruis]. Z.Gastroenterol. 1992;30:376. View abstract.
- Sonmez, A., Yilmaz, M. I., Mas, R., Ozcan, A., Celasun, B., Dogru, T., Taslipinar, A., and Kocar, I. H. Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation. Acta Gastroenterol.Belg. 2005;68:385-387. View abstract.
- Ramkumar, D. and Rao, S. S. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100:936-971. View abstract.
- Ziegenhagen, D. J., Zehnter, E., Tacke, W., Gheorghiu, T., and Kruis, W. Senna vs. bisacodyl in addition to Golytely lavage for colonoscopy preparation--a prospective randomized trial. Z.Gastroenterol. 1992;30:17-19. View abstract.
- BALDWIN, W. F. CLINICAL STUDY OF SENNA ADMINISTRATION TO NURSING MOTHERS: ASSESSMENT OF EFFECTS ON INFANT BOWEL HABITS. Can.Med Assoc.J 9-14-1963;89:566-568. View abstract.
- Milner, P., Belai, A., Tomlinson, A., Hoyle, C. H., Sarner, S., and Burnstock, G. Effects of long-term laxative treatment on neuropeptides in rat mesenteric vessels and caecum. J Pharm.Pharmacol. 1992;44:777-779. View abstract.
- Chilton, A. P., O'Sullivan, M., Cox, M. A., Loft, D. E., and Nwokolo, C. U. A blinded, randomized comparison of a novel, low-dose, triple regimen with fleet phospho-soda: a study of colon cleanliness, speed and success of colonoscopy. Endoscopy 2000;32:37-41. View abstract.
- Mengs, U., Grimminger, W., Krumbiegel, G., Schuler, D., Silber, W., and Volkner, W. No clastogenic activity of a senna extract in the mouse micronucleus assay. Mutat.Res 8-18-1999;444:421-426. View abstract.
- Valverde, A., Hay, J. M., Fingerhut, A., Boudet, M. J., Petroni, R., Pouliquen, X., Msika, S., and Flamant, Y. Senna vs polyethylene glycol for mechanical preparation the evening before elective colonic or rectal resection: a multicenter controlled trial. French Association for Surgical Research. Arch.Surg. 1999;134:514-519. View abstract.
- Stickel, F. and Schuppan, D. Herbal medicine in the treatment of liver diseases. Dig.Liver Dis. 2007;39:293-304. View abstract.
- Mereto, E., Ghia, M., and Brambilla, G. Evaluation of the potential carcinogenic activity of Senna and Cascara glycosides for the rat colon. Cancer Lett 3-19-1996;101:79-83. View abstract.
- Hangartner, P. J., Munch, R., Meier, J., Ammann, R., and Buhler, H. Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients. Endoscopy 1989;21:272-275. View abstract.
- Borkje, B., Pedersen, R., Lund, G. M., Enehaug, J. S., and Berstad, A. Effectiveness and acceptability of three bowel cleansing regimens. Scand J Gastroenterol 1991;26:162-166. View abstract.
- Krumbiegel G and Schulz HU. Rhein and aloe-emodin kinetics from senna laxatives in man. Pharmacology 1993;47(suppl 1):120-124. View abstract.
- de Witte, P. and Lemli, L. The metabolism of anthranoid laxatives. Hepatogastroenterology 1990;37:601-605. View abstract.
- Duncan AS. Standardized senna as a laxative in the puerperium; a clinical assessment. Br Med J 1957;1:439-41. View abstract.
- Faber P, Strenge-Hesse A. Relevance of rhein excretion into breast milk. Pharmacology 1988;36 Suppl 1:212-20. View abstract.
- Faber P, Strenge-Hesse A. Senna-containing laxatives: excretion in the breast milk? Geburtshilfe Frauenheilkd 1989;49:958-62. View abstract.
- Hagemann TM. Gastrointestinal medications and breastfeeding. J Hum Lact 1998;14:259-62. View abstract.
- Werthmann WM Jr, Krees SV. Quantitative excretion of Senokot in human breast milk. Med Ann Dist Columbia 1973;42:4-5. View abstract.
- Prather CM. Pregnancy-related constipation. Curr Gastroenterol Rep 2004;6:402-4. View abstract.
- Kittisupamongkol W, Nilaratanakul V, Kulwichit W. Near-fatal bleeding, senna, and the opposite of lettuce. Lancet 2008;371:784. View abstract.
- Senokot Package Labeling. Purdue Products L.P. 2007.
- MacLennan WJ, Pooler AFWM. A comparison of sodium picosulphate ("Laxoberal") with standardised senna ("Senokot") in geriatric patients. Curr Med Res Opin. 1974;2:641-7. View abstract.
- Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ 1993;307:769-71. View abstract.
- Passmore AP, Davies KW, Flanagan PG, et al. A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology 1993;47:249-52. View abstract.
- Kinnunen O, Winblad I, Koistinen P, Salokannel J. Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacology 1993;47:253-5. View abstract.
- [No authors listed] Senna in the puerperium. Pharmacology 1992;44:23-5. View abstract.
- Shelton MG. Standardized senna in the management of constipation in the puerperium: A clinical trial. S Afr Med J 1980;57:78-80. View abstract.
- Perkin JM. Constipation in childhood: a controlled comparison between lactulose and standardized senna. Curr Med Res Opin 1977;4:540-3. View abstract.
- Sondheimer JM, Gervaise EP. Lubricant versus laxative in the treatment of chronic functional constipation of children: a comparative study. J Pediatr Gastroenterol Nutr 1982;1:223-6. View abstract.
- Ramesh PR, Kumar KS, Rajagopal MR, et al. Managing morphine-induced constipation: a controlled comparison of an Ayurvedic formulation and senna. J Pain Symptom Manage 1998;16:240-4. View abstract.
- Ewe K, Ueberschaer B, Press AG. Influence of senna, fibre, and fibre + senna on colonic transit in loperamide-induced constipation. Pharmacology 1993;47:242-8. View abstract.
- Arezzo A. Prospective randomized trial comparing bowel cleaning preparations for colonoscopy. Surg Laparosc Endosc Percutan Tech. 2000;10:215-7. View abstract.
- van Os FH. Anthraquinone derivatives in vegetable laxatives. Pharmacology 1976;14:7-17. View abstract.
- Godding EW. Laxatives and the special role of senna. Pharmacology 1988;36:230-6. View abstract.
- Joo JS, Ehrenpreis ED, Gonzalez L, et al. Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. J Clin Gastroenterol 1998;26:283-6. View abstract.
- Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver disease--benefits and dangers. Aliment Pharmacol Ther 2001;15:1239-52. View abstract.
- Prior J, White I. Tetany and clubbing in patient who ingested large quantities of senna. Lancet 1978;2:947. View abstract.
- Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9. View abstract.
- Vanderperren B, Rizzo M, Angenot L, et al. Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides. Ann Pharmacother 2005;39:1353-7. View abstract.
- Seybold U, Landauer N, Hillebrand S, Goebel FD. Senna-induced hepatitis in a poor metabolizer. Ann Intern Med 2004;141:650-1. View abstract.
- Marlett JA, Li BU, Patrow CJ, Bass P. Comparative laxation of psyllium with and without senna in an ambulatory constipated population. Am J Gastroenterol 1987;82:333-7. View abstract.
- Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. View abstract.
- American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-89. View abstract.
- Young DS. Effects of Drugs on Clinical Laboratory Tests 4th ed. Washington: AACC Press, 1995.
- Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
- McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
- The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
- Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
- Monographs on the medicinal uses of plant drugs. Exeter, UK: European Scientific Co-op Phytother, 1997.