What is it?
Cascara sagrada contains chemicals that stimulate the bowel and have a laxative effect.
People use cascara sagrada for constipation, emptying the colon before a colonoscopy, and other conditions, but there is no good scientific evidence to support these uses.
Cascara sagrada used to be approved by the US FDA as an over-the-counter (OTC) drug for constipation, but this approval was taken away in 2002 due to a lack of evidence. Today, you can buy cascara sagrada as a dietary supplement, but not as a drug
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 CASCARA SAGRADA are as follows:
Possibly ineffective for...
- Emptying the colon before a colonoscopy. Taking cascara sagrada by mouth, along with magnesium sulfate or milk of magnesia, does not improve bowel cleansing in people who are having a colonoscopy.
Is it safe?
Special precautions & warnings:Pregnancy: There isn't enough reliable information to know if cascara sagrada is safe to use when pregnant. Stay on the safe side and avoid use.
Breast-feeding: Cascara sagrada is possibly unsafe when taken by mouth while breast-feeding. Cascara sagrada can cross into breast milk and might cause diarrhea in a nursing infant.
Children: Cascara sagrada is possibly unsafe when taken by mouth in children. Don't give cascara sagrada to children. They are more likely than adults to have serious side effects, including dehydration and low potassium levels.
Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara sagrada.
Are there interactions with medications?
- Digoxin (Lanoxin)
- Cascara sagrada 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 from digoxin.
- Medications for inflammation (Corticosteroids)
- Cascara sagrada is a type of laxative called a stimulant laxative. Stimulant laxatives can cause diarrhea and decrease potassium levels. Some medications for inflammation, called corticosteroids, can also decrease potassium levels. Taking these products together might cause potassium levels to drop too low.
- Stimulant laxatives
- Cascara sagrada is a type of laxative called a stimulant laxative. Stimulant laxatives can cause diarrhea and decrease potassium levels. Taking cascara sagrada with other stimulant laxatives might cause more diarrhea and very low potassium levels.
- Warfarin (Coumadin)
- Cascara sagrada can work as a laxative. In some people, cascara sagrada can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take large doses of cascara sagrada.
- Water pills (Diuretic drugs)
- Cascara sagrada is a laxative. Some laxatives can cause diarrhea and decrease potassium levels. "Water pills" can also decrease potassium levels. Taking cascara sagrada along with "water pills" might make potassium levels drop too low.
Are there interactions with herbs and supplements?
- Chromium-containing herbs and supplements
- Cascara sagrada contains chromium. Taking it with other supplements that contain chromium can increase the risk of chromium poisoning. Examples of supplements that contain chromium include bilberry, brewer's yeast, and horsetail.
- Herbs that contain cardiac glycosides
- Cascara sagrada contains chemicals that can affect the heart. These chemicals are called cardiac glycosides. Using it along with other supplements that also contain cardiac glycosides can increase the risk of heart damage. Examples of supplements that contain cardiac glycosides include black hellebore, foxglove, lily-of-the-valley, oleander, and pleurisy root.
- Horsetail can act as a "water pill." "Water pills" can decrease potassium levels. Cascara sagrada is a laxative. Laxatives can also decrease potassium levels. Taking cascara sagrada along with horsetail might make potassium levels drop too low.
- Licorice causes the body to lose potassium. Cascara sagrada is a laxative. Laxatives can also decrease potassium levels. Taking cascara sagrada along with licorice might make potassium levels drop too low
- Stimulant laxative herbs
- Cascara sagrada s a type of laxative called a stimulant laxative. Stimulant laxatives can cause diarrhea and decrease potassium levels. Taking cascara sagrada with other supplements with similar effects might cause more diarrhea and very low potassium levels. Examples of supplements with this effect include aloe, alder buckthorn, gossypol, rhubarb, and senna.
Are there interactions with foods?
- There are no known interactions with foods.
How is it typically used?
There isn't enough reliable information to know what an appropriate dose of cascara sagrada might be. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult a healthcare professional before using.
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.
- Cirillo C, Capasso R. Constipation and botanical medicines: an overview. Phytother Res 2015;29:1488-93. View abstract.
- Nakasone ES, Tokeshi J. A serendipitous find: a case of cholangiocarcinoma identified incidentally after acute liver injury due to cascara sagrada ingestion. Hawaii J Med Public Health 2015;74:200-2. View abstract.
- Chang, L. C., Sheu, H. M., Huang, Y. S., Tsai, T. R., and Kuo, K. W. A novel function of emodin: enhancement of the nucleotide excision repair of UV- and cisplatin-induced DNA damage in human cells. Biochem Pharmacol 1999;58:49-57.
- Chang, C. J., Ashendel, C. L., Geahlen, R. L., McLaughlin, J. L., and Waters, D. J. Oncogene signal transduction inhibitors from medicinal plants. In Vivo 1996;10:185-190.
- Chen, H. C., Hsieh, W. T., Chang, W. C., and Chung, J. G. Aloe-emodin induced in vitro G2/M arrest of cell cycle in human promyelocytic leukemia HL-60 cells. Food Chem Toxicol 2004;42:1251-1257.
- Petticrew, M., Watt, I., and Sheldon, T. Systematic review of the effectiveness of laxatives in the elderly. Health Technol Assess. 1997;1:i-52. View abstract.
- Tramonte, S. M., Brand, M. B., Mulrow, C. D., Amato, M. G., O'Keefe, M. E., and Ramirez, G. The treatment of chronic constipation in adults. A systematic review. J Gen.Intern.Med 1997;12:15-24. 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.
- Silberstein, E. B., Fernandez-Ulloa, M., and Hall, J. Are oral cathartics of value in optimizing the gallium scan? Concise communication. J Nucl.Med 1981;22:424-427. View abstract.
- Marchesi, M., Marcato, M., and Silvestrini, C. [Clinical experience with a preparation containing cascara sagrada and boldo in the therapy of simple constipation in the elderly]. G.Clin.Med. 1982;63(11-12):850-863. View abstract.
- Fork, F. T., Ekberg, O., Nilsson, G., Rerup, C., and Skinhoj, A. Colon cleansing regimens. A clinical study in 1200 patients. Gastrointest.Radiol. 1982;7:383-389. View abstract.
- Novetsky, G. J., Turner, D. A., Ali, A., Raynor, W. J., Jr., and Fordham, E. W. Cleansing the colon in gallium-67 scintigraphy: a prospective comparison of regimens. AJR Am J Roentgenol. 1981;137:979-981. View abstract.
- Stern, F. H. Constipation--an omnipresent symptom: effect of a preparation containing prune concentrate and cascarin. J Am Geriatr Soc 1966;14:1153-1155. 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.
- Phillip, J., Schubert, G. E., Thiel, A., and Wolters, U. [Preparation for colonoscopy using Golytely--a sure method? Comparative histological and clinical study between lavage and saline laxatives]. Med Klin (Munich) 7-15-1990;85:415-420. 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.
- Huang, Q., Shen, H. M., and Ong, C. N. Inhibitory effect of emodin on tumor invasion through suppression of activator protein-1 and nuclear factor-kappaB. Biochem Pharmacol 7-15-2004;68:361-371. View abstract.
- Liu, J. B., Gao, X. G., Lian, T., Zhao, A. Z., and Li, K. Z. [Apoptosis of human hepatoma HepG2 cells induced by emodin in vitro]. Ai.Zheng. 2003;22:1280-1283. View abstract.
- Lai, G. H., Zhang, Z., and Sirica, A. E. Celecoxib acts in a cyclooxygenase-2-independent manner and in synergy with emodin to suppress rat cholangiocarcinoma growth in vitro through a mechanism involving enhanced Akt inactivation and increased activation of caspases-9 and -3. Mol.Cancer Ther 2003;2:265-271. View abstract.
- Chen, Y. C., Shen, S. C., Lee, W. R., Hsu, F. L., Lin, H. Y., Ko, C. H., and Tseng, S. W. Emodin induces apoptosis in human promyeloleukemic HL-60 cells accompanied by activation of caspase 3 cascade but independent of reactive oxygen species production. Biochem Pharmacol 12-15-2002;64:1713-1724. View abstract.
- Kuo, P. L., Lin, T. C., and Lin, C. C. The antiproliferative activity of aloe-emodin is through p53-dependent and p21-dependent apoptotic pathway in human hepatoma cell lines. Life Sci 9-6-2002;71:1879-1892. View abstract.
- Rosengren, J. E. and Aberg, T. Cleansing of the colon without enemas. Radiologe 1975;15:421-426. View abstract.
- Koyama, J., Morita, I., Tagahara, K., Nobukuni, Y., Mukainaka, T., Kuchide, M., Tokuda, H., and Nishino, H. Chemopreventive effects of emodin and cassiamin B in mouse skin carcinogenesis. Cancer Lett 8-28-2002;182:135-139. View abstract.
- Lee, H. Z., Hsu, S. L., Liu, M. C., and Wu, C. H. Effects and mechanisms of aloe-emodin on cell death in human lung squamous cell carcinoma. Eur J Pharmacol 11-23-2001;431:287-295. View abstract.
- Lee, H. Z. Protein kinase C involvement in aloe-emodin- and emodin-induced apoptosis in lung carcinoma cell. Br J Pharmacol 2001;134:1093-1103. View abstract.
- Lee, H. Z. Effects and mechanisms of emodin on cell death in human lung squamous cell carcinoma. Br J Pharmacol 2001;134:11-20. View abstract.
- Muller, S. O., Eckert, I., Lutz, W. K., and Stopper, H. Genotoxicity of the laxative drug components emodin, aloe-emodin and danthron in mammalian cells: topoisomerase II mediated? Mutat.Res 12-20-1996;371(3-4):165-173. View abstract.
- Fork FT, Ekberg O, Nilsson G, et al. Colon cleansing regimens. A clinical study in 1200 patients. Gastrointest Radiol 1982;7:383-9. View abstract.
- Cascara sagrada, aloe laxatives, O-9 contraceptives are category II-FDA. The Tan Sheet May 13, 2002.
- Choice of laxatives for constipation. Pharmacist's Letter/Prescriber's Letter 2002;18:180614.
- Food and Drug Administration, HHS. Status of certain additional over-the counter drug category II and III active ingredients. Final rule. Fed Regist 2002;67:31125-7. View abstract.
- Nadir A, Reddy D, Van Thiel DH. Cascara-sagrada induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol 2000;95:3634-7. 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.
- Young DS. Effects of Drugs on Clinical Laboratory Tests 4th ed. Washington: AACC Press, 1995.
- Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
- Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
- Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
- Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994.
- 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.
- Tyler VE. Herbs of Choice. Binghamton, NY: Pharmaceutical Products Press, 1994.
- Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
- Monographs on the medicinal uses of plant drugs. Exeter, UK: European Scientific Co-op Phytother, 1997.