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Cascara Sagrada

What is it?

Cascara sagrada is a shrub. The dried bark is used to make medicine.

Cascara sagrada used to be approved by the U.S. Food and Drug Administration (FDA) as an over-the-counter (OTC) drug for constipation. However, over the years, concerns were raised about cascara sagrada’s safety and effectiveness. The FDA gave manufacturers the chance to submit safety and effectiveness information to answer these concerns. But the companies decided the cost of conducting safety and effectiveness studies would likely be more than the profit they could expect from sales of cascara sagrada. So they didn’t comply with the request. As a result, the FDA notified manufacturers to remove or reformulate all OTC laxative products containing cascara sagrada from the U.S. market by November 5, 2002. Today, you can buy cascara sagrada as a “dietary supplement,” but not as a drug. “Dietary supplements” don’t have to meet the standards that the FDA applies to OTC or prescription drugs.

Cascara sagrada is commonly used by mouth as a laxative for constipation.

In foods and beverages, a bitterless extract of cascara sagrada is sometimes used as a flavoring agent.

In manufacturing, cascara sagrada is used in the processing of some sunscreens.

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 effective for...

  • Constipation. Cascara sagrada has laxative effects and may help relieve constipation in some people.

Possibly ineffective for...

  • Bowel preparation before colonoscopy. Most research shows that taking cascara sagradaalong with magnesium sulfate or milk of magnesia does not improve bowel cleansing in people who are undergoing a colonoscopy.

Insufficient evidence to rate effectiveness for...

  • Gallstones.
  • Liver disease.
  • Cancer.
  • Other conditions.
More evidence is needed to rate the effectiveness of cascara for these uses.

How does it work?

Cascara sagrada contains chemicals that stimulate the bowel and have a laxative effect.

Are there safety concerns?

Cascara sagrada is POSSIBLY SAFE for most adults when taken by mouth for less than one week. Side effects include stomach discomfort and cramps.

Cascara sagrada is POSSIBLY UNSAFE when used long-term. Don’t use cascara for longer than one or two weeks. Long-term use can cause more serious side effects including dehydration; low levels of potassium, sodium, chloride, and other “electrolytes” in the blood; heart problems; muscle weakness; and others.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of cascara sagrada during pregnancy. Stay on the safe side and avoid use if you are pregnant. 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 in children when taken by mouth. Don’t give cascara sagrada to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.

Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn’s 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?

Moderate
Be cautious with this combination.
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 of digoxin (Lanoxin).
Medications for inflammation (Corticosteroids)
Some medications for inflammation can decrease potassium in the body. Cascara sagrada is a type of laxative that might also decrease potassium in the body. Taking cascara sagrada along with some medications for inflammation might decrease potassium in the body too much.

Some medications for inflammation include dexamethasone (Decadron), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisone (Deltasone), and others.
Medications taken by mouth (Oral drugs)
Cascara sagrada is a laxative. Laxatives can decrease how much medicine your body absorbs. Decreasing how much medicine your body absorbs can decrease the effectiveness of your medication.
Stimulant laxatives
Cascara sagrada is a type of laxative called a stimulant laxative. Stimulant laxatives speed up the bowels. Taking cascara sagrada along with other stimulant laxatives could speed up the bowels too much and cause dehydration and low minerals in the body.

Some stimulant laxatives include bisacodyl (Correctol, Dulcolax), castor oil (Purge), senna (Senokot), and others.
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 excessive amounts of cascara.
Water pills (Diuretic drugs)
Cascara sagrada is a laxative. Some laxatives can decrease potassium in the body. "Water pills" can also decrease potassium in the body. Taking cascara sagrada 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?

Chromium-containing herbs and supplements
Cascara sagrada contains chromium and could increase the risk of chromium poisoning when taken with chromium supplements or chromium-containing herbs such as bilberry, brewer's yeast, or horsetail.
Herbs that contain cardiac-glycosides
Cardiac glycosides are chemicals that are similar to the prescription drug digoxin. Cardiac glycosides can cause the body to lose potassium.

Cascara sagrada can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

Using cascara sagrada along with an herb that contains cardiac glycosides can cause the body to lose too much potassium, and this can cause heart damage. Herbs that contain cardiac glycosides include black hellebore, Canadian hemp roots, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, oleander leaf, pheasant's eye plant, pleurisy root, squill bulb leaf scales, star of Bethlehem, strophanthus seeds, and uzara. Avoid using cascara sagrada with any of these.
Horsetail
Horsetail increases the production of urine (acts as a diuretic) and this can cause the body to lose potassium.

Cascara sagrada can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using horsetail with cascara sagrada increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara sagrada with horsetail.
Licorice
Licorice causes the body to lose potassium.

Cascara sagrada can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using licorice with cascara sagrada increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara sagrada with licorice.
Stimulant laxative herbs
Cascara sagrada is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

There is a concern that taking cascara sagrada along with other stimulant laxatives herbs can make potassium levels drop too low, and this can harm the heart. Other stimulant laxative herbs are 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. Avoid using cascara sagrada with any of these.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The appropriate dose of cascara sagrada depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for cascara sagrada. 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 your pharmacist or physician or other healthcare professional before using.

Other names

Aulne Noir, Bitter Bark, Bois Noir, Bois à Poudre, Borzène, Bourgène, Buckthorn, California Buckthorn, Cáscara, Cascara Sagrada, Chittem Bark, Dogwood Bark, Écorce Sacrée, Frangula purshiana, Nerprun, Pastel Bourd, Purshiana Bark, Rhamni Purshianae Cortex, Rhamnus purshiana, Rhubarbe des Paysans, Sacred Bark, Sagrada Bark, Yellow Bark.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

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Last reviewed - 06/22/2018