Senna Glycosides

Registered South African indications:

• Constipation

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients 
• Intestinal obstruction
• Intestinal bleeding
• Ileostomy
• Colostomy
• Intestinal stenosis
• Atony
• Appendicitis
• Inflammatory bowel disease
• Abdominal pain of unknown origin
• Severe dehydration
• Electrolyte imbalances
• Nausea and vomiting
• Congestive cardiac failure
• Coadministration with other laxatives

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Children
• Prolonged use
• Incontinent adults
• Post bowel surgery  
• Faecal impaction  
• Undiagnosed, acute or persistent gastrointestinal complaints
• Galactose intolerance
• Lapp lactase deficiency
• Glucose-galactose malabsorption

Forms avail. in SA and covered in this monograph: tab, cap

Constipation

• Oral (tab): 15-30mg, at night; Max: 30mg/24hrs; Treatment duration: 2-3 times/week
• Oral (cap): 20-40mg, at night; Max: 60mg/dose

Do not use in presence of abdominal pain, nausea or vomiting

If no bowel action has occurred after three days of progressively increased dosage, a medical examination should be considered.

Start with the lowest dose and titrate by half the initial dose, daily, until a comfortable, formed stool is produced

 Once regularity has been regained dosage should be reduced and can usually be stopped

Paed. forms avail. in SA and covered in this monograph: tab

Constipation

Younger than 2 years

• Not established for use

Between 2-6 years

• Oral (tab): 3.75-7.5mg, at night

Between 6-12 years

• Oral (tab): 7.5-15mg, at night

Do not use in presence of abdominal pain, nausea or vomiting

If no bowel action has occurred after three days of progressively increased dosage, a medical examination should be considered.

Start with the lowest dose and titrate by half the initial dose, daily, until a comfortable, formed stool is produced 

Once regularity has been regained dosage should be reduced and can usually be stopped

Pregnancy 

• Caution
• There are no reports of undesirable or damaging effects during pregnancy and on the foetus when used at the recommended dosage schedule
• However, as a consequence of experimental data concerning a genotoxic risk of several anthranoids, e.g emodin and aloe-emodin, use is not recommended during pregnancy

Breastfeeding 

• Caution
• There is insufficient data on the excretion of metabolites in breast milk
• Small amounts of active metabolites (rhein) are excreted in breast milk. A laxative effect in breastfed babies has not been reported

Renal Impairment 

• Caution; no information available

Hepatic Impairment 

• Caution; no information available

Elderly

• No dose adjustment recommended 

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Respiratory Disorders

• Asthma

Gastrointestinal Disorders

• Abdominal pain
• Abdominal spasm
• Diarrhoea
• Gastrointestinal tract mucosal pigmentation

Genitourinary Disorders

• Chromaturia

Endocrine and Metabolic Disorders

• Hypokalaemia
• Cachexia

Musculoskeletal Disorders

• Finger clubbing
• Tetany
• Hypertrophic osteoarthropathy

Skin and Subcutaneous Tissue Disorders

• Urticartia
• Pruritis

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity
• Local or generalised exanthema
• Hypogammaglobulinaemia

• Cardiac glycosides
• QT prolonging agents 
• Potassium-depleting agents

None routine

Senna is an anthraquinone laxative. The sugar moiety of the sennosides is removed by bacteria in the large intestine releasing the active anthrone fraction. This stimulates peristalsis via the submucosal and myenteric nerve plexuses. It produces stimulation of the motility of the large intestine resulting in accelerated colonic transit and has a influence on secretion processes by inhibition of absorption of water and electrolytes into the colonic epithelial cells (antiabsorptive effect) and increase of the leakiness of the tight junctions and stimulation of secretion of water and electrolytes into the lumen of the colon (secretagogue effect), resulting in enhanced concentrations of fluid and electrolytes in the lumen of the colon.

Senna glycosides is available in several formulations. Please note the list below gives examples of products which are available and is not necessarily comprehensive. The listing of a product does not constitute endorsement of the product by EMGuidance; likewise, failure to list a product does not imply that EMGuidance disapproves of the product. This information is put together on the basis of the National Government's Medicines Price Registry at the time of publication

Tablet 7.5mg

• Senokot (Reckitt)

Tablet 13.5mg

• Soflax (Cipla)

Capsule 20mg

• Depuran (Pharmacare)