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Senna glycoside

From Wikipedia, the free encyclopedia
(Redirected from Ex-Lax)

Senna glycoside
Clinical data
Trade namesEx-Lax, Senokot, others[1]
AHFS/Drugs.comMonograph
MedlinePlusa601112
License data
Pregnancy
category
Routes of
administration		Oral, rectal
ATC code
Legal status
Legal status
Pharmacokinetic data
Onset of actionMinutes (by rectum), 6 to 12 hours (orally)[3]
Identifiers
  • 9-[2-carboxy-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracen-9-yl]-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracene-2-carboxylic acid
CAS Number
PubChem CID
DrugBank
ChemSpider
KEGG
Chemical and physical data
FormulaC42H38O20[4]
Molar mass862.746 g·mol−1
 X markNcheckY (what is this?)  (verify)
Picture depicting an old Ex-Lax™ carton

Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][5] The medication is taken orally (swallowed by mouth) or via the rectum.[1][6] It typically begins working in around 30 minutes when given by rectum and within twelve hours when given orally.[3] It is a weaker laxative than bisacodyl and castor oil.[1]

Common side effects of senna glycoside include abdominal cramps.[3] While no harm has been found to result from use while breastfeeding, such use is not typically recommended.[1] It is not typically recommended in children.[1] Senna may change urine to a somewhat reddish color.[1] Senna derivatives are a type of stimulant laxative and are of the anthraquinone type.[1] While its mechanism of action is not entirely clear, senna is thought to act by increasing fluid secretion within and contraction of the large intestine.[1]

Sennosides come from the group of plants Senna.[3] In plant form, it has been used at least since the 700s AD.[7] It is on the World Health Organization's List of Essential Medicines.[8] It is available as a generic medication.[1][6] In 2023, it was the 302nd most commonly prescribed medication in the United States, with more than 300,000 prescriptions.[9] In 2023, the combination with docusate was the 242nd most commonly prescribed medication in the United States, with more than 1 million prescriptions.[10][11] It is sold under a number of brand names including Ex-Lax and Senokot.[1]

Medical uses

[edit]

Senna is used for episodic and chronic constipation, though there is a lack of high-quality evidence to support its use for these purposes.[5]

It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[12][13]

Administration

[edit]

Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories can act within minutes or take up to two hours.[14]

Contraindications

[edit]

According to Commission E, senna is contraindicated in cases of intestinal obstruction, acute intestinal inflammation (e.g., Crohn's disease), ulcerative colitis, appendicitis, and abdominal pain of unknown origin.[12]

Senna is considered contraindicated in people with a documented allergy to anthraquinones. Such allergies are rare and typically limited to dermatological reactions of redness and itching.[12]

Adverse effects

[edit]

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[12]

Evidence no longer supports traditional concerns that longterm senna use damages the colon, causes dependence, or leads to tolerance, though high-quality longterm human data are lacking for this reassurance.[15][16][17] Such concerns originated mostly from early studies in patients with severe constipation who likely had pre-existing enteric neuromuscular abnormalities, not laxative-induced damage.[18]

Regular use of senna products can lead to a characteristic brown pigmentation of the internal colonic wall seen on colonoscopy. This abnormal pigmentation is known as melanosis coli.[14]

Interactions

[edit]

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[19]

Mechanism of action

[edit]

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[20]

Pharmacology

[edit]

They are anthraquinones derivatives and dimeric glycosides.[21]

Society and culture

[edit]

Formulations

[edit]

Senna is an over-the-counter drug available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers and sold under various brand names.[13]

Brand names

[edit]

Ex-Lax, Geri-kot, Perdiem Overnight Relief, Senexon, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot.[12]

References

[edit]
  1. 1 2 3 4 5 6 7 8 9 10 11 American Society of Health-System Pharmacists (1 January 2008). "Senna". Drugs.com. Archived from the original on 6 September 2015. Retrieved 11 August 2015.
  2. ↑ "Prescribing medicines in pregnancy database". Therapeutic Goods Administration (TGA). Australian Government, Department of Health and Aged Care.
  3. 1 2 3 4 Navti P (2010). Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. p. 337. ISBN 9780199559824. Archived from the original on 5 March 2016.
  4. ↑ "Senna(Powdered)". PubChem. U.S. National Library of Medicine.
  5. 1 2 Wald A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91. doi:10.1001/jama.2015.16994. PMID 26757467.
  6. 1 2 Hamilton RJ (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. Archived from the original on 5 March 2016.
  7. ↑ Khare CP (2004). Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 133. ISBN 9783642186592. Archived from the original on 5 March 2016.
  8. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  9. ↑ "Sennosides Drug Usage Statistics, United States, 2014 - 2023". ClinCalc. Retrieved 21 August 2025.
  10. ↑ "The Top 300 of 2023". ClinCalc. Archived from the original on 12 August 2025. Retrieved 12 August 2025.
  11. ↑ "Senna; Docusate Drug Usage Statistics, United States, 2014 - 2023". ClinCalc. Retrieved 21 August 2025.
  12. 1 2 3 4 5 Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.
  13. 1 2 Drugs.com "Senna (Professional Patient Advice)". Archived from the original on 19 April 2014. Retrieved 17 April 2014.
  14. 1 2 McQuaid KR (2012). "Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases.". In Katzung BG, Masters SB, Trevor AJ (eds.). Basic & Clinical Pharmacology (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
  15. ↑ Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, et al. (June 2023). "American Gastroenterological Association–American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation". Gastroenterology. 164 (7): 1086–1106. doi:10.1053/j.gastro.2023.03.214. PMC 10542656. PMID 37211380.
  16. ↑ Whorwell P, Lange R, Scarpignato C (16 June 2024). "Review article: Do stimulant laxatives damage the gut? A critical analysis of current knowledge". Therapeutic Advances in Gastroenterology. 17 17562848241249664. doi:10.1177/17562848241249664. PMC 11181897. PMID 38887508.
  17. ↑ Wald A (2016). "Constipation: Advances in Diagnosis and Treatment". JAMA. 315 (2): 185–191. doi:10.1001/jama.2015.16994. PMID 26757467.
  18. ↑ Rajindrajith S, Devanarayana NM, Thapar N, Benninga MA (2023). "Myths and misconceptions about childhood constipation". European Journal of Pediatrics. 182 (4): 1447–1458. doi:10.1007/s00431-023-04821-8. PMID 36689003.
  19. ↑ "Senna: MedlinePlus Supplements". Archived from the original on 6 April 2015.
  20. ↑ Sharkey KA, Wallace JL (2011). "Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease.". In Brunton LL, Chabner BA, Knollmann BC (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
  21. ↑ Franz G (October 1993). "The senna drug and its chemistry". Pharmacology. 47 (Suppl. 1): 2–6. doi:10.1159/000139654. PMID 8234429.
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