Cascara Sagrada - Drug Interactions, Side Effects and Precautions of Use
Common Trade Names
Multi-ingredient preparations: Bassoran with Cascara, Bicholax, Cas-Evac, Casvlium, Kondremul with Cascara
Available as capsules, bitter and sweet fluidextracts, powders, and dried
bark for teas. Cascara sagrada prepared as a tea is not popular because of its extremely bitter taste and the availability of standardized pharmaceutical preparations that perform the same functions.
Cascara sagrada is the dried bark of Rhamnus purshiana. It should be aged for at least 1 year before use in medicinal preparations, but 3-yearold bark is preferred for pharmaceutical purposes because it exhibits a milder cathartic activity because of the oxidation of glycosides present in the bark. Cascara sagrada is found in the Pacific Northwest, from Canada to California.
Two types of anthracene compounds-emodin glycosides (O-glycosides) and aloinlike C-glycosides-have been reported. The C-glycosides are divided into barbaloin, deoxybarbaloin (chrysaloin), and the cascarosides. Dried, medicinal-quality cascara bark yields not less than 7% of total hydroxyanthracene derivatives, calculated as cascaroside A, on a dried basis. The cascarosides should make up at least 60% of this total. Actions
The glycosides found in cascara sagrada are stimulant cathartics that exert their action by increasing the smooth-muscle tone in the wall of the large intestine and have only minor effects on the small intestine. The drug is transformed by intestinal bacteria into substances that increase peristalsis in the large intestine and help restore intestinal tone.
Cascara sagrada was traditionally used as a laxative by Native Americans of the Pacific Northwest. In 1990, the FDA released the results of its study on OTC products and placed cascara sagrada in category I (safe and effective) as a laxative . Dried, aged cascara sagrada bark is widely accepted as a mild and effective treatment for chronic constipation .
Aromatic fluidextract (sweet cascara): 5 ml P.O.
Extract capsules: 300 mg EO.
Liquid extract (bitter cascara): 1 to 5 ml P.O.
None reported, but the absorption of some drugs may be diminished.
Contraindications And Precautions
Cascara sagrada is contraindicated in pregnant or breast-feeding patients because it crosses the placental barrier, is excreted in breast milk, and increases the risk of diarrhea in a breast-fed infant. Although cascara sagrada may be used cautiously during pregnancy, other laxatives (such as bulk-forming and surfactant laxat ives) may be preferred.
Points of Interest
Cascara sagrada mostly comes from Oregon, Washington, and southern British Columbia. During the summer, sections of bark are peeled off and rolled into large quills. The bark is then carefully sun-dried so that the inner surface is not exposed to the sun and its yellow color is retained. The drug is then processed into its final form.
Cascara sagrada is a mild stimulant laxative that is safe and effective. Although the FDA has approved its use, caution should be used when treating chronic constipation to avoid laxative dependency. Reliable and standardized pharmaceutical forms are preferred because there is no advantage in using the bark as a tea for its medicinal effects. Standardized pharmaceutical products ensure correct dosage and minimize the risk of adverse reactions.
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