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Senna glycoside

Senna glycoside
Clinical data
Trade namesEx-Lax, Senokot, and others[1]
Routes of
By mouth (PO), rectal (PR)
ATC code
Legal status
Legal status
Pharmacokinetic data
Onset of actionMinutes (PR), 6 to 12 hours (PO)[2]
  • none
Chemical and physical data
Molar mass862.75 g·mol−1
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Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][4] The medication is taken by mouth or via the rectum.[1][5] It typically begins working in minutes when given by rectum and within twelve hours when given by mouth.[2] It is a weaker laxative than bisacodyl or castor oil.[1]

Common side effects of senna glycoside include abdominal cramps.[2] It is not recommended for long-term use, as it may result in poor bowel function or electrolyte problems.[1] 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]

Senna is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] It is available as a generic medication and is relatively cheap.[1][5] The wholesale cost in the developing world is about 0.01 USD per pill.[7] Sennosides come from the group of plants Senna.[2] In plant form, it has been used at least since the 700s CE.[8] In 2016 it was the 287th most prescribed medication in the United States with more than 1 million prescriptions.[9]

Medical uses

Senna is used for episodic and chronic constipation though there is a lack of high-quality evidence to support its use for these purposes.[4] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[10][11]


It should be taken once daily at bedtime.[11][12] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories act within two hours.[13]


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.[10]

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.[10]

Adverse effects

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[10] 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.[13]


Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[14]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[15]


They are anthraquinone derivatives and dimeric glycosides.

Society and culture


Senna is an over-the-counter medication available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers as various brand names.[11]

Brand names

Ex-Lax Maximum Strength, Ex-Lax, Geri-kot, GoodSense Senna Laxative, Natural Senna Laxative, Perdiem Overnight Relief, Senexon, Senna Lax, Senna Laxative, Senna Maximum Strength, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot To Go, Senokot XTRA, Senokot, Kayam churna.[10]


  1. ^ a b c d e f g h i j k l American Society of Health-System Pharmacists (January 1, 2008). "Senna". Archived from the original on 6 September 2015. Retrieved 11 August 2015.
  2. ^ a b c d Navti, Phyllis (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 2016-03-05.
  3. ^ "Senna(Powdered)". PubChem.
  4. ^ a b Wald, A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91. doi:10.1001/jama.2015.16994. PMID 26757467.
  5. ^ a b Hamilton, Richard J. (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. Archived from the original on 2016-03-05.
  6. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  7. ^ "Senna". International Drug Price Indicator Guide. Retrieved 11 August 2015.
  8. ^ Khare, C.P. (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 2016-03-05.
  9. ^ "The Top 300 of 2019". Retrieved 22 December 2018.
  10. ^ a b c d e Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  11. ^ a b c "Archived copy". Archived from the original on 2014-04-19. Retrieved 2014-04-17.CS1 maint: archived copy as title (link)
  12. ^ Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  13. ^ a b McQuaid KR. Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In: Katzung BG, Masters SB, Trevor AJ. eds. Basic & Clinical Pharmacology, 12e. New York, NY: McGraw-Hill; 2012. "Archived copy". Archived from the original on 2014-04-19. Retrieved 2014-04-18.CS1 maint: archived copy as title (link). Accessed April 18, 2014.
  14. ^ "Senna: MedlinePlus Supplements". Archived from the original on 2015-04-06.
  15. ^ Sharkey KA, Wallace JL. 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, 12e. New York, NY: McGraw-Hill; 2011. "Archived copy". Archived from the original on 2014-04-19. Retrieved 2014-04-18.CS1 maint: archived copy as title (link). Accessed April 18, 2014.