Senna glycosides

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Senna glycosides
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Senna glycosides or sennosides are medications which are used as laxatives. Senna derivatives act on the large intestine, or colon, to stimulate fluid secretion and contractions of the colonic wall known as peristalsis.[2]

It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[3] They are named after plants of the genus Senna.

Medical uses

Senna is used for the short-term treatment of symptomatic constipation. It may also be used to aide in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[4][5]

Administration

It should be taken once daily at bedtime.[6][7] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories act within 2 hours.[8]

Contraindications

According to Commission E, the German equivalent of the U.S. Food and Drug Administration, 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.[9]

Senna is considered contraindicated in patients 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.[11] 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.[12]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic contraction.[13]

Pharmacology

They are anthraquinone derivatives and dimeric glycosides.

Formulations

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.[14]

References

  1. Drugs.com http://www.drugs.com/ppa/senna.html
  2. McQuaid KR. Chapter 15. Gastrointestinal Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=330&Sectionid=44291017. Accessed April 18, 2014.
  3. "WHO Model List of Essential Medicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014. 
  4. Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  5. Drugs.com http://www.drugs.com/ppa/senna.html
  6. Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  7. Drugs.com http://www.drugs.com/ppa/senna.html
  8. 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. http://accessmedicine.mhmedical.com/content.aspx?bookid=388&Sectionid=45764290. Accessed April 18, 2014.
  9. Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  10. Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  11. Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  12. 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. http://accessmedicine.mhmedical.com/content.aspx?bookid=388&Sectionid=45764290. Accessed April 18, 2014.
  13. 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. http://accessmedicine.mhmedical.com/content.aspx?bookid=374&Sectionid=41266256. Accessed April 18, 2014.
  14. Drugs.com http://www.drugs.com/ppa/senna.html

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