Administration and Suggestions of Cascara sagrada.
- Basic Botanical Information of Cascara sagrada.
- Botanical Description of the herb Cascara sagrada.
- Rhamnus Purshiana:Botanical Source and History.
- Phytochemical and Compositions of Cascara sagrada.
- Traditional Use of Cascara Sagrada.
- Current Status of Cascara Sagrada.
- Cascara sagrada Therapeutic uses and health benefit.
- Administration and Suggestions of Cascara sagrada.
- Cascara sagrada Related Species and Pharmaceutical Preparations.
- Research Update:Cascara Sagrada.
Administration and Suggestions of Cascara sagrada.
Caution: When should I be careful taking it?
Fresh Rhamnus purshiana bark should never be taken by mouth. Fresh bark or bark that has not been aged properly contains chemicals that can cause intense and prolonged vomiting. To be aged properly, Rhamnus purshiana bark must be air-dried for at least one year. It can also be aged under controlled heat in special facilities. If you have any doubts about how the Rhamnus purshiana you plan to use has been aged, do not use it.
Rhamnus purshiana works by irritating the lining of the gastrointestinal tract. For most individuals, this irritation is minor. However, it can worsen inflammatory bowel conditions such as Crohn's disease and irritable bowel syndrome. In addition, Rhamnus purshiana can complicate blocked bowels. Therefore, individuals who have inflammatory bowel conditions or who have had bowel blockages should not use Rhamnus purshiana.
Women who are pregnant should avoid taking Rhamnus purshiana because not enough is known about how it might affect developing babies.
The use of Rhamnus purshiana is not recommended for women who are breast-feeding because it is known that Rhamnus purshiana enters breast milk. Taking it while breast-feeding may cause diarrhea in the infant.
Rhamnus purshiana should not be given to children under 12 years of age.
Only bark which has been stored for a year or more should be used. Excessive dosages may result in hypokalaemia. It should be avoided in during pregnancy, lactation and in cases of intestinal obstruction. Treatment should be short-term, no longer than ten days.
Should my health care professional be advised before I take Cascara Sagrada?
They should be consulted first if you have any of these conditions, as Cascara Sagrada usage may be contraindicated:
If you are menstruating (possible stimulation of endometrial activity)
If you have Crohn's disease
If you have ulcerative colitis
If you have appendicitis, or any other inflamed intestinal disease.
If you have abdominal pain (from an unknown source)
If you are taking medication with cardiac glycosides (Potassium loss - a possible side effect- can effect the drugs action)
If you are taking antiarrythimic medication (Potassium loss - a possible side effect - can effect the drugs action)
If you are taking thiazide diuretics, licorice, or corticosteroids (Potassium loss may be aggravated with these drugs)
Safety precautions and warnings:
Individuals who have unexplained abdominal or stomach pain may have conditions that could be worsened by Rhamnus purshiana. Its use should be avoided by individuals with such pain.
The use of cascara is contraindicated during pregnancy and lactation as well as in cases of intestinal obstruction.
If taken in excess cascara sagrada causes diarrhea and vomiting. Stimulant laxatives should not be used for long periods, and should be contained to one week maximum, and only be used after a change of diet (with higher bulk contents) was found to be ineffective.
Side effects of Cascara Sagrada:
A medline search did not reveal any significant cascara sagrada side effects as long as it is not used for more than a week or two at a time without a break. It is best to avoid cascara sagrada if you have a chronic intestinal condition such as ulcerative colitis.
Major Side Effects:
Fresh Rhamnus purshiana bark or bark that has not been aged properly contains chemicals that cause intense vomiting.
If Rhamnus purshiana is used in high doses or for prolonged periods of time, it can lead to reduced potassium levels in the body. Low potassium levels can result in muscle weakness and potentially dangerous changes in heart rhythm.
Taking Rhamnus purshiana is believed to have caused a type of hepatitis that involves the build up of bile in the liver's bile ducts. Known as cholestatic hepatitis or intrahepatic cholestasis, this condition results in symptoms such as intense itching and yellow-colored skin.
Less Severe Side Effects:Taking Rhamnus purshiana has been associated with abdominal cramping.
Interactions with Prescription Drugs:
Both corticosteroid drugs and Rhamnus purshiana may promote the loss of potassium from the body. It is best not to take Rhamnus purshiana and corticosteroids at the same time. Corticosteroids are used for a wide range of inflammatory conditions including arthritis, asthma, cancer, eye conditions, and skin infections. Commonly prescribed corticosteroids include: beclomethasone (Beconase, Vancenase),dexamethasone (Decadron),hydrocortisone,methylprednisolone (Medrol),prednisolone,prednisone (Deltasone, Sterapred),triamcinolone (Azmacort, Nasacort)
Diuretic drugs ("water pills"), such as furosemide and hydrochlorothiazide, can also reduce potassium levels in the body. If they are taken at the same time as Rhamnus purshiana, potassium may become too low possibly leading to muscle weakness and potentially dangerous changes in heart rhythm.
Rhamnus purshiana can increase the risk of side effects such as dizziness, headache, heart rhythm changes, nausea, slow pulse, vision changes, and vomiting from digoxin (Lanoxin). Rhamnus purshiana should not be taken with digoxin.
Rhamnus purshiana shortens the time that intestinal contents stay in the body. In theory, the effects of other drugs that are absorbed in the intestines may be reduced.
Interactions with Non-prescription Drugs:
Taking Rhamnus purshiana at the same time as a commercial laxative may increase the effects as well as the risk of potassium loss from the body. Using Rhamnus purshiana is not recommended at all, but special care should be taken to avoid using it and another laxative at the same time.
Interactions with Herbal Products:
Both Rhamnus purshiana and extremely large amounts of true licorice (not licorice flavoring) can promote the loss of potassium from the body, potentially causing muscle weakness and changes in heart rhythm. The amounts of true licorice ordinarily contained in candy that is sold in the United States are not thought to be large enough to present a problem if Rhamnus purshiana is taken as directed.
Rhamnus purshiana possibly could increase the laxative effects of other herbal laxatives including:
Aloe,Rhamnus cathartica,Rhamnus frangula,Rhubarb,Senna,Yellow dock
Some interactions between herbal products and medications can be more severe than others.
Toxicity and Contraindications:
ESCOP lists contraindications for intestinal obstruction and stenosis, atony, inflammatory disease of the colon ( e.g. Crohn`s disease, ulcerative colitis), appendicitis; abdominal pain of unknown origin; severe dehydration state with water and electrolyte depletion. It is also listed not to be used by children under the age of 10 years old Western herbalists often use Cascara (since 19th century) for atony and in small doses for Crohn's and colitis (under practitioner care). In complex formulas, Cascara is used in children as young as six, if under practitioner care.
Large doses can cause extensive diarrhea accompanied by nausea, vomiting and cramping. The cascarosides are "generally considered to be safe drugs with a minimum of side effects..." Toxicity appears to be an issue in excessively large doses which may cause irritation.
The Merck Index lists the upper therapeutic dose as 8 grams. Cascarosides may enter a mother`s milk and act as a laxative for some children (many practitioners have noticed this) however, experimental data suggest it should have very little or no effect.. Long term use may induce chronic diarrhea or a pseudomelanin pigmentation of the colon and rectal mucosa. This pigmentation is completely harmless and reversible in four to twelve months after use is discontinued. Some authors note that excessive doses can result in cramping, vomiting, and nausea.These side effects are generally countered by the addition of a carminative such as ginger or fennel. The younger the bark, the more pronounced the side effects. The ratio of anthrone to anthraquinone constituents changes as the bark is stored. The less predominant and more desirable anthraquinone cascarosides become more common through a slow process of hydrolysis of the constituent glycosides. Grieve states that "the action of the bark becomes milder and less emetic by keeping. Matured bark, three years old, is preferred for pharmaceutical purposes".
Experimental studies as well as centuries of experience has shown that there is no undesirable or damaging effect if Cascara is taken in moderate doses during pregnancy even though several pharmacopeia suggest it should not be used during the first trimester and others suggest at any time.
Official Recognition and Medical References
Cascara Sagrada has had a long history of use as an official drug. The following are just some of the official preparations of Cascara used in the past.
.Extractum Cascarae B.P.1914, U.S.P. 1905, Fr.Codex 1908.
Elixir Cascarae Sagradae B.P., 1934.
Extractum Cascarae Sagradae Liquidum B.P.,1934.
P.ITAL. 1909(59) Fr.Codex, 1908, German Pharm, 1910.
Extractum Cascarae Liquidum Miscible B.P.C. 1911.
Extractum Cascarae Sagradae Siccum B.P., 1934.
Tinctura Cascarae Sagradae Fr.Codex, 1908, Ital. Pharm 1909.
ESCOP 1996 and 1997
German Commision E:5.12.84
UK:General sales list Schedule 1 table A
Belgium:Accepted for specific indication No. 90/22 bis.
France:Accepted for specific indication.
Cascara Sagrada is also currently found in many prescription and "over-the-counter" laxative preparations including: Bicholax, Cas-Evac, Casylium, Kordremul with Cascara and many others.
Dosage and Prepareation:
Even though Rhamnus purshiana is no longer included in prescription or non-prescription medications that are sold in the United States, they are still be available as herbal products. Their use is not recommended. If you decide to use one of them, however, follow exactly the recommendations on the package of the product you purchase. Do not take more than needed to produce a soft stool and do not take Rhamnus purshiana any longer than necessary.
If you use Rhamnus purshiana, you should take the smallest amount that produces a stool. Results may take up to 8 hours. If diarrhea occurs, the use of Rhamnus purshiana should be stopped. It should be used only long enough to correct constipation never longer than 7 days to 10 days because prolonged use has been associated with the loss of potassium from the body. Potassium levels that are too low can cause muscle weakness and heart rhythm changes.
Only the dried form of cascara sagrada should be used. Two capsules containing dried cascara can be taken up to two times per day. As a tincture, 1 - 5 ml per day is generally taken. It is important to drink eight 6-ounce glasses of water throughout the day. Cascara sagrada should be taken for a maximum of eight to ten days.
Avaiability of Cascara Sagrada herb:Cascara sagrada is available in capsules, extracts, and as dried bark.
Preparation and Dosage:
Regulatory Status: GSL,One dose daily at bedtime
Powdered bark: 0.25-1g
Liquid Extract BP (1973): 2-5ml
Additional Comments: The name Rhamnus is derived from the Greek rhamnos, meaning a branch
Capsules: 1-3, 2-3 times daily,450 mg of cascara sagrada per capsule.
Fluid extract BP: 6 drops - 1 dram (3.6 ml)
Powder extract: 2 -10 grains.
Cascara Sagrada powdered bark is listed as between 0.10 and 8.0 grams in the literature.
Merck Index and the U.S. Dispensory: 0.60 to 2.0 grams.
B.P.C., 1934: lists the dose as 0.10 to 4.0 grams.
1.0 gram Cascara extract: is equal to 3.0 grams Cascara, usual dose is 300 mg.
Cascara produces its action 6-8 hours after ingestion.
Fluid extract: B.P., 5 drops to 1 drachm.
Fluid extract: U.S.P., 15 drops.
Fluid extract, tasteless: 1/4 to 1 drachm.
Fluid extract, aromatic: U.S.P., 15 drops.
Aromatic syrup: B.P., 1/2 to 2 drachms.
Powder extract: 2 to 10 grains.
Rhamnin: 2 to 6 grains.
In veterinary practice, Cascara Sagrada is also much used and is probably the best mild purgative remedy for dogs with chronic constipation, as the dose does not require to be increased by repetition and the tone of the bowels is improved by the drug.
Dosage: Since everyone responds differently to laxatives, it is always recommended to start with the lowest dose. Be sure to drink plenty of water when using any laxative. For constipation and related discomforts such as hemorrhoids: 1 teaspoon of liquid extract three times a day or 1 or 2 teaspoons at bedtime; or 1 or 2 capsules of dried bark at bedtime.
Action, Medical Uses, and Dosage:
Cascara sagrada, when introduced as a medicine, was highly recommended as a certain remedy in cases of habitual constipation, and in some forms of indigestion. Further trial has substantially sustained these assertions, and it is, undoubtedly, a valuable addition to our list of therapeutical agents. It does not, however, succeed in all cases, but acts best where a tonic to the intestines is required. As it tones the whole intestinal tract, it is valuable in doses of 10 drops, after meals, for that dyspeptic condition which depends most largely upon constipation, and is due to intestinal weakness. Administered in large doses, it has served us nicely in sick headache, due to like causes. Loss of tone in the rectum, with constipation, giving rise to hemorrhoids, is benefited by it. In chronic constipation it may be necessary to begin with the larger doses, and gradually reduce the quantity to a few drops, 3 times a day, though, as a rule, it is better to give repeated small doses, gradually increased, until the desired action is obtained, and then to gradually withdraw the drug. It acts kindly without irritating or griping, and produces stools of a semifluid consistence. Occasionally, but rarely, have reports of harsh action been made, such as cramps, colic, vomiting, and inordinate catharsis, while a soreness of the bowels, persistent in character, has been attributed to it. These effects, however, are not common. The remedy, in 10 to 15-drop doses, has been used with asserted success in rheumatism. Chronic diarrhoea, when due to hepatic sluggishness, has been checked by this agent, and it is said to be of some value in gastric, duodenal, and biliary catarrh, with jaundice. It is commonly prepared in the form of a fluid extract, the dose of which is from 10 to 60 minims, repeated, a required, 2 or 3 times a day. The powder may be given in 5-grain doses; the solid extract in 2 or 3-grain doses.
Cascara sagrada should be combined with aromatics and carminatives, for instance with liquorice.Rhamnus may be combined with Berberis, Glycyrrhiza and Zingiber in constipation.
- 1.Cascara is an official herb in many countries for relieving chronic constipation.
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