Senna: Laxative & Colonoscopy Uses, Warnings, Side Effects, Dosage

Generic Name: senna

Brand Names: Senokot, ExLax Regular Strength, Lax Pills, Little Tummys Stimulant Laxative Drops, Senexon, SennaGen, Senna Smooth, ExLax Maximum Strength, SenokotXTRA

Drug Class: Laxatives, Stimulant

What is senna, and what is it used for?

Senna is a stimulant laxative medication available over the counter used to treat occasional constipation and bowel movement irregularity in both adults and children. Senna is also used for cleansing the colon before colonoscopy in adults. Senna generally causes bowel movement in about 6 to 12 hours. People also use senna for irritable bowel syndrome (IBS), hemorrhoids, and weight loss, but there is no good scientific evidence to support these uses.

Senna is an herbal laxative made from the leaves or fruits of the plant Senna alexandrina. The fruit is considered to have milder effect than the leaves. Senna contains chemicals known as sennosides that irritate the intestinal lining, which stimulates peristalsis, a series of contractions by which intestines propel their contents, resulting in bowel movement.

Warnings

Do not use senna in the following conditions:
- Hypersensitivity to senna, sennosides, or any component of the product
- Gastrointestinal (GI) obstruction or perforation
- Severe fecal impaction
- GI or rectal bleeding
- Symptoms of appendicitis or any other abdominal condition that requires immediate surgical intervention (acute surgical abdomen)
- Inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease
Senna dose of 15 mg/kg is potentially toxic to children younger than 6 years
Over-the-counter use is not recommended in children younger than 2 years
Some dosage forms of senna may contain benzyl alcohol which has been associated with fatal toxicity in newborn babies; do not administer formulations containing benzyl alcohol derivatives to neonates
High doses of senna for prolonged periods can cause liver injury

What are the side effects of senna?

Common side effects of senna include:

Nausea
Vomiting
Abdominal cramps or pain
Gas (flatulence)
Urgent and frequent bowel movements
Diarrhea
Urine discoloration
Kidney inflammation (nephritis)
Rash
Low potassium level (hypokalemia)
Melanosis coli, a condition in which the intestinal lining turns dark brown or black, from chronic use
Finger clubbing (with chronic use)
Wheezing
Severe allergic (anaphylactoid) reaction

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

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What are the dosages of senna?

Tablet, extended-release

8.6 mg
15 mg
25 mg

Chewable tablet

10 mg
15 mg

Liquid

8.8 mg/5mL

Concentrated oral drops

8.8 mg/mL

Syrup

8.8 mg/5mL

Senna leaves

454g

Adult:

Constipation

15 mg orally once daily; not to exceed 70-100 mg/day divided every 12 hours
Not for use more than 1 week

Senna Leaf Extract

362-1056 mg orally once/day

Bowel Preparation (Off-label)

Various regimens exist that include senna laxative with additional gastric lavage
Usual dose: 130 mg orally between 2:00 and 4:00 PM in afternoon of the day before the procedure

Pediatric:

Constipation

Children 2-6 years: 4.3-17.2 mg/day orally; not to exceed 17.2 mg/day
Children 6-12 years: 6-50 mg/day orally; not to exceed 50 mg/day
Children over 12 years: 12-100 mg/day orally; not to exceed 100 mg/day
Not for use more than 1 week

Senna Leaf Extract

2-6 years: 166.5-666 mg/day orally
6-12 years: 333-999 mg/day orally

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Overdose

Most laxative overdoses in children are accidental, however, some people may take overdoses of laxatives to try to lose weight.
Senna overdose may cause severe abdominal pain and/or cramping, persistent nausea, vomiting and diarrhea, and bloody stools. Overdose is treated with symptomatic and supportive care.

What drugs interact with senna?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

Senna has no known severe interactions with other drugs.
Serious interactions of senna include:
- sodium sulfate/magnesium sulfate/potassium chloride
- sodium sulfate/potassium sulfate/magnesium sulfate
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
Moderate Interactions of senna include:
- deflazacort
- dichlorphenamide
- digoxin
- lily of the valley
Senna has no known mild interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

Pregnancy and breastfeeding

Constipation during pregnancy should ideally be managed with moderate exercise and dietary intake of fiber and fluid; use senna with caution during pregnancy, can increase the risk for electrolyte imbalances
Senna is not present in breast milk and is considered compatible with use by breastfeeding women
Ideally, check with your healthcare provider before taking senna if you are pregnant or breastfeeding

What else should I know about senna?

Senna is generally safe for occasional use in recommended doses in patients older than 2 years
Avoid chronic use of senna; may lead to laxative dependence and electrolyte imbalance
Consult with your doctor before taking senna if you have nausea, vomiting, stomach pain or changes in bowel habits that persist for longer than 2 weeks
Do not use senna for longer than 1 week; if you do not have bowel movement within a week or if you have diarrhea or rectal bleeding, discontinue and seek medical help
In case of overdose, get medical help or contact Poison Control Center
Keep senna out of reach of children