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Cascara Sagrada

Cascara Sagrada Fact Sheet

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Updated September 13, 2013

What is Cascara Sagrada?

Alternate Names: rhamnus purshiana, cascara, California buckthorn, sacred bark

Cascara sagrada has a long history of traditional use by native americans. Cascara sagrada contains compounds called anthroquinones, which are responsible for cascara's powerful laxative effects. Anthraquinones trigger contractions in the colon, called peristalsis, which causes the urge to have a bowel movement. Today, it is one of the most common herbal laxatives.

In addition to being a powerful laxative, cascara is also believed to improve the muscle tone of the colon walls.

Why Do People Use Cascara Sagrada?

Constipation

Dosage Information

Cascara can be found in various forms: capsules, liquid extracts, and dried bark.

The dried bark can be made into tea, although it tastes bitter.

Fresh cascara bark should not be used, because it can cause bloody diarrhea and vomiting. It should be aged for at least one year or put through a special heat treatment.

A typical dosage of cascara is a 300 mg capsule taken in the early evening to stimulate a bowel movement in the morning. The laxative effect usually occurs 6 to 12 hours after cascara is taken.

Side Effects and Safety

Cascara sagrada should not be used for longer than 7 days in a row.

Pregnant or nursing women should not use cascara sagrada. Children should not use cascara sagrada.

Cascara or other anthraquinone-containing herbs should not be used by people diverticular disease, ulcerative colitis, Crohn's disease, severe hemorrhoids, blood vessel disease, congestive heart failure, heart disease, severe anemia, abdominal hernia, gastrointestinal cancer, recent colon surgery, or liver and kidney disease. It should not be used if appendicitis is suspected.

Cascara may interact with drugs called cardiac glycosides, such as digitalis.

Side effects of cascara may include strong cramping in the abdomen (due to muscle contractions, electrolyte imbalance (loss of potassium) and loss of body fluids, and dark pigmentation in the colon, called melanosis coli with longer term use. Call your doctor if you experience bloody diarrhea, discolored urine, vomiting, or prolonged abdominal pain after using cascara.

There has been one report of the development of cholestatic hepatitis, complicated by portal hypertension, after use of cascara. Long-term use of anthraquinones has been linked to the development of colorectal growths (adenomas) and cancer.

Large doses of anthraquinones may cause bloody diarrhea or vomiting.

Long-term use can cause dependence.

Sources

Feltrow, C.W. and J.R. Avila. The Complete Guide to Herbal Medicines. New York: Simon and Schuster, 2000.

Lust, John. The Herb Book: The Complete and Authoritative Guide to More Than 500 Herbs. New York: Benedict Lust Publications, 2005.

Nadir A, Reddy D, Van Thiel DH. Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol. 2000 Dec;95(12):3634-7.

Andrea Peirce. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: William Morrow, 1999.

Willems M, van Buuren HR, de Krijger R. Anthranoid self-medication causing rapid development of melanosis coli. Neth J Med. 2003 Jan;61(1):22-4.

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