Cascara sagrada

Related Terms

Aloe, aloe-emodin, amerikanische faulbaumrinde, amerikanische faulbaum, anthracene glycosides, anthranoid, anthraquinone, anthroid, anthrone C-glycosides, Artemisia scoparia, ayapin, bearberry bark, bearwood, bitter bark, California buckthorn, carminic acid, casanthranol, cascara buckthorn, cascara fluid extract aromatic, cascara liquid extract, cascararinde, cascara sagrada, cascara sagrada (dried bark), cascara sagrada extract, cascara sagrada fluid extract (bitter cascara), cascarosides, cassia, cassia senna, chittem bark, coffee tree, dihydroxy-anthraquinones, dihydroxy-anthrones, dihydroxy-dianthrones, dogwood bark, emodin, fimbriatone, Frangula purshiana, nepodin, parietin, Persian bark, phytoestrogens, Polygonaceae, purshiana bark, pursh's buckthorn, Rhamnaceae (family), Rhamni purshianae cortex, Rhamnus purshiana, rhein, rheum, sacred bark, sagrada bark, Sagradafaulbaum (German), vegetable laxatives, wahoo plant, xanthoria elegans, yellow bark.

Background

Cascara is obtained from the dried bark of Rhamnus purshianus (Rhamnaceae), both a medicinal and poisonous plant. It is found in Europe, western Asia, and in North America from northern Idaho to the Pacific coast in mountainous areas. In Spanish, cascara sagrada means "sacred bark," perhaps because this woody shrub has provided relief for several constipated individuals. Cascara has been used as a tree bark laxative by Native American tribes and Spanish and Mexican priests since the 1800s. The cascara sagrada bark is aged for a year so that the active principles become milder, as freshly dried bark produces too strong a laxative for safe use.
Cascara possesses purgative, toxic, therapeutic, and tonic activity. It is most commonly used as an anthraquinone stimulant laxative for bowel cleansing. Stimulant and cathartic laxatives are the most commonly abused laxatives and have the potential for causing long-term damage.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Early studies have examined the use of cascara for bowel preparation. Evidence is insufficient to suggest effectiveness over conventional treatments for this indication.

 C


Early studies have examined the use of cascara for bowel preparation. Evidence is insufficient to suggest effectiveness over conventional treatments for this indication.

 C


Cascara sagrada is widely accepted as a mild and effective treatment for chronic constipation. However, limited data is available. Additional study is needed before a strong recommendation can be made.

 C


Cascara sagrada is widely accepted as a mild and effective treatment for chronic constipation. However, limited data is available. Additional study is needed before a strong recommendation can be made.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
There is no proven safe or effective dose for cascara. Traditionally, 20-30 milligrams per day of the active ingredient, hyroxyanthracene derivatives, has been used. This is calculated as cascaroside A, from the cut bark, powder, or extracts. Doses of 300-1,000 milligrams dried bark have also been given at bedtime for constipation. The cascara liquid extract is often given in a dose of 2-5 milliliters three times daily. Traditionally, 4-6 milliliters of aromatic fluid extract have been administered at bedtime for constipation. As a tea, cascara has been given for constipation including a dose of 1 cup of tea, which can be made by steeping 2 grams of finely chopped bark in 150 milliliters of boiling water for 5-10 minutes, and then straining. The appropriate amount of cascara is the smallest dose that is necessary to maintain soft stools.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Cascara may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin?) or heparin, anti-platelet drugs such as clopidogrel (Plavix?), and non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?).
Cascara may inhibit the absorption of digitalis glycosides, such as digoxin, and decrease their effects on the heart. Consult with a qualified healthcare professional, including a pharmacist, before combining therapies.
Cascara has been used as a laxative and laxative-induced diarrhea may result in decreased absorption of isoniazid or sulfisoxazole.
Use of cascara with other laxatives may theoretically cause electrolyte and fluid depletion. Theoretically, concomitant use of cascara with diuretics (agents that increase urine flow), corticosteroids (steroids), or potassium depleting drugs may cause excessive loss of potassium.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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