Cassia senna

Cassia Senna Omer B. 2014
SENNA LEAF
Cassia senna
Fabaceae
By Omer Bayazeid

SNNA LEAF
Definition:
Folium Sennae consists of the dried leaflets of Cassia senna L. (Fabaceae) Known as Alexandrain or
Khartoum senna.
It contain not less than 2.5 per cent of hydroxyanthracene glycosides, calculated as sennoside B
( 863) with refrence to the dried drug.
Synonyms:
Fabaceae are also referred to as Leguminosae. Although recognized as two distinct species in many
pharmacopoeias , Cassia acutifolia Delile and are considered botanically to be synonyms of the single
species Cassia senna L.
Description:
Low shrubs, up to 1.5m high, with compound paripinnate leaves, having 3–7 pairs of leaflets, narrow or
rounded, pale green to yellowish green.
The entire, lanceolate to narrowly lanceolate, pinnate leaflets have a short petiolule and are 2-6 cm long
and 7-12 mm wide. The leaflets have an asymmetric base and a thin, stiff and brittle, light green lamina
which appears as if glabrous. The leaflets are often marked with transverse or oblique lines.
Odour: Faint, characteristic.
Taste: To begin with sweetish, then bitter.
Constituents:
The main active constituents are sennoside A and B (ca.2.5%), which are rhein-dianthrone diglucosides .
Smaller amounts of other diglucosides, monoanthraquinone glucosides and aglycones are also present.
Geographical distribution:
The plant is indigenous to tropical Africa. It grows wild near the Nile river from Aswan to Kordofan, and
in the Arabian peninsula, India and Somalia. It is cultivated in India, Pakistan, and the Sudan.

Identification:
A. C. senna occur as grayish-green or brownish-green, thin, fragile leaflets, lanceolate, mucronate,
asymmetrical at the base, usually 15-40 mm long and 5-15 mm wide .
B. Reduce to a powder. The powder is light green or greenish-yellow. Examine under a microscope
using chloral hydrate solution. The powder shows the following diagnostic characters:
Epidermis with polygonal cells containing mucilage; unicellular thick-walled trichomes, length,
up to 260µm, slightly curved at the base, warty; paracytic stomata on both surfaces; under the
epidermal cells a single row of palisade layer; cluster crystals of calcium oxalate distributed
throughout the lacunose tissue; on the adaxial surface, sclerenchymatous ﬁbres and a gutter-
shaped group of similar ﬁbres on the abaxial side containing prismatic crystals of calcium
oxalate.
C. Thin-layer chromatography:
Test solution. To 0.5g of the powdered drug add 5ml of a mixture of equal volumes of ethanol
(96%) and water and heat to boiling. Centrifuge and use the supernatant liquid.
Reference solution: Dissolve 10 mg of senna extract in 1 ml of a mixture of equal volumes of
ethanol (96%) and water.
Plate: Silica gel G plate.
Mobile Phase: glacial acetic acid, water, ethyl acetate, propanol ( 1:30:40:40)
Detection: Spray with a 20% V/V solution of nitric acid and heat at 120 C for 10 min. Allow to
cool and spray with a 50 g/L solution of potassium hydroxide in alcohol until the zones appear.
Result: The principle zones in the chromatogram obtained with the test solution are similar in
position ( sennosides B,A,D and C in order of increasing Value ).
Tests:
Foreign matter: Maximum 3% of foreign organs and maximum 1% of foreign elements.
Loss on drying: Maximum 12% determined on 1000g of the powdered drug by drying in an oven
at 105C.
Total ash: Maximum 12%.
Ash soluble in hydrochloric acid: Maximum 2.5%.

Uses described:
In folk medicine, not supported by experimental or clinical data As an expectorant, a wound
dressing, an antidysenteric, and a carminative agent; and for the treatment of gonorrhoea, skin
diseases, dyspepsia, fever, and haemorrhoids.
Laxative effects: Senna is an anthranoid-type stimulating laxative. The laxative effect is due to the
action of sennoside and their active metabolite, rhein anthone, in the colon. The laxative effect is
realized by inhibition of water and electrolyte absorption from the large intestinal contents. This will
stimulate colon motility resulting in propulsive contraction.
Dosage:
Mode of Administration: Comminuted herb, powder or dried extract for teas, decoctions, cold
macerates or elixirs. Liquid or solid forms of medication exclusively for oral use.
How to Supplied:
Capsule —25 mg, 450 mg
Chewable tablet – 15 mg sennosides
Granules – 15 mg sennosides per teaspoon
Liquid – 2.5 oz. (alcohol 7% by volume), 8.8 mg sennosides per teaspoon
Tablet – 8.6 mg sennosides, 15 mg sennosides, 17 mg sennosides, 25 mg sennosdies
Biological Activities:
(1) Antimicrobial.
(2) Cytotoxic.
(3) Thrombolytic activity.
Clinical pharmacology:
Pharmacology of Cassia Senna: Senna leaves and pods have been shown to have laxative activity. It is
usefull in habitual constipation. Pharmacological investigations show that sennosides A and B account
for the entire activity of the senna leaves and pods.Leaves contain glycosides, sennoside A, B, C and D.

Two naphthalene glycosides have been isolated from leaves and pods. The medicinal action of Senna
can be attributed mainly to the anthraquinone glycosides, especially sennoside A and B. It appears that
the aglycone portion is responsible for its action. The breakdown of the anthraquinone glycosides in the
digestive tract can occur in one of two ways. The bowel flora can directly hydrolyze themin a similar way
to that of free active aglycone. Alternatively, in the presence of bile and the sugar moiety, the free
aglycone can be absorbed into the blood stream and secreted later into the colon. The final result is
stimulation of the Auerbach plexus resulting in increased intestinal muscle contraction. In addition, its
mucilage content decreases bodily absorption of fluid leading to an enhancement of the final laxative
action.
1. Constipation: Taking senna orally is effective for short- term treatment of constipation. Senna is an
FDA-approved nonprescription drug for adults and children ages 2 years and older. However, in children
ages 3-15 years, mineral oil and a medication called lactulose might be more effective. In elderly people,
senna plus psyllium is more effective than lactulose for treating ongoing constipation.
2. Bowel preparation before colonoscopy: Taking senna by mouth might be effective for bowel
cleansing before colonoscopy; however, sodium phosphate or polyethylene glycol is more effective.
3. Pregnancy and Breast-Feeding: Senna is Possibly Safe during pregnancy and breast-feeding when
used short-term. It is Possibly Unsafe when used long-term or in high doses. Long-term, frequent use, or
use of high doses has been linked to serious side effects including laxative dependence and liver
damage. Although small amounts of senna cross into breast milk, it doesn’t seem to be a problem for
nursing babies. As long as the mother uses senna in recommended amounts, senna does not cause
changes in the frequency or consistency of babies’ stools.
4. Interactions with Medications:
(a) Digoxin (Lanoxin) Senna is a type of laxative called a stimulant laxative. Stimulant laxatives
can decrease potassium levels in the body. Low potassium levels can increase the risk of side
effects of digoxin (Lanoxin).
(b) Warfarin (Coumadin) Senna can work as a laxative. In some people, senna can cause
diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you
take warfarin, do not take excessive amounts of senna.
(c) Water Pills (Diuretic Drugs) Senna is a laxative. Some laxatives can decrease potassium in the
body. "Water pills" can also decrease potassium in the body. Taking senna along with "water
pills" might decrease potassium in the body too much. Some "water pills" that can decrease
potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix),
hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.

(d) Laxative: Children over the age of two years and adults can orally take senna to treat
constipation, but only on a short-term basis, which is about two weeks. If you take it any longer
than that, you could cause your bowels to become dependent on it, and they might stop
functioning properly. Overuse of senna can also cause an electrolyte imbalance that could
worsen heart disease. Another use for senna is to cleanse the bowels before a colonoscopy.
(e) Losing Weight: to lose weight using senna typically means taking the product for longer than
the recommended two weeks and possibly taking more than the recommended dosage of 17.2
milligrams daily. Overuse of this herb is considered senna abuse and can cause serious
problems. Drugs.com reported a case of an anorexia nervosa patient who took up to 100 tablets
of senna daily. When you take more than the dosage recommended on the package, you run the
risk, as this patient did, of developing nephrocalcinosis, or too much calcium in the kidneys;
finger clubbing, a deformity of the fingers; and osteoarthropathy, a bone and joint disease.
(f) Pregnancy: Constipation is a common problem that affects about half of all pregnant women
at some point. Although senna is FDA- approved, it is approved as an herbal supplement, which
falls under a different criterion than a medicine. Herbs, including senna, can come in different
formulations and strengths, making them unsafe to take during pregnancy, according to the
American Pregnancy Association. Senna has not been associated with abnormalities or birth
defects, according to Drugs.com. However, not enough information is available to confidently
deem senna safe for pregnant women, so it is best to avoid it while pregnant and breastfeeding.
(g) Hemorrhoids: The herb of senna is quite popular as chief ingredient in many teas and colon
cleansing products prescribed to heal hemorrhoids. Senna contains special components known
as sennosides that act on the lining of the bowel causing a laxative effect. Constipation or hard
stools is one of the triggering factors for causing and worsening hemorrhoids. Other folk
medicine uses are for skin diseases, gonorrhea, fever and upset stomach
5. Dyspeptic Syndrome: Senna contains natural enzymes that help in regulating the bowel movements
and also restoring the gastric juice secretion in stomach. It is therefore, the herb is found effective in
treating dyspeptic syndrome. Senna supplements, if used in proper dosage for certain period, have
shown potential role in reducing the irritability in intestines by improving overall digestion.
6. Gastrointestinal Conditions: Senna possesses natural anti-inflammatory properties due to its
compound called resveratrol and hence is used in various gastrointestinal conditions where
inflammation is one of the symptoms. Furthermore, component found in senna called barakol is used
for counteracting aconitine poisoning in the gastrointestinal tract. Senna, in some cases, has been used
to empty the stomach and intestines so as to relieve from acidity and constipation. The herb specifically
acts on lower bowel alleviating the symptoms of constipation. In addition, various products containing
senna as their main ingredient have been prescribed to get rid of abdominal cramps, pains, sprains and
discomfort.

7. Obesity: as Dietary Supplement In most of the dieter’s tea, the herb of senna is found as primary
ingredient. Due to the combination of acting as laxative and stimulant, regular intake of senna tea is
found to reduce the appetite without disturbing other body systems. It is also revealed that its quick
gastric and intestinal emptying property augments overall therapy of weight loss as food moves through
the systems quite earlier than many calories get absorbed. However, this may lead to even dangerous
weight loss and hence, before taking senna supplement it is important to fix the dosage and period.
8. Usual Dosage: The herb or its extracts may be taken in several forms - capsules, tablets, and
decoction as well as tea. A number of people take capsules and tablets prepared from the senna extract
to alleviate constipation. Normally, capsules and tablets containing 10 mg to 60 mg of sennosides are
taken daily for a period of 10 days. However, it is not advisable to continue using the medication for
more than 10 days. In case there is no relief from constipation even after taking the medication for 10
days, one should consult a physician for necessary actions. In additionto this, consuming a mint tea
prepared with the herb is effective for curing cramps. While the dose for the adults is 10 mg to 60 mg of
senna daily for 10 days, children above the age of six years may be administered half the adult dose.
However, the herb should never be given to children below the age of six as it may prove to be
detrimental. It is best to take senna after consulting a physician.
Toxicity:
The major symptoms of overdose are griping and severe diarrhoea with consequent losses of fluid and
electrolytes. Treatment should be supportive with generous amounts of fluid. Electrolytes, particularly
potassium, should be monitored, especially in children and the elderly.
Warnings:
Stimulant laxative products should not be used when abdominal pain, nausea, or vomiting are present.
Rectal bleeding or failure to have a bowel movement after use of a laxative may indicate a serious
condition. Chronic abuse, with diarrhoea and consequent fluid electrolyte losses, may cause
dependence and need for increased dosages, disturbance of the water and electrolyte balance (e.g.
hypokalaemia), atonic colon with impaired function, albuminuria and haematuria. The use of stimulant
laxatives for more than 2 weeks requires medical supervision. Chronic use may lead to pseudomelanosis
coli (harmless). Hypokalaemia may result in cardiac and neuromuscular dysfunction, especially if
cardiac glycosides (digoxin), diuretics, corticosteroids, or liquorice root are taken. .
Precautions General Use for more than 2 weeks requires medical attention.

Drug interactions:
Decreased intestinal transit time may reduce absorption of orally administered drugs. The increased loss
of potassium may potentiate the effects of cardiotonic glycosides (digitalis, strophanthus). Existing
hypokalaemia resulting from long- term laxative abuse can also potentiate the effects of antiarrhythmic
drugs, such as quinidine, which affect potassium channels to change sinus rhythm. Simul- taneous use
with other drugs or herbs which induce hypokalaemia, such as thiazide diuretics, adrenocorticosteroids,
or liquorice root, may exacerbate electrolyte imbalance.
Drug and laboratory test interactions Urine discoloration by anthranoid metabolites may lead to false
positive test results for urinary urobilinogen, and for estrogens measured by the Kober procedure.
Carcinogenesis, mutagenesis, and impairment of fertility No in vivo genotoxic effects have been
reported to date. Although chronic abuse of anthranoid-containing laxatives was hypothesized to play
arole in colorectal cancer, no causal relationship between anthranoid laxative abuse and colorectal
cancer has been demonstrated.
Pregnancy: non-teratogenic effects Use during pregnancy should be limited to conditions in which
changes in diet or fibre laxatives are not effective. .
Nursing mothers Use during breast-feeding is not recommended owing to insufficient data on the
excretion of metabolites in breast milk. Small amounts of active metabolites (rhein) are excreted into
breast milk, but a laxative effect in breast-fed babies has not been reported.
Pediatrics use Contraindicated for children under 10 years of age.
Other precautions No information available on teratogenic effects in pregnancy.
Adverse reactions:
Senna may cause mild abdominal discomfort such as colic or cramps .A single case of hepatitis has been
described after chronic abuse. Melanosis coli, a condition which is characterized by pigment-loaded
macro- phages within the submucosa, may occur after long-term use. This condition is clinically
harmless and disappears with cessation of treatment. Long-term laxative abuse may lead to electrolyte
disturbances (hypokalaemia, hypocalcaemia), metabolic acidosis or alkalosis, malabsorption, weight
loss, albuminuria, and haematuria. Weakness and orthostatic hypotension may be exacerbated in
elderly patients when stimulant laxatives are repeatedly used. Conflicting data exist on other toxic
effects such as intestinal-neuronal damage due to long-term misuse.

Posology The correct individual dose is the smallest required producing a comfortable, soft-formed
motion. Powder: 1–2g of leaf daily at bedtime. Adults and children over 10 years: standardized daily
dose equivalent to 10–30mg sennosides (calculated as sennoside B) taken at night.
Overview of Clinical trials:
The efficacy of senna preparations has been evaluated in clinical trials in the treatment of constipation
and for bowel cleansing before radiological investigations or colonoscopy. In the majority of the studies
combinations of senna with fibre were investigated. For bowel cleansing high doses of a senna
preparation were tested.
There is no well-designed non-experimental descriptive study with a mono-preparation of senna
available which investigates the short-term use of occasional constipation. Evidence is obtained from
experts’ reports and opinions and extensive clinical experiences.
Well-designed clinical studies are available for combination products for occasional constipation and for
high doses of senna preparations for bowel cleansing and they clarify the pharmacodynamics.
Furthermore pharmacological studies in humans are available.
The conditions determined in the pharmacovigilance actions for anthranoid-containing laxatives have to
be maintained for the moment because further investigations are needed to clarify the carcinogenic risk.
The results of the most recent studies are inconsistent. However, a risk was also revealed for
constipation itself and underlying dietary habits. The use in children under 12 years of age is
contraindicated and use during lactation is not recommended. During pregnancy only a specified extract
(as described above) can be regarded as safe, but with the advice that the use is to be avoided during
the first trimester. Senna leaves should only be used intermittently and if other actions like behavioural
modification, dietary changes and use of bulk forming agents failed.
Provided that the correct dose and duration of administration and the advices given in the SPC are
followed, senna can be regarded as a safe and effective medicinal plant for the short-term use in cases
of occasional constipation. In this indication the benefit/risk ratio is positive.
The data available on use for bowel cleansing in a high dose are not consistent. An adequate bowel
cleansing can be achieved as well by other preparation methods than with a high dose of senna with a
less favourable benefit-risk-ratio. In particular if different methods are combined, lower doses of senna
seem to be effective enough. Use at a high dose cannot therefore be recommended. In an unpublished
multicentre, prospective, controlled, randomised, two-parallel-group, observer-blind study in 133
patients, which was presented in the application procedure of a senna preparation (150 mg
hydoxyanthracene glycosides, calculated as sennoside B) for bowel cleansing a statistically significant
non-inferiority of this preparation in combination with 2 l PEG-ELS could not be shown in comparison to

4 l PEG-ELS. The descriptive evaluation shows a better bowel cleansing in the rectum, colon descendens,
colon transversum and flexura coli dextra for 4 l PEG-ELS and an equivalent cleansing for both
preparations in the colon sigmoideum , colon ascendens and caecum.
Up to now there is no clear evidence to recommend a specific dose nor a specific combination of
different bowel cleansing methods. No recommendation concerning the use of senna for bowel
cleansing is therefore made in the Community herbal monograph, even not for a special patient group,
who is not able to ingest high amounts of fluid, e.g. patients suffering from cardiac insufficiency.
Traditional use:
Senna was traditionally used for purification the blood, bowel and other organs in many diseases. In
former times, such purification was often the first step to treat a lot of diseases. Such a procedure is
now obsolete. There are no plausible pharmacological data available for the purification of the blood
1 As referred to in the HMPC ‘Guideline on the assessment of clinical safety and efficacy in the
preparation of Community herbal monographs for well-established and of Community herbal
monographs/entries to the Community list for traditional herbal products/substances/preparations and
other organs than the bowel, or for use as a cholagogum. In view of possible risks, such traditional uses
cannot be recommended. This is in accordance with the German pharmacovigilance actions for
anthranoid-containing laxatives.

References:
1. European Pharmacopia 7.0 Volume 1.
2. PDR for Herbal Medicine.
3. Herbal Drug.
4. E/S/C/O/P.
5. WHO Monographs.

Cassia senna

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