Senna is a stimulant laxative that is used for the treatment of patients with occasional constipation. Stimulant laxatives like senna and bisacodyl should be used with caution in elderly patients, for a prolonged duration, and if the tummy is empty. See a list of medicines used to treat constipation here: Treatment of constipation with medicines.

Senna Uses:

• Constipation:

  • Helps in alleviating occasional constipation/bowel irregularity; generally causes bowel motility in 6 to 12 hours

• Off Label Use in Adults:

  • used for cleansing colon thoroughly before colonoscopy (adjunct)

Senna dose in Adults

Note:

• Several types of the products are available on the market and multiple formulations exist that are not equivalent; products composed of sennosides are considered OTC medications; senna pod concentrate and leaf extract are considered dietary supplements and are not interchangeable on an mL-to-mL (or mg-to-mg) basis with other products that contain sennosides; close attention must be paid to the product description and concentration when ordering or administering.

Senna dose in the treatment of Constipation: Oral:

• Sennosides:

  • Syrup (8.8 mg sennosides/5 mL):

    • 10 to 15 mL (17.6 mg to 26.4 mg sennosides) once daily;
    • the maximum: 15 mL (26.4 mg sennosides) twice daily.

  • Tablets:

    • 6 mg sennosides/tablet:
      • Two tablets (17.2 mg sennosides) once daily;
      • The maximum: 4 tablets (34.4 mg sennosides) twice daily
    • 15 mg sennosides/tablet:
      • Two tablets (30 mg sennosides) once or twice daily
      • 2 mg sennosides/tablet: One tablet (17.2 mg sennosides) once daily;
      • The maximum dose is 2 tablets (34.4 mg sennosides) twice daily
    • 25 mg sennosides/tablet:
      • Two tablets (50 mg sennosides) once or twice daily

  • Senna leaf extract syrup (176 mg/5 mL leaf extract):

Note: Senna leaf extract is used as a dietary supplement and cannot be replaced/interchanged on an mL-to-mL (or mg-to-mg) basis with other products that constitute sennosides.

• 10 to 15 mL (352 to 528 mg senna leaf extract) once daily (preferably at bedtime); can be increased to 10 to 15 mL (352 to 528 mg leaf extract) twice daily if needed; maximum daily dose: 30 mL/day

Senna dose in Childrens

Note:

• Many types of products are available on the market and different types of formulations exist that are not equivalent; products composed of sennosides are OTC medications; senna pod concentrate and leaf extract can be used as dietary supplements and are not interchangeable on an mL to mL (or mg to mg) basis with other products that contain sennosides;
• product description constitutes and concentration must be carefully read before ordering or administering.

Senna Dose in the treatment of Constipation: Oral:

• Sennosides:

  • Syrup (8.8 mg sennosides/5 mL):

    • Children 2 to <6 years:5 to 3.75 mL (4.4 to 6.6 mg sennosides) at bedtime,should not exceed 3.75 mL (6.6 mg sennosides) twice daily
    • Children 6 to <12 years: 5 to 7.5 mL (8.8 to 13.2 mg sennosides) at bedtime, should not exceed 7.5 mL (13.2 mg sennosides) twice daily
    • Children ≥12 years and Adolescents: 10 to 15 mL (17.6 mg to 26.4 mg sennosides) at bedtime, should not exceed 15 mL (26.4 mg sennosides) twice daily.

  • Tablets:

    • 6 mg sennosides/tablet:

      • Children 2 to <6 years: 1/2 tablet (4.3 mg sennosides) at bedtime, not to exceed 1 tablet (8.6 mg sennosides) twice daily
      • Children 6 to <12 years: 1 tablet (8.6 mg sennosides) at bedtime, not to exceed 2 tablets (17.2 mg sennosides) twice daily
      • Children ≥12 years and Adolescents: 2 tablets (17.2 mg sennosides) at bedtime, not to exceed 4 tablets (34.4 mg sennosides) twice daily

    • 15 mg sennosides/tablet:

      • Children 6 to <12 years: 1 tablet (15 mg sennosides) once or twice daily
      • Children ≥12 years and Adolescents: 2 tablets (30 mg sennosides) once or twice daily

    • 25 mg sennosides/tablet:

      • Children 6 to <12 years: 1 tablet (25 mg sennosides) once or twice daily
      • Children ≥12 years and Adolescents: 2 tablets (50 mg sennosides) once or twice daily

• Senna pod concentrate liquid (Fletcher's Laxative for Kids; 167 mg/5 mL senna pod concentrate):

Note: Senna pod concentrate is considered a dietary supplement and is not interchangeable on an mL to mL (or mg to mg) basis with other senna products that contain sennosides.

• Children 2 to <6 years:

  • 5 to 10 mL (167 to 333 mg senna pod concentrate) once or twice daily.

• Children and Adolescents 6 to 15 years:

  • 10 to 15 mL (333 to 500 mg senna pod concentrate) once or twice daily.

• Senna Leaf Extract Syrup (176 mg/5 mL senna leaf extract):

Note: Senna leaf extract is considered a dietary supplement and is not interchangeable on an mL to mL (or mg to mg) basis with other senna products that contain sennosides. Begin with once-daily dosing (at bedtime); can be increased to twice daily if needed.

• Children 2 to <6 years:

  • 5 to 3.75 mL (88 to 132 mg senna leaf extract) once or twice daily;
  • The maximum daily dose: 7.5 mL/day.

• Children ≥6 years to <12 years:

  • 5 to 7.5 mL (176 to 264 mg senna leaf extract) once or twice daily;
  • The maximum daily dose: 15 mL/day.

• Children ≥12 years and Adolescents:

  • 10 to 15 mL (352 to 528 mg senna leaf extract) once or twice daily;
  • The maximum daily dose: 30 mL/day.

Senna  dose in the treatment of bowel evacuation:

• Children ≥12 years and Adolescents:

  • Oral: 130 mg sennosides between 2:00 PM to 4:00 PM on the day prior to the procedure.

Pregnancy Risk Category: C

• Pregnant women can have constipation treated the same way as non-pregnant women. If diet and lifestyle changes are ineffective, medications may be prescribed.
• Agents other than sennosides should not be used at first.
• You should not use stimulant laxatives (including sennosides) for a prolonged period of time, but you can use them intermittently if necessary.

Use during breastfeeding:

• Breast milk contains Rhein, which is an active metabolite.
• After maternal administration of sennosides B (equivalent to sennosides 15. mg [rhein 9.8mg]) to mothers, breast milk was collected.
• The evenings of the postpartum days 2, 3 and 4 were when dosing took place.
• The breast milk was tested prior to and 26 hours after the last dose.
• The highest levels of rhein were detected 10 hours after administration. This was the first time that a sample had been taken.
• Rhein was still detectable in breast milk 26 hours later than the dose given to half the women.
• Researchers calculated that milk contains approximately 0.007% of the maternal dose.
• There have been some reports of infants who were breastfed experiencing diarrhea and loose stool. However, most cases did not show any significant changes in their bowel habits.
• Senna is safe for breastfeeding if it is used to treat maternal constipation according to the WHO (WHO 2002).

Use in Kidney disease:

No dosage adjustments have been mentioned in patients with kidney disease.

Dose in Liver disease:

No dosage adjustments have been mentioned in patients with liver disease.

Side effects of Senna:

• Gastrointestinal:

  • Abdominal Cramps
  • Diarrhea
  • Nausea
  • Vomiting

Contraindications and Warnings:

None mentioned. Patients with severe abdominal pain, inflammatory bowel disease, active colitis and absolute constipation should consult a healthcare provider before taking this medication.

Senna: Drug Interaction

Monitoring Parameters:

None mentioned. Monitor the response to treatment.

How to administer Senna?

• A once-daily dose should be preferentially taken at bedtime.
• The drug should be given two hours prior to or after taking any other medication.

Mechanism of action of Senna:

• Anthraquinone is a group that includes stimulant laxatives derived from plants, such as senna. 
• Stimulant drugs cause defecation by increasing motility by stimulating peristalsis in intestinal mucosa and nerve plexus.

The onset of action: Oral: Within 6 to 24 hours

Metabolism: Hepatic

Excretion: Feces (via bile); urine

International Brand Names of Senna:

• Ex-Lax Maximum Strength
• Ex-Lax
• Geri-kot
• GoodSense Laxative Pills
• GoodSense Senna Laxative
• Perdiem Overnight Relief
• Senexon
• Senna Lax
• Senna Laxative
• Senna Smooth
• Senna-GRX
• Senna-Lax
• Senna-Tabs
• Senna-Time
• SennaCon
• Senno
• Senokot Extra Strength
• Senokot XTRA
• Senokot
• Adjust-A
• Bekunis
• Bekunis Instant
• Cholax
• Ciruelax Comp
• Colonorm
• Darmol
• Depuran
• Efectilax
• Falquilax
• Fuca
• Fuca Excellent
• Jungborn
• Lacass
• Lagenbach
• Laxal
• Laxante Olan
• Laxen
• Linella
• List Senny
• Midro
• Midro Tee
• Naturlax
• Neholis
• Purgaton
• Pursennid
• Pursennide
• Ramend
• Regulax
• Senade
• Senadex
• Senadexin
• Senadin
• Senalax
• Senareti
• Senna
• Sennalax
• Sennalax Fort
• Sennefol
• Sennocol
• Sennoket
• Sennove Lusky
• Senokot
• Soflax
• Thea Bona
• X-Prep
• Xenna
• Yodel-S

Senna Brand Names in Pakistan: