Senna glycoside

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Senna glycoside
Trade namesEx-Lax, Senokot, and others[1]
Clinical data
Routes of
By mouth (PO), rectal (PR)
Onset of actionMinutes (PR), 6 to 12 hours (PO)[3]
Defined daily dosenot established[4]
External links
License data
Legal status
  • US: OTC / Rx-only
Chemical and physical data
Molar mass862.75 g·mol−1
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Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][6] The medication is taken by mouth or via the rectum.[1][7] It typically begins working in minutes when given by rectum and within twelve hours when given by mouth.[3] It is a weaker laxative than bisacodyl or castor oil.[1]

Common side effects of senna glycoside include abdominal cramps.[3] It is not recommended for long-term use, as it may result in poor bowel function or electrolyte problems.[1] While no harm has been found to result from use while breastfeeding, such use is not typically recommended.[1] It is not typically recommended in children.[1] Senna may change urine to a somewhat reddish color.[1] Senna derivatives are a type of stimulant laxative and are of the anthraquinone type.[1] While its mechanism of action is not entirely clear, senna is thought to act by increasing fluid secretion within and contraction of the large intestine.[1]

It is on the World Health Organization's List of Essential Medicines.[8] It is available as a generic medication and is relatively inexpensive.[1][7] The wholesale cost in the developing world is about 0.01 USD per pill.[9] Sennosides come from the group of plants Senna.[3] In plant form, it has been used at least since the 700s CE.[10] In 2017, it was the 287th most commonly prescribed medication in the United States, with more than one million prescriptions.[11][12] It is sold under a number of brand names including Ex-Lax and Senokot.[1]

Medical uses

Senna is used for episodic and chronic constipation though there is a lack of high-quality evidence to support its use for these purposes.[6] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[13][14] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories act within two hours.[15]


The defined daily dose is not established.[4] In the United States the adult dose is 17.2 mg once to twice per day.[16] The dose in children 2 to 6 years old is 4.3 mg once to twice per day and in children 6 to 12 years old is 8.6 mg once to twice per day.[16]

If used once daily it is recommended at bedtime.[14][17]


According to Commission E senna is contraindicated in cases of intestinal obstruction, acute intestinal inflammation (e.g., Crohn's disease), ulcerative colitis, appendicitis, and abdominal pain of unknown origin.[13]

Senna is considered contraindicated in people with a documented allergy to anthraquinones. Such allergies are rare and typically limited to dermatological reactions of redness and itching.[13]

Adverse effects

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[13] Regular use of senna products can lead to a characteristic brown pigmentation of the internal colonic wall seen on colonoscopy. This abnormal pigmentation is known as melanosis coli.[15]


Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[18]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[19]


They are anthraquinone derivatives and dimeric glycosides.[medical citation needed]

Society and culture


Senna is an over-the-counter medication available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers as various brand names.[14]

Brand names

Ex-Lax Maximum Strength, Ex-Lax, Geri-kot, GoodSense Senna Laxative, Natural Senna Laxative, Perdiem Overnight Relief, Senexon, Senna Lax, Senna Laxative, Senna Maximum Strength, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot To Go, Senokot XTRA, Senokot, Kayam churna.[13]


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 American Society of Health-System Pharmacists (1 January 2008). "Senna". Archived from the original on 6 September 2015. Retrieved 11 August 2015.
  2. 2.0 2.1 "Senna Use During Pregnancy". 12 June 2019. Retrieved 12 January 2020.
  3. 3.0 3.1 3.2 3.3 Navti, Phyllis (2010). Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. p. 337. ISBN 9780199559824. Archived from the original on 5 March 2016.
  4. 4.0 4.1 "WHOCC - ATC/DDD Index". Retrieved 22 September 2020.
  5. "Senna(Powdered)". PubChem.
  6. 6.0 6.1 Wald, A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91. doi:10.1001/jama.2015.16994. PMID 26757467.
  7. 7.0 7.1 Hamilton, Richard J. (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. Archived from the original on 5 March 2016.
  8. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  9. "Senna". International Drug Price Indicator Guide. Retrieved 11 August 2015.
  10. Khare, C.P. (2004). Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 133. ISBN 9783642186592. Archived from the original on 5 March 2016.
  11. "The Top 300 of 2020". ClinCalc. Retrieved 11 April 2020.
  12. "Sennosides - Drug Usage Statistics". ClinCalc. Retrieved 11 April 2020.
  13. 13.0 13.1 13.2 13.3 13.4 Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  14. 14.0 14.1 14.2 "Archived copy". Archived from the original on 19 April 2014. Retrieved 17 April 2014.CS1 maint: archived copy as title (link)
  15. 15.0 15.1 McQuaid KR. Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In: Katzung BG, Masters SB, Trevor AJ. eds. Basic & Clinical Pharmacology, 12e. New York, NY: McGraw-Hill; 2012. "Archived copy". Archived from the original on 19 April 2014. Retrieved 18 April 2014.CS1 maint: archived copy as title (link). Accessed April 18, 2014.
  16. 16.0 16.1 "Senna - WikEM". Retrieved 5 August 2020.
  17. Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  18. "Senna: MedlinePlus Supplements". Archived from the original on 6 April 2015.
  19. Sharkey KA, Wallace JL. Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. New York, NY: McGraw-Hill; 2011. "Archived copy". Archived from the original on 19 April 2014. Retrieved 18 April 2014.CS1 maint: archived copy as title (link). Accessed April 18, 2014.

External links

  • "Senna". Drug Information Portal. U.S. National Library of Medicine.