Senna

Senna is a Stimulant Laxative belonging to Drug for Constipation.

Senna (Sennosides) is a laxative used to treat constipation.

About <10% of Senna (Sennosides) is absorbed from the gut mostly in the form of the active metabolite rheinanthrone. Senna when administered orally its onset of action is within 6 to 24 hours. The volume of distribution of radiolabelled intravenous sennoside B in rats was 0.802±0.124L/kg. Because sennosides are ingested and their action occurs in the gut, it is generally not thought to be protein bound. Senna is primarily metabolized via hepatic route, about 3-6% of metabolites are excreted in urine with some in bile. >90% of sennosides are excreted in the feces as polymers with 2-6% of the parent compounds excreted unchanged.

Senna shows side effects like Brown discoloration of urine, faintness, stomach discomfort, nausea, and stomach cramps.

Senna is available in the form of oral granule, oral tablets, rectal suppository, oral syrup, and oral disintegrating film.

Senna belongs to the Drug for Constipation acts as a Stimulant Laxative.

Senna the anthraquinone group of stimulant laxatives includes plant-derived agents such as senna. Stimulant laxatives typically induce defecation by stimulating peristaltic activity on the intestine by direct action on intestinal mucosa or nerve plexus, therefore increasing motility.

The Onset of action of Senna (Sennosides) is approximately within 6 to 24 hours (oral).

The Data on Duration of action and Tmax is not clinically established.

Senna is available in the form of Oral granule, oral tablet, rectal suppository, oral syrup, oral disintegrating film. 

Sennosides (also known as senna glycoside or senna) is a medication used to treat constipation and empty the large intestine before surgery. 

Senna is a Stimulant Laxative belonging to Drug for Constipation.

Senna stimulant laxatives typically induce defecation by stimulating peristaltic activity on the intestine by direct action on intestinal mucosa or nerve plexus, therefore increasing motility.

Senna is approved for use in the following clinical indications

• Constipation

Senna (Sennosides) is a laxative used to treat constipation.

• Constipation

Adult Dose:

Syrup:

Syrup (8.8 mg sennosides/5 mL):10 to 15 mL (17.6 mg to 26.4 mg sennosides) once daily; maximum: 15 mL (26.4 mg sennosides) twice daily.

Tablets:

8.6 mg sennosides/tablet: Two tablets (17.2 mg sennosides) once daily; maximum: 4 tablets (34.4 mg sennosides) twice daily

15 mg sennosides/tablet: Two tablets (30 mg sennosides) once or twice daily

17.2 mg sennosides/tablet: One tablet (17.2 mg sennosides) once daily; maximum: 2 tablets (34.4 mg sennosides) twice daily.

25 mg sennosides/tablet: Two tablets (50 mg sennosides) once or twice daily

Pediatric Dose:

Syrup:

Syrup (8.8 mg sennosides/5 mL):

Children <2 years: Very limited data available: Oral: 1.25 to 2.5 mL (2.2 to 4.4 mg sennosides) per day; maximum daily dose: 5 mL (8.8 mg sennosides) per day.

Children 2 to <6 years: Oral: 2.5 to 3.75 mL (4.4 to 6.6 mg sennosides) at bedtime; maximum daily dose: 3.75 mL (6.6 mg sennosides) twice daily.

Children 6 to <12 years: Oral: 5 to 7.5 mL (8.8 to 13.2 mg sennosides) at bedtime; maximum daily dose: 7.5 mL (13.2 mg sennosides) twice daily.

Children ≥12 years and Adolescents: Oral: 10 to 15 mL (17.6 to 26.4 mg sennosides) at bedtime; maximum daily dose: 15 mL (26.4 mg sennosides) twice daily.

Tablets:

3 mg sennosides per chewable tablet

Children 2 to <6 years: Oral: 1 tablet (3 mg sennosides) once or twice daily.

Children 6 to <12 years: Oral: 2 tablets (6 mg sennosides) once or twice daily.

8.6 mg sennosides per tablet

Children 2 to <6 years: Oral: 1/2 tablet (4.3 mg sennosides) at bedtime; maximum daily dose: 1 tablet (8.6 mg sennosides) twice daily.

Children 6 to <12 years: Oral: 1 tablet (8.6 mg sennosides) at bedtime; maximum daily dose: 2 tablets (17.2 mg sennosides) twice daily.

Children ≥12 years and Adolescents: Oral: 2 tablets (17.2 mg sennosides) at bedtime; maximum daily dose: 4 tablets (34.4 mg sennosides) twice daily.

12 mg sennosides per tablet

Children 6 to <12 years: Oral: 1/2 tablet (6 mg sennosides) once or twice daily.

Children ≥12 years and Adolescents: Oral: 1 tablet (12 mg sennosides) once or twice daily.

15 mg sennosides per tablet

Children 6 to <12 years: Oral: 1 tablet (15 mg sennosides) once or twice daily.

Children ≥12 years and Adolescents: Oral: 2 tablets (30 mg sennosides) once or twice daily.

17.2 mg sennosides per tablet

Children 6 to <12 years: Oral: 1/2 tablet (8.6 mg sennosides) at bedtime; maximum daily dose: 1 tablet (17.2 mg sennosides) twice daily.

Children ≥12 years and Adolescents: Oral: 1 tablet (17.2 mg sennosides) at bedtime; maximum daily dose: 2 tablets (34.4 mg sennosides) twice daily.

25 mg sennosides per tablet

Children 6 to <12 years: Oral: 1 tablet (25 mg sennosides) once or twice daily.

Children ≥12 years and Adolescents: Oral: 2 tablets (50 mg sennosides) once or twice daily.

Senna is available in various strengths as 326 mg/5 g; 8.6 mg; 652 mg; 218 mg/5 mL; 8.8 mg/5 mL; 15 mg; 25 mg; leaf extract 176 mg/5 mL; 7.5 mg/5 mL; 33.3 mg/mL; 600 mg; 1.65 g/2.5 g; 217 mg; 8.8 mg/mL; 17 mg; 17.2 mg; 12 mg; 3 mg.

Senna is available in the form of oral granules, oral tablets, rectal suppositories, oral syrup, and oral disintegrating film. 

Senna is contraindicated in patients with

• Patients with cramps, colic, nausea, vomiting or other symptoms of appendicitis or any undiagnosed abdominal pain.

• Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse; some data suggests that benzoate displaces bilirubin from protein binding sites avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates.

Clinical studies have shown that breastfed infants of mothers taking Senna did not show any side effects of the drug.

Use of senna should be limited during pregnancy due to an increased risk of adverse events, such as electrolyte abnormalities. 

Common

• Abdominal cramps, diarrhea, nausea, vomiting.

Dichlorphenamide

Laxatives may enhance the hypokalemic effect of Dichlorphenamide.

Digoxin

Senna may enhance the adverse/toxic effect of Digoxin.

Polyethylene Glycol-Electrolyte Solution:

Senna may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution.

Sodium Sulfate

Laxatives (Stimulant) may enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased.

The common side effects of Senna include the following

Common side effects

• Brown discoloration of urine, faintness, stomach discomfort, nausea, and stomach cramps.

Rare side effects

• Rectal bleeding

• Pregnancy

Pregnancy Category C

Use of senna should be limited during pregnancy due to an increased risk of adverse events, such as electrolyte abnormalities.

• Nursing Mothers

Clinical studies have shown that breastfeeding infants of mothers taking Senna did not show any side effects to the drug.

• Pediatric Use

Information not available.

• Geriatric Use

Information not available.

Overdosage may occasionally cause griping. In case of gross accidental overdosage, where diarrhea is severe, conservative measures are usually sufficient ie, and generous amounts of fluid especially fruit drinks should be given.

• Pharmacodynamic

Senna stimulates peristalsis and increases fecal water content to increase the motility of feces through the large intestine.

• Pharmacokinetics

Absorption

About <10% of Senna (Sennosides) is absorbed from the gut mostly in the form of the active metabolite rheinanthrone. Senna when administered orally onset of action is within 6 to 24 hours.

Distribution

The volume of distribution of radiolabelled intravenous sennoside B in rats was 0.802±0.124L/kg. Because sennosides are ingested and their action occurs in the gut, it is generally not thought to be protein bound.

Metabolism and Excretion

Senna is primarily metabolized via the hepatic route, about 3-6% of metabolites are excreted in urine with some in bile. >90% of sennosides are excreted in the feces as polymers with 2-6% of the parent compounds excreted unchanged.

Baldwin WF. Clinical study of senna administration to nursing mothers: assessment of effects on infant bowel habits. Canadian Medical Association Journal. 1963 Sep 9;89(11):566.

Brusick D, Mengs U. Assessment of the genotoxic risk from laxative senna products. Environmental and molecular mutagenesis. 1997;29(1):1-9.

de Senna AM, Vieira MM, Machado-de-Sena RM, Bertolin AO, Núñez SC, Ribeiro MS. Photodynamic inactivation of Candida ssp. on denture stomatitis. A clinical trial involving palatal mucosa and prosthesis disinfection. Photodiagnosis and Photodynamic Therapy. 2018 Jun 1;22:212-6.