Cassia angustifolia

 

Cassia angustifolia

Synonyms

No documentation

Vernacular Name

Indian Senna, Senna, Cassia Senna, Tinnervelly Senna

Description

Cassia angustifolia has been used in many cultures as a natural laxative and treatment for constipation.  There are presently several drug products available that contain C. angustifolia leaf powder.  This particular medicinal use of C. angustifolia dates back to the 9th century AD.[1]

C. angustifolia is an annual shrub that grows up to 1m tall. It produces small yellow flowers with oblong seed pods containing several dark brown seeds.  It directs a pale green stem with leaf branches having up to five leaves.

Origin / Habitat

C. angustifolia is native to Africa and is now found in parts of the Middle East and in India.  The plant requires the warm climates of these areas and can survive very dry conditions.  It is also cultivated in these areas for drug production.

Chemical Constituents

Approximately 3% dianthrone glycosides (sennosides  A, A1, B, C, D, E, F & G ); small amounts of anthraquinones including aloe-emodin and rhein 8-glucoside; approximately 10% mucilage; tannins; and flavonoids.

Plant Part Used

Leaf, pod.

Medicinal Uses

General

Constipation

Most Frequently Reported Uses

Constipation

Dosage

Dosage Range 

The dose of C. angustifolia as a laxative is15-60mg of sennosides (sennoside B) per dose at bedtime; for short-term use only.

Most Common Dosage

The standard dose of C. angustifolia powder is 1 to 2g taken at bedtime, always with the lowest dosage possible to relieve constipation.  The goal of treatment in constipation should be a bowel movement every 2 to 3 days without difficulty (not having to strain).  Do not use C. angustifolia laxatives more than 2 weeks.  Onset of bowel movement after taking C. angustifolia is approximately 8 to 10 hours.[2]

Standardized to

Sennoside B with ranges of 20% to 60% sennoside content.

Pharmacology

Pre-clinical

C. angustifolia is a stimulant laxative and categorized as an anthraquinone laxative. C. angustifolia is widely accepted as a stool softener and a short-term treatment for constipation. C. angustifolia leaf is approved by the World Health Organization (WHO) for short-term use in occasional constipation. C. angustifolia contains hydroxyanthracene glycosides, also called sennosides. Sennosides stimulate peristalsis of the colon along with altering colonic absorption and secretion of fluids, resulting in accumulation of liquids to soften the stool and increased defecation. Clinical studies suggest that C. angustifolia is effective in managing constipation associated with a number of causes including surgery, childbirth, and use of narcotic pain relievers.[3],[4]

It has been thought that using anthraquinone laxatives, in particular C. angustifolia, may damage the intestinal epithelial layer of the GI tract and therefore increase the risk of developing colorectal cancer. Sennosides have been found to induce acute massive cell loss in the GIT, probably by apoptosis, causing shorter crypts, and increased cell proliferation.[5] However, in a laboratory study, the isolated constituent rhein showed no cytotoxic and genotoxic effects in colon adenocarcinoma cells.[6] Of interest is that by being antioxidant, rhein actually inhibited cell proliferation via a mechanism that seems to involve the MAP kinase pathway.

Clinical

No documentation

Interaction and Depletions

Interaction with other Herbs

No documentation

Interaction with Drugs

Based on pharmacology, use with caution when taking prescription or non-prescription medications and dietary supplements. Stimulant laxatives may increase gastrointestinal transit time and decrease the absorption of drugs and supplements.

Based on pharmacology, stimulant laxatives may lead to electrolyte imbalances such as increased loss of potassium. Loss of potassium may potentiate the effects of cardiotonic glycosides (digitalis). Hypokalemia resulting from long-term laxative use/abuse can also potentiate the effects of antiarrhythmic drugs, such as qunidine or calcium channel blockers. Using C. angustifolia with other drugs or herbs that induce hypokalemia, such as thiazide diuretics, corticosteroids, or licorice root (Glycyrrhiza glabra), may lead to electrolyte imbalances.

Precautions and Contraindications

Side effects

C. angustifolia may significantly reduce drug absorption and lessen the efficiency of any over-the-counter or prescription medications. Discontinue if allergy occurs.

As with other stimulant laxatives, C. angustifolia is contraindicated in individuals with cramps, gastric pain, nausea, vomiting, colic, hemorrhoids, or nephritis.

C. angustifolia has been reported safe in recommended doses. As with other stimulant laxatives, C. angustifolia should not be administered to patients with intestinal obstruction and stenosis, atony, dehydration, or chronic constipation.   C. angustifolia should not be used in patients with inflammatory intestinal diseases, such as appendicitis, Crohn’s disease, ulcerative colitis, or irritable bowel syndrome.

Pregnancy

C. angustifolia should not be used during pregnancy or lactation except under medical supervision after benefits and risks have been measured.  A review found that the use of C. angustifolia in pregnancy had no association with a higher risk of congenital abnormalities.[7]

Age limitation

Do not use C. angustifolia in children under 10 years of age.

Adverse reaction

Chronic use of C. angustifolia has been reported to cause hepatotoxicity, including portal vein thrombosis, in several case reports.[8] Do not use in individuals with pre-existing liver or kidney disease.

Read More

  1) Cultivation

References

  1. Barceloux DG.  Medical Toxicology of Natural Substances. New Jersey: John Wiley & Sons Pub.; 2008.  591-594.
  2. Agra Y, Sacristan A, Gonzalez M, et al. Efficacy of senna versus lactulose in terminal cancer patients treated with opioids. J.Pain Symptom.Manage. 1998;15(1):1-7.
  3. Kinnunen O, Winblad I, Koistinen P, Salokannel J. Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacology.1993;47 Suppl 1:253-255.
  4. van Gorkom BA, Karrenbeld A, van Der Sluis T, et al. Influence of a highly purified senna extract on colonic epithelium. Digestion. 2000;61(2):113-120.
  5. Aviello G, Rowland I, Gill CI, et al. Antiproliferative effect of rhein, an anthraquinone isolated from Cassia species, on Caco-2 human adenocarcinoma cells. J Cell Mol Med.16Jun2009.
  6. Acs N, Bánhidy F, Puhó EH, Czeizel AE. Senna treatment in pregnant women and congenital abnormalities in their offspring--a population-based case-control study. Reprod Toxicol. Jul2009;28(1):100-104.
  7. Soyuncu S, Cete Y, Nokay AE. Portal vein thrombosis related to Cassia angustifolia. Clin Toxicol (Phila). Sep2008;46(8):774-777.
  8. Vanderperren B, Rizzo M, Angenot L, et al. Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides. Ann Pharmacother. Jul-Aug2005;39(7-8):1353-1357.