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Cassia senna

Centella asiatica
Chamomilla recutita
Cinnamomum verum
Coptis chinensis
Curcuma longa
Calendula officinalis
Cimicifuga racemosa
Crataegus monogyna
Carthamus tinctorius
Cephaelis ipecacuanha
Commiphora molmol
Commiphora mukul
Crocus sativus
Cordyceps sinensis
Cyperus rotundus


 

 

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Untitled Document Cassia senna L. (Fabaceae).

Synonyms
Fabaceae are also referred to as Leguminosae. Although recognized as two distinct species in many pharmacopoeias (1–8), Cassia acutifolia Delile and C. angustifolia Vahl. are considered botanically to be synonyms of the single species Cassia senna L.

Local names
Alexandria senna, Alexandrian senna, cassia, eshrid, falajin, fan xie ye, filaskon maka, hindisana, illesko, Indian senna, ma khaam khaek, makhaam khaek, mecca senna, msahala, nelaponna, nelatangedu, nilavaka, nilavirai, nubia senna, rinji, sanai, sand hijazi, sanjerehi, sen de alejandria, sen de la india, senna makki, senna, senamikki, sennae folium, sona-mukhi, Tinnevelly senna, true senna

Description
Low shrubs, up to 1.5 m high, with compound paripinnate leaves, having 3–7 pairs of leaflets, narrow or rounded, pale green to yellowish green. Flowers, tetracyclic, pentamerous, and zygomorphic, have quincuncial calyx, a corolla of yellow petals with brown veins, imbricate ascendent prefloration, and a partially staminodial androeceum. The fruit is a broadly elliptical, somewhat reniform, flattened, parchment-like, dehiscent pod, 4–7 cm long by 2 cm wide, with 6 to 10 seeds

Plant material used
leaflets

Chemical assays
Contains not less than 2.5% of hydroxyanthracene glycosides, calculated as sennoside B. Quantitative analysis is performed by spectrophotometry) and by high-performance liquid chromatography. Thin-layer chromatography is employed for qualitative analysis for the presence of sennosides A and B

Major chemical constituents
Folium Sennae contains a family of hydroxyanthracene glycosides, the most plentiful of which are sennosides A and B. There are also small amounts of aloeemodin and rhein 8-glucosides, mucilage, flavonoids, and naphthalene precursors

Dosage forms
Crude plant material, powder, oral infusion, and extracts (liquid or solid) standardized for content of sennosides A and B. Package in well-closed containers protected from light and moisture.

Medicinal uses
Uses supported by clinical data
Short-term use in occasional constipation.

Uses described in pharmacopoeias and well established documents
None.

Uses described in traditional medicine
As an expectorant, a wound dressing, an antidysenteric, and a carminative agent; and for the treatment of gonorrhoea, skin diseases, dyspepsia, fever, and haemorrhoids

Proven pharmacological activity
Animal studies
Laxative

Human studies
Laxative

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.

Contraindications
As with other stimulant laxatives, the drug is contraindicated in persons with ileus, intestinal obstruction, and stenosis, atony, undiagnosed abdominal symptoms, inflammatory colonopathies, appendicitis, abdominal pains of unknown cause, severe dehydration states with water and electrolyte depletion, or chronic constipation. Folium Sennae should not be used in children under the age of 10 years.

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 longterm laxative abuse can also potentiate the effects of antiarrhythmic drugs, such as quinidine, which affect potassium channels to change sinus rhythm. Simultaneous 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, 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.

Paediatric 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 macrophages 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 to produce 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


Plant material used
dried ripe fruit

Chemical assays
Contains not less than 2.2% of hydroxyanthracene glycosides, calculated as sennoside B. Quantitative analysis is performed by spectrophotometry or by high-performance liquid chromatography. The presence of sennosides A and B can be determined by thin-layer chromatography

Major chemical constituents
Fructus Sennae contains a family of hydroxyanthracene glycosides, the most plentiful of which are sennosides A and B. There are also small amounts of aloe-emodin and rhein 8-glucosides, mucilage, flavonoids, and naphthalene precursors

Dosage forms
Crude plant material, powder, oral infusion, and extracts (liquid or solid, standardized for content of sennosides A and B). Package in wellclosed containers protected from light and moisture.

Medicinal uses
Uses supported by clinical data
Short-term use in occasional constipation.

Uses described in pharmacopoeias and well established documents
None.

Uses described in traditional medicine
As an expectorant, a wound dressing, an antidysenteric, and a carminative agent; and for the treatment of gonorrhoea, skin diseases, dyspepsia, fever, and haemorrhoids.

Proven pharmacological activity
Animal studies

Laxative

Human studies
Laxative
(onset of action in 8-10 hours)

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.

Contraindications
As with other stimulant laxatives, the drug is contraindicated in cases of ileus, intestinal obstruction, stenosis, atony, undiagnosed abdominal symptoms, inflammatory colonopathies, appendicitis, abdominal pains of unknown cause, severe dehydration states with water and electrolyte depletion, or chronic constipation. Fructus Sennae should not be used in children under the age of 10 years.

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 and 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 and 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 longterm laxative abuse can also potentiate the effects of antiarrhythmic drugs, such as quinidine, which affect potassium channels to change sinus rhythm. Simultaneous 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, impairment of fertility
No in vivo genotoxic effects have been reported to date. Although chronic abuse of anthranoid-containing laxatives was hypothesized to play a role 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 available 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 breastfed babies has not been reported.

Paediatric use
Contraindicated for children under 10 years of age.

Other precautions
No information available concerning teratogenic effects on pregnancy.

Adverse reactions
Senna may cause mild abdominal discomfort such as colic or griping. A single case of hepatitis has been described after chronic abuse. Melanosis coli, a condition which is characterized by pigment-loaded macrophages 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 who repeatedly use stimulant laxatives. Conflicting data exist on other toxic effects such as intestinal-neuronal damage after long-term misuse.

Posology
The correct individual dose is the smallest required to produce a comfortable, soft-formed motion . Powder, 1–2g of fruit daily at bedtime. Adults and children over 10 years: standardized daily dose equivalent to 10–30mg sennosides (calculated as sennoside B) taken at night.


 

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