Senokot

Contact/Stimulant Laxatives

Senna is administered orally.

It is suggested to administer at bedtime with a full glass of water. However, the products may be given one or two times daily; see the product directions.
Some marketed tablets are chewable; follow the directions on the product label for the specific product chosen.
The products usually produce a bowel movement 6 to 12 hours later.

Oral solutions, syrups or suspensions:
Shake well prior to each administration.
To ensure accurate dosage, use a calibrated oral measuring device to measure each dose.
The solution or syrup may be administered with milk or juice to mask taste.
It is suggested to administer at bedtime with a full glass of water. However, the products may be given one or two times daily; follow the directions on the specific product label.
The products usually produce a bowel movement in 6 to 12 hours.

anaphylactoid reactions / Rapid / Incidence not known

hypokalemia / Delayed / Incidence not known
melanosis coli / Delayed / Incidence not known
wheezing / Rapid / Incidence not known

nausea / Early / Incidence not known
vomiting / Early / Incidence not known
abdominal pain / Early / Incidence not known
flatulence / Early / Incidence not known
diarrhea / Early / Incidence not known
fecal urgency / Early / Incidence not known
urine discoloration / Early / Incidence not known
rash / Early / Incidence not known

Black Draught, Ex-Lax, Fletchers Laxative, Geri-kot, Lax-Pills, Perdiem, Plus PHARMA, Senexon, Senna, Senna-Lax, Senna-Tabs, Senna-Time, SennaGen, Sennatural, Senokot, Senokot Extra Strength, Senokot Xtra, SenoSol, Uni-Cenna

OTC

Anthraquinone stimulant laxative; plant derivative; long history of safe and effective use
Useful for constipation in adult and pediatric patients 2 years and older; used off-label for occasional use in younger children with prescriber supervision
Effective in the management of opioid-induced constipation (OIC)

1 to 2 tablets (8.6 to 17.2 mg sennosides) PO twice daily. Max dose: 4 tablets (34.4 mg sennosides) PO twice daily.

1 to 2 tablets (8.6 to 17.2 mg sennosides) PO twice daily. Max dose: 4 tablets (34.4 mg sennosides) PO twice daily.

1 tablet (8.6 mg sennosides) PO at bedtime. Max: 2 tablets (17.2 mg sennosides) PO twice daily.

One-half tablet (4.3 mg sennosides) PO once daily at bedtime. Max: 1 tablet (8.6 mg sennosides) PO twice daily.

2 softgel capsules (17.2 mg sennosides) PO at bedtime. Max dose: 4 softgel capsules (34.4 mg sennosides) PO twice daily.

2 softgel capsules (17.2 mg sennosides) PO at bedtime. Max dose: 4 softgel capsules (34.4 mg sennosides) PO twice daily.

1 softgel capsule (8.6 mg sennosides) PO at bedtime. Max: 2 softgel capsules (17.2 mg sennosides) PO twice daily.

10 to 15 mL (17.6 to 26.4 mg sennosides) PO at bedtime. Max: 15 mL (26.4 mg sennosides) PO twice daily.

10 to 15 mL (17.6 to 26.4 mg sennosides) PO at bedtime. Max: 15 mL (26.4 mg sennosides) PO twice daily.

5 to 7.5 mL (8.8 to 13.2 mg sennosides) PO at bedtime. Max: 7.5 mL (13.2 mg sennosides) PO twice daily.

2.5 to 3.75 mL (4.4 to 6.6 mg sennosides) PO at bedtime. Max: 3.75 mL (6.6 mg sennosides) PO once daily.

15 mL to 30 mL (25 mg to 50 mg sennosides) PO once daily. Max: 30 mL (50 mg sennosides) PO twice daily.

15 mL to 30 mL (25 mg to 50 mg sennosides) PO once daily. Max: 30 mL (50 mg sennosides) PO twice daily.

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

Atropine; Difenoxin: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Bumetanide: (Minor) The risk of hypokalemia due to loop diuretics may be increased in patients receiving prolonged therapy with certain laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy in patients receiving loop diuretics. Senna rarely causes hypokalemia with proper use.
Dichlorphenamide: (Minor) Use dichlorphenamide and senna together with caution. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Senna very rarely causes hypokalemia. Measure potassium concentrations at baseline and periodically during dichlorphenamide treatment. If hypokalemia occurs or persists, consider reducing the dichlorphenamide dose or discontinuing dichlorphenamide therapy.
Diphenoxylate; Atropine: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Droperidol: (Minor) Caution is advised when using droperidol in combination with certain laxatives, which may lead to electrolyte abnormalities, especially hypokalemia. Such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. However, senna very rarely causes hypokalemia or other electrolyte abnormalities.
Ethacrynic Acid: (Minor) The risk of hypokalemia due to loop diuretics may be increased in patients receiving prolonged therapy with certain laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy in patients receiving loop diuretics. Senna rarely causes hypokalemia with proper use.
Furosemide: (Minor) The risk of hypokalemia due to loop diuretics may be increased in patients receiving prolonged therapy with certain laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy in patients receiving loop diuretics. Senna rarely causes hypokalemia with proper use.
Lactulose: (Major) In general, other laxatives, such as senna, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved. (Major) In general, other laxatives, such as sennosides, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved.
Loop diuretics: (Minor) The risk of hypokalemia due to loop diuretics may be increased in patients receiving prolonged therapy with certain laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy in patients receiving loop diuretics. Senna rarely causes hypokalemia with proper use.
Polyethylene Glycol: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes; Ascorbic Acid: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polyethylene Glycol; Electrolytes; Bisacodyl: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Torsemide: (Minor) The risk of hypokalemia due to loop diuretics may be increased in patients receiving prolonged therapy with certain laxatives. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy in patients receiving loop diuretics. Senna rarely causes hypokalemia with proper use.

Black Draught/Ex-Lax/Geri-kot/Perdiem/Plus PHARMA/Senexon/Senna/SennaGen/Senna-Lax/Senna-Tabs/Senna-Time/Sennatural/Sennosides/Senokot/Senokot Extra Strength/SenoSol/Uni-Cenna Oral Tab: 8.6mg, 10mg, 15mg, 17.2mg, 25mg
Ex-Lax Oral Tab Chew: 15mg
Fletchers Laxative Oral Liq: 1mL, 33.3mg
Senexon/Senna/Sennosides/Uni-Cenna Oral Sol: 5mL, 8.8mg, 176mg
Senna Concentrate Oral Syrup: 5mL, 176mg

68.8 mg/day PO of sennosides for capsules and tablets; 52.8 mg/day PO of sennosides for oral solution; 100 mg/day PO of sennosides for maximum strength oral solution.

68.8 mg/day PO of sennosides for capsules and tablets; 52.8 mg/day PO of sennosides for oral solution; 100 mg/day PO of sennosides for maximum strength oral solution.

68.8 mg/day PO of sennosides for capsules and tablets; 52.8 mg/day PO of sennosides for oral solution; 100 mg/day PO of sennosides for maximum strength oral solution.

12 years: 68.8 mg/day PO of sennosides for capsules and tablets; 52.8 mg/day PO of sennosides for oral solution; 100 mg/day PO of sennosides for maximum strength oral solution.
6 to 11 years: 34.4 mg/day PO of sennosides for capsules and tablets; 26.4 mg/day PO of sennosides for 8.8 mg/5 mL oral solution (not FDA-approved for maximum strength oral solution 25 mg/15 mL).
2 to 5 years: 17.2 mg/day PO of sennosides for tablets; 6.6 mg/day PO of sennosides for 8.8 mg/5 mL oral solution (not FDA-approved for maximum strength oral solution 25 mg/15 mL). Safety and efficacy have not been established for capsules.
1 year: Safety and efficacy have not been established.

Safety and efficacy have not been established.

Anthraquinone derivatives such as senna are stimulant laxatives. Stimulant laxatives work by irritating luminal sensory nerve endings, thereby stimulating colonic motility and reducing colonic water absorption. Senna can alter permeability of cell walls in the colon because it increases cyclic 3',5'-adenosine monophosphate, which also regulates active ion secretion. The result is increased fluid accumulation in the colon and a laxative action. Tolerance to stimulant laxatives is uncommon.

Senna is administered orally and rectally. The pharmacokinetics of senna are not well characterized. There is insufficient evidence of distribution into breast milk, but amounts are unlikely to be a problem. Absorbed anthraquinones are believed to be metabolized by the liver and may be excreted via the bile in feces, and, possibly, in urine.

There is minimal GI absorption following oral administration. Free anthraquinones are released in the colon as a result of enzymatic hydrolysis of the glycosides. With oral dosing, a laxative effect is typically produced in 6—12 hours but may take up to 24 hours.

Following rectal administration of senna, laxative effect is seen in 30 to 120 minutes.

Systemic absorption of the sennosides is minimal and there have been no reports of teratogenicity or an increased risk of congenital anomalies due to senna use during pregnancy. The intermittent use of senna should be limited to use under the advice of a qualified health care professional and after safer agents have failed to produce intended results. The safest first-line treatments to use for constipation during pregnancy are those that are not absorbed systemically (e.g., fiber, bulk-forming laxatives, stool softeners such as docusate) in order to minimize drug exposure to the fetus. Polyethylene glycol 3350 has minimal systemic absorption and is also considered a first-line option for chronic constipation during pregnancy.

Senna is considered compatible for use during breast-feeding. Senna is not excreted into human milk, but it is a prodrug which is metabolized in vivo to the sennosides. Sennosides are glucosides of rhein, and the sennosides are essentially undetectable in human milk. Rhein appears to be excreted only in minimal amounts. There is a lack of reported adverse events in nursing infants whose mothers ingested sennosides during lactation. Agents that are non-absorbed or poorly absorbed (e.g., bulk-forming laxatives or stool softeners such as docusate) are often the preferred drugs for first-line use in the lactating female when such therapy is necessary. Other agents that may be considered based on lack of systemic effect or lack of reported adverse effects in nursing infants include magnesium hydroxide, polyethylene glycol 3350, and bisacodyl.[27500] [42282] [46842] [46846] [46847] [61291]