SupplementModerate evidenceImmunity

Cascara sagrada (Rhamnus purshiana)

EMA-monograph stimulant laxative, same hydroxyanthracene class as senna, similar short-term-only positioning.

Why

Cascara sagrada (Rhamnus purshiana) bark holds an EMA HMPC Traditional Use monograph for short-term occasional constipation. Hydroxyanthracene mechanism is essentially the same class as senna. EFSA has flagged hydroxyanthracene safety concerns (genotoxicity at high cumulative doses), limit to short courses; senna is the more commonly-prescribed European alternative.

How it works

Cascarosides are converted in the colon to active aglycones, which stimulate colonic motility and inhibit Na/K-ATPase in colonocytes, same mechanism as senna and aloe latex.

Expected onset · 8–12 hours after a single dose

How to take

Dosage

Dried bark: 20–30 mg hydroxyanthracene derivatives at bedtime (typically equivalent to 0.25–1 g dried bark). Maximum 1–2 weeks of continuous use.

Timing

Bedtime, effect 8–12 hours later

On the label

Aged cascara bark (at least 1 year stored, per EMA monograph) is required, fresh bark contains free anthrones causing severe cramping. EMA-registered preparations comply.

Ideal for

Adults with short-term occasional constipation; not for chronic use.

Safety

Hydroxyanthracene class. Chronic use causes hypokalaemia, melanosis coli, and is genotoxicity-flagged by EFSA. Avoid in intestinal obstruction, ileus, undiagnosed abdominal pain, severe dehydration, inflammatory bowel disease, children under 12, and pregnancy. Interactions with cardiac glycosides, antiarrhythmics, diuretics (potassium depletion). Limit to 1–2 weeks continuous use; no more than 5 episodes per year.

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Evidence

At a glance

EMA classifies cascara bark at Traditional Use for short-term occasional constipation. EFSA's 2018 hydroxyanthracene safety opinion flagged genotoxicity concerns at high cumulative doses, supports the short-term-only positioning.

Where to get it

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