SupplementStrong evidenceImmunity

Senna

EMA Well-Established Use stimulant laxative for short-term relief of occasional constipation, not for chronic use.

Why

Senna leaf and pod (Senna alexandrina / Cassia angustifolia) contain hydroxyanthracene sennosides that hold an EMA HMPC monograph at Well-Established Use for short-term symptomatic relief of occasional constipation. Onset is reliable at 6–12 hours; effect is consistent across individuals. Chronic daily use causes electrolyte loss, melanosis coli, and possible cathartic colon, limit to short courses and intermittent use.

How it works

Sennosides are inactive prodrugs hydrolysed by colonic bacteria to rhein-anthrone, which stimulates colonic motility via enteric nerve and direct smooth-muscle effects, and inhibits Na/K-ATPase in colonocytes, increasing intraluminal fluid.

Expected onset · 6–12 hours after a single dose

How to take

Dosage

Adults: 15–30 mg sennosides at bedtime. Children 12+: 7.5–15 mg. Maximum continuous use: 2 weeks; for repeated use, intermittent only.

Timing

At bedtime, effect 6–12 hours later

On the label

Stated sennoside (sennoside B) content per tablet. Suitable for short courses; consider osmotic laxatives (e.g. magnesium-based) or stool-bulking (psyllium) for chronic constipation.

Ideal for

Adults and children (over 12 years) with occasional constipation needing short-term symptomatic relief.

Safety

Not for chronic use, hypokalaemia, dehydration, melanosis coli, possible long-term cathartic colon. Avoid in intestinal obstruction, ileus, undiagnosed abdominal pain, severe dehydration, inflammatory bowel disease. Caution with cardiac glycosides (digoxin), antiarrhythmics, diuretics (electrolyte effects). Pregnancy: avoid as a routine laxative. EFSA has flagged hydroxyanthracenes broadly; senna remains permitted under medicinal product regulation.

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Evidence

At a glance

EMA classifies senna as Well-Established Use for short-term occasional constipation, the highest regulatory tier for a botanical, requiring bibliographic evidence of efficacy. EFSA's 2018 safety opinion on hydroxyanthracenes flagged genotoxicity concerns at high cumulative doses, supports the short-term-use-only positioning.

Where to get it

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