Page 134 - Pharmacognosy-I (02-06-06-102)

Warnings
• Products containing cascara should only be used if no effect can be
obtained through a change of diet or by the use of bulk-forming
laxatives.

• Patients should also be warned that certain constituents of the bark
are excreted by the kidney and may colour the urine orange, which
is harmless.

• Cascara and other stimulant laxatives should not be used in patients
with abdominal pain, nausea or vomiting.

• The use of stimulant laxatives for longer than 2 weeks requires
medical supervision. Rectal bleeding or failure to have a bowel
movement after taking a laxative may indicate a serious condition.

• Chronic use may result in aggravation of constipation with laxative
dependence, a need for increased dosages and disturbances of
water and electrolyte balance (e.g. hypokalaemia). Chronic use
may also lead to colonic dysfunction (atonicity).

• Laxative abuse resulting in diarrhea and consequent fluid and
electrolyte losses (mainly of potassium) may cause albuminuria,
haematuria, and cardiac and neuromuscular dysfunction (may arise
particularly in the case of concomitant use of cardiotonic
glycosides e.g. digoxin, diuretics, corticosteroids or liquorice root).

Precautions
General

• Cascara and other laxatives containing anthraquinone glycosides
should not be used continuously for longer than 1–2 weeks,
because of the risk of electrolyte imbalance.

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