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colon with reduced motility, and occasionally albuminuria or haematuria.
Laxatives of this type should not be used for more than two weeks without medical
supervision. Long-term use has been associated with pseudomelanosis coli, a benign
pigmentation of the colonic mucosa.
Hypokalaemia induced by overuse can impair cardiac and neuromuscular function,
particularly in patients concurrently taking cardiac glycosides (e.g., digoxin), diuretics,
corticosteroids, or liquorice root preparations.
Precautions
Use for more than 2 weeks requires medical attention.
Drug interactions
Decreased intestinal transit time maycause reduction of the absorption of orally
administered drugs.
The increased loss of potassium may potentiate the effects of similarly affecting drugs as
cardiotonic glycosides (digitalis, strophanthus). Hypokalaemia resulting from long term
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.
Pregnancy
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 due 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.

Adverse reactions
Senna may occasionally produce mild gastrointestinal discomfort, including abdominal
colic or cramping. A single case of hepatitis has been reported following chronic misuse
of the herb.
Melanosis coli, characterized by the accumulation of pigment-laden macrophages within
the colonic submucosa, may develop after prolonged use. This condition is clinically
benign and typically reverses once treatment is discontinued.
Prolonged or excessive use of stimulant laxatives may result in electrolyte imbalances

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