PDR for Herbal Medicines

154/CASCARA SAGRADA PDR FOR HERBAL MEDICINES

Leaves, Stem and Root: The plant is either a bush or a 6 to

18 m tall tree with branches which are gray tomentose when

young. The leaves are oblong-ovate, rounded at the base or

sometimes narrowing at the petiole. On the longer shoots

they are up to 17 cm long and 7.5 cm wide with an 8 to 18

mm long petiole. The margins are finely dentate and the

young leaves are tomentose, later becoming dark-green but

not coriaceous even in autumn.

Habitat: The plant is indigenous to the western part of North

America and is cultivated on the Pacific coast of the U.S.,

Canada and in eastern Africa.

Production: Cascara Sagrada bark consists of the dried bark

of Rhamnus purshiana.

Not to be Confused With: The bark of other Rhamnus

species.

Other Names: Purshiana Bark, Sagrada Bark, Sacred Bark,

Bitter Bark, Yellow Bark, Dogwood Bark, California Buck-

thorn, Chittem Bark, Cascara Buckthorn

ACTIONS AND PHARMACOLOGY

COMPOUNDS

Anthracene derivatives (8-10%): anthranoids, chief compo-

nents cascarosides A and B (stereoisomeric aloin-8-gluco-

sides), C and D (stereoisomeric 1 l-deoxy-aloin-8-

glucosides), E and F (C-glucosyl-emodin-anthron-8-

glucosides), further including aloin, 11-deoxyaloin

EFFECTS

Laxative Effects

The anthranoid compounds of Cascara are carried unab-

sorbed to the large intestine where the active aglycon is

released by bacterial hydrolysis of the sugar. The intestinal

bacterial flora reduces anthraquinone aglycons to the active

components of 1,8-dihydroxy-anthracene derivatives, which

have the laxative effect (de Witte & Lemli, 1990).

The anthranoids are anti-absorptive, hydrogogic and inhibit
the absorption of electrolytes and water from die colon. The
laxative effect is caused by an increase in the volume of the
intestinal contents with the resulting increase in pressure and
stimulation of intestinal peristalsis. In addition, stimulation
of the active chloride secretion into the intestine by nitric-
oxide-donating compounds or nitric oxide itself increases
water and electrolyte content (Izzo, 1998). Aloin and other
anthranoid derivatives stimulate prostaglandin production in
isolated segments of intestinal tissue, thus contributing to die
cathartic action (Cohen, 1982; Capasso, 1983).

CLINICAL TRIALS ,

Bowel Preparation

The effectiveness and acceptability of three bowel-cleansing

regimens was determined in 271 patients for colonoscopy.

Senna laxative (X-prep), combined with a saline enema, a

polyethylene glycol electrolyte lavage solution (Golytely 4

liters) or combined regimen of Cascara-Salax laxative

(PicoSalax) and 1.51 Golytely was administered. No clinical-

ly important differences were found between the three bowel

preparation regimens (Borkje, 1991).

A prospective, randomized clinical trial was conducted to

determine the side effects, patient acceptance, residual liquid

and stool during colonoscopy and also quality of examina-

tion of three colon cleansing methods. Three hundred

ambulatory patients were randomly assigned to one of the

following three groups for colon preparation: Group 1, (4

liters of Golytely), group 2, (2 liters of Golytely combined

with Cascara-Salax), and group 3, (X-Prep (a Senna prepara-

tion) combined with an enema). X-Prep caused significantly

more abdominal cramps than Group 1 or Group 2. Vomiting

was most frequent with Group 1, and the patients preferred

X-Prep to 4 liters of Golytely. The cleanest colon was

obtained with 4 liters of Golytely; 2 liters of Golytely with

Cascara-Salax was least effective. The quality of the

examination was equal in groups 1 and 3, which were both

significantly better than group 2 (Hangartner, 1989).

INDICATIONS AND USAGE

Approved by Commission E:

• Constipation
  Cascara Segrada is used for constipation, relief of defecation
  with anal fissures, hemorrhoids, and as a recto-anal post-
  opeiative treatment. The herb is also used in preparation of
  diagnostic procedures of the gastrointestinal tract and to
  obtain a soft stool.

Unproven Uses: In Folk medicine, Cascara is used as a tonic

and for cleaning wounds.

Homeopathic Uses: The herb is used for rheumatism and as

a digestive aid.

CONTRAINDICATIONS

The drug is contraindicated in intestinal obstruction, acute

inflammatory intestinal disease (colitis, Crohn's disease,

irritable bowel), appendicitis and abdominal pain of un-

known origin. Cascara drug is not to be administered to

children under 12 years of age.

PRECAUTIONS AND ADVERSE REACTIONS

General: Spasmodic gastrointestinal complaints can occur as

a side effect to the drug's purgative effect. In rare cases,

prolonged use may lead to heart arrhythmias, nephropathies,