HERBAL MONOGRAPHS CASCARA SAGRADA / 155edema and accelerated bone deterioration. Intake of the fresh
rind could lead to European cholera, intestinal colic, bloody
diarrhea and kidney irritation.Electrolyte Abnormalies: Long-term use leads to loss of
£T electrolytes, in particular potassium ions. Hyperaldosteron-
ism, albuminuria, hematuria, inhibition of intestinal motility,
and muscle weakness may occur. Enhancement of cardioac-
tive steroids and antiarrythics may also occur as a conse-
quense of hypokalemia.Carcinogenesis: The probability of carcinomas in the colon
following long-term administration of anthracene drugs has
not yet been fully clarified. Cascara glycoside may act as
weak promoters in colon carcinogenesis in animal models
(Mereto, 1996). One study determined aloin-enriched diets
did not promote incidence and growth of adenomas, carcino-
mas or significant hepatotoxicity after 20 weeks (Siegers,
1993a). Anthranoid laxative abuse is a relative risk factor for
colorectal cancer (Siegerss, 1993b).Drug Interactions:Thiazide Diuretics/Corticoadrenal Steroids/Liquorice Root
ftk — These drugs may potentiate potassium deficiency when
used concomitantly with Cascara.Antiarrythmics — Loss of potassium associated with pro-
longed use of Cascara may potentiate arrhythmias when
given concomitantly with antiarrhythmic medications.Digitalis Glycosides — With prolonged use or abuse of
Cascara, loss of potassium may potentiate digitalis toxicity.Indomethacin (NSAIDS) — Indomethacin given concomi-
tantly with anthracene derivatives had a decrease in thera-
peutic effect due to the inhibition of prostaglandin E2 (SEE
EFFECTS) (Cohen, 1982; Capasso, 1983).Pregnancy: Use during pregnancy or while nursing only
after consulting a physician.Nursing Mothers: Cascara has been identified by the
American Academy of Pediatrics as compatible with breast-
feeding. (Hagemann, 1998).. Pediatric Use: The drug is not to be administered to children
•* under 12 years of age.
DOSAGE
Mode of Administration: Liquid or solid forms of medication
are exclusively for oral use. The drug is used as comminuted
drug, powder or dry extracts for infusions, decoction, and as
a cold maceration or elixir.How Supplied:
Capsule — 425 mg, 440 mg, 450 mg, 850 mgPreparation: To prepare an infusion, add 2 gm finely cut
drug to boiling water and strain after 10 minutes. (1
teaspoonful = 2.5 gm drug)Daily Dosage: Administer 20 to 30 mg hydroxyanthracene
derivatives daily, calculated as cascaroside A.Tea: Take 1 fresh cup mornings and evenings.Homeopathic Dosage: from D3: 5 drops, 1 tablet or 10
globules every 30 to 60 minutes (acute) or 1 to 3 times daily
(chronic); parenterally: 1 to 2 ml sc acute: 3 times daily;
chronic: once a day (HAB34)Note: The individually correct dosage is the smallest dosage
necessary to maintain a soft stool. Stimulating laxatives must
not be used over a period of more than 1 to 2 weeks without
medical advice.
LITERATURE
Anonym, Abwehr von Arzneimittelrisiken, Stufe II. In: DAZ
136(38):3253-2354. 1996.
Anonym, Anwendungseinschrankungen fur Anthranoid-haltige
Abfuhrmittel angeordnet. In: PUZ 25(6)341-342. 1996.
Borkje B; Pedersen R: Lund GM et al. Effectiveness and
acceptability of three bowel cleansing regimens. Scand J
Gastroenterol 1991 Feb:26(2): 162-6.
BGA, Arzneimittelrisiken: Anthranoide. In: DAZ 132(21): 1164.
1992.
Capasso F; Mascolo N; Autore G: Duraccio MR. Effect of
indomethacin on aloin and 1,8 dioxianthraquinone-induced
production of prostaglandins in rat isolated colon. Prostaglandins
1983 Oct;26(4):557-62.
Cohen MM. The effect of cathartics on prostaglandin synthesis
by rat gastrointestinal tract. Prostaglandins Leukot Med 1982
Apr;8(4):389-97.
de Witte P, Cuveele J, Lemli J, Bicascarosides in fluid extracts
of Cascara. In: PM 57:440. 1991.
de Witte P; Lemli L. The metabolism of anthranoid laxatives.
Hepatogastroenterology 1990 Dec:37(6):601-5.
Evans FJ et al., (1975) J Pharm Pharmacol 27.91P.
Fairbairn JW et al., (1977) J Pharm Sci 66:1300.
Fairbairn JW, Simic S, (1964) J Pharm Pharmacol 16:450.
Griffini A et al., Isolation and characterisation of pure
Cascarosides A, B, C, and D. In: PM 58(Suppl.7):A593. 1992.
Hagemann TM. Gastrointestinal medications and breastfeeding. J
Hum Lact 1998 Sep;14(3):259-62.
Hangartner PJ; Munch R; Meier J et al. Comparison of three
colon cleansing methods: evaluation of a randomized clinical
trial with 300 ambulatory patients. Endoscopy 1989
Nov;21(6):272-5.
Helrnholz H, Ruge A, Piasecki A, Schroder S, Westendorf J,
Genotoxizitat der Faulbaumrinde. In: PZ 138(43):3478. 1993.