CASCARA SAGRADA
(kas-kar'a)
Cascara Sagrada Aromatic Fluid-extract, Cascara Sagrada Fluidextract
Classifications: gastrointestinal agent; stimulant, laxative
Prototype: Bisacodyl
Pregnancy Category: C

Availability

325 mg tablets; liquid

Actions

Anthraquinone derivative obtained from bark of buckhorn tree (Rhamnus purshiana). Acts principally in large intestine by stimulating propulsive movements of colon through direct chemical irritation. Casanthrol, which is present in a variety of OTC mixtures, is a derivative of cascara sagrada.

Therapeutic Effects

Effective laxative with results in 6–12 h. Useful in conditions where straining at stool is to be avoided.

Uses

Temporary relief of constipation and to prevent straining at stool in various disease conditions. Sometimes used with milk of magnesia.

Contraindications

Abdominal pain, fecal impaction; GI bleeding, ulcerations; appendicitis, gastroenteritis, intestinal obstruction, CHF; pregnancy (category C).

Cautious Use

Lactation; renal impairment; diabetic patients; rectal bleeding; concomitant laxative use.

Route & Dosage

Laxative
Adult: PO Tablet: 325–1000 mg/d; fluid extract: 0.5–1.5 mL/d; aromatic fluid extract: 2–6 mL/d
Child: PO 2–12 y: ½ of adult dose; <2 y: 1/4 of adult dose
Infant: PO Aromatic fluid extract: 1.25 mL/d as single dose

Administration

Oral

Administer with a full glass of water on an empty stomach for best results. Results may be delayed somewhat by food.
Store in tightly covered, light-resistant containers, unless otherwise directed by manufacturer.

Adverse Effects (1%)

GI: Anorexia, nausea, gripping, abnormally loose stools, constipation rebound, melanosis of colon. Metabolic: Hypokalemia, impaired glucose tolerance, calcium deficiency, Urogenital: Discoloration of urine.

Diagnostic Test Interference

Possibility of interference with PSP excretion test because of urine discoloration.

Interactions

Drug: Decreased effect of oral anticoagulants.

Pharmacokinetics

Absorption: Minimal absorption from GI tract. Onset: 6–12 h. Metabolism: Metabolized in liver. Elimination: Eliminated in feces and urine; excreted in breast milk.

Nursing Implications

Assessment & Drug Effects

Monitor electrolyte balance if significant diarrhea occurs, especially with frail older adults.
Monitor restoration of normal bowel function.

Patient & Family Education

A single dose taken before retiring usually results in evacuation of soft stool 6–12 h later.
Frequent or prolonged use of irritant cathartics disrupts normal reflex activity of colon and rectum and can lead to drug dependence for evacuation.
See bisacodyl for additional information.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug