Cascara Sagrada
(Rhamnus purshiana)

General Info

Active Forms

Absorption

Dietary Sources

Dosage Info

Dosage Range
100-300mg daily; do not recommend taking longer than 7-10 days without seeking medical advice.

Tea: One cup, 2 times daily using 2 gm fresh herb per cup.(1)

Most Common Dosage
100mg daily; do not recommend taking longer than 7-10 days without seeking medical advice.

Tea: One cup 2 times daily using 2 gm fresh herb per cup.

Dosage Forms

Adult RDI

Adult ODA

Overview

Interactions

Herb/Nutrient Depletions
•	Electrolytes
Drug/Herb Interactions
•	digoxin
•	Oral medications

Northern California Native Americans introduced this herb, which they called sacred bark, to sixteenth-century Spanish explorers. Being much milder in its laxative action than the herb buckthorn, cascara became popular in Europe as a treatment for constipation and has been part of the U.S. Pharmacopoeia since 1890.(2) Cascara traditionally has been used to treat a sluggish gallbladder, digestive problems, hemorrhoids, skin problems, intestinal parasites, jaundice, and colitis.(3)

Toxicities & Precautions

General
Cascara has been reported safe in recommended dosages.(4)

Health Conditions
Contraindicated in individuals with intestinal obstruction, appendicitis, ulcerative colitis, diarrhea, or dehydration.(5)

Side Effects
A recent case report suggested that anthracene glycosides from cascara sagrada were associated with the development of cholestatic hepatitis, thus causing portal hypertension.(6)

In vitro and animal studies have reported a potential role of anthranoid laxatives in both the initiation and promotion of tumorigenesis in the GIT; however, a recent human study reported no adverse effects on GI health.(7, 8) Although the short-term use of these substances is generally safe, long-term use cannot be recommended.

Pregnancy/Breast-Feeding
Do not use in pregnancy and lactation, as anthraquinones may be excreted in breast milk and may cause endometrial stimulation.(9)

Age Limitations
Avoid use in children under 12 years of age.

Symptoms & Causes of Deficiency

Footnotes

¹ PDR for Herbal Medicines, 2nd edition. Montvale, NJ: Medical Economics Company; 2000:155.
² Leung A, et al. Encylopedia of Common Natural Ingredients Used in Foods, Drugs, and Cosmetics. New York: Wiley-Interscience Publication;1996:128-130.
³ Newall CA, et al. Herbal Medicines: A Guide for Health Care Professionals. London: The Pharmaceutical Press;1996:62.
⁴ LaValle JB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp Inc;2000:404.
⁵ Izzo AA, Sautebin L, Rombola L, Capasso F. The role of constitutive and inducible nitric oxide synthase in senna- and cascara-induced diarrhoea in the rat. Eur J Pharmacol. Mar1997;323(1):93-7.
View Abstract
⁶ Nadir A, Reddy D, Van Thiel DH. Cascara sagrada-induced Intrahepatic Cholestasis Causing Portal hypertension: Case Report and Review of Herbal Hepatotoxicity. Am J Gastroenterol. Dec2000;95(12):3634-7.
View Abstract
⁷ Van Gorkom BA, et al. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment Pharmacol Ther. Apr1999;13(4):443-52.
View Abstract
⁸ Nusko G, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut. May2000;46(5):651-5.
View Abstract
⁹ DeSmet PAGM, et al (eds). Adverse Effects of Herbal Drugs 2. Berlin: Springer-Verlag;1993;70.

Cascara Sagrada(Rhamnus purshiana)

Cascara Sagrada
(Rhamnus purshiana)