senna fruit extract + senna pods tinnevelly: clinical use

Prescribing considerations

• Use is intended for occasional constipation after dietary measures or bulk-forming treatment have been insufficient.
• Investigate the cause if laxatives are required every day or abdominal pain persists.
• Avoid prolonged stimulant-laxative use because of dependence, impaired bowel function, dehydration and electrolyte disturbance.
• Stimulant laxatives do not reduce calorie or nutrient absorption and do not support weight loss.

Contraindications and cautions

• Hypersensitivity to the active substances or excipients
• Concurrent use of another laxative
• Intestinal obstruction or stenosis, bowel atony or faecal impaction
• Appendicitis, Crohn's disease or ulcerative colitis
• Unexplained abdominal pain or acute or persistent gastrointestinal symptoms such as nausea and vomiting
• Severe dehydration with water and electrolyte depletion
• Children younger than 12 years
• Pregnancy and lactation

Monitoring

• Assess persistent or worsening constipation and investigate regular laxative requirements.
• Monitor hydration and electrolytes, particularly potassium, after severe diarrhoea, excessive use or suspected misuse.
• Give particular attention to older people, renal impairment, and people taking cardiac glycosides or potassium-lowering medicines.

Clinical pharmacology

Sennosides are not absorbed substantially in the upper gastrointestinal tract. Colonic bacteria convert them to rhein anthrone, which stimulates enteric nerve plexuses, accelerates colonic transit and promotes water and electrolyte secretion.

Formulation and product differences

• The selected product is an oral tablet containing powdered Alexandrian and Tinnevelly senna fruit standardised by hydroxyanthracene-glycoside content.
• The tablets contain lactose monohydrate; check suitability in relevant rare hereditary carbohydrate-intolerance disorders.
• Other excipients include calcium phosphate, maize starch and magnesium stearate.