Home Ingredients Cascara Sagrada Bark (Rhamnus purshiana)

Cascara Sagrada Bark (Rhamnus purshiana)

Rhamnus purshiana (Frangula purshiana)
Evidence Level
Preliminary
6 Clinical Trials
5 Documented Benefits
1/5 Evidence Score

Cascara sagrada is the dried, aged bark of Rhamnus purshiana (also called Frangula purshiana), a buckthorn tree of the Pacific coast of North America. It is a stimulant laxative: its cascarosides pass the small intestine intact and colon bacteria convert them mainly into emodin-9-anthrone, which speeds colonic transit and draws water into the stool. Fresh bark causes vomiting, so only dried, aged bark is used. EU regulators accept it as an herbal medicine for short-term use in occasional constipation, but their review found no controlled clinical studies of cascara, and the use rests on long experience and data from senna and aloe. In the US, FDA removed cascara from over-the-counter laxative drugs after no safety data were submitted, and rare cases of liver injury have been reported. It is not the coffee cherry husk also sold as cascara.

Studied Dose No controlled trial has tested cascara bark alone. EU monograph: a preparation equal to 10 to 30 mg hydroxyanthracene derivatives (as cascaroside A) once daily at night, or a tea with no more than 30 mg in 150 ml boiling water. No more than 1 week.
Active Compound Hydroxyanthracene (anthranoid) glycosides: mainly cascarosides A to F, which make up 60 to 70% of the hydroxyanthracene complex of dried bark, plus aloins and chrysaloins; colon bacteria convert them mainly to emodin-9-anthrone. Pharmacopoeia-grade bark contains at least 8.0% hydroxyanthracene glycosides, at least 60% of them cascarosides (as cascaroside A).

Benefits

Short-term bowel movement support recognized in the EU herbal monograph

EU herbal medicine regulators accept cascara bark as well-established use for short-term relief of occasional constipation. Their review found no controlled clinical studies of cascara, so the decision rests on pharmacology, expert opinion, clinical experience and trials of related laxatives such as senna and aloe.

Supported by Trial 1, Trial 2

Overnight action once colon bacteria activate its cascarosides

Cascarosides are not split by human digestive enzymes and only work after colon bacteria convert them, so a dose taken at night acts after a delay of 8 to 12 hours, according to the EU monograph. The monograph says the right dose is the smallest one that gives a comfortable soft stool, and 2 or 3 doses in a week usually suffice.

Supported by Trial 6, Trial 4

Bowel preparation before scans and colonoscopy with cascara combinations

Cascara with a saline laxative was once used to clear the bowel before X-ray and colonoscopy. In a randomized trial of 300 patients, a cascara combination with a short lavage cleaned the colon least well, and before gallium scans milk of magnesia with cascara did no better than no preparation in two randomized trials.

Supported by Trial 4, Trial 2

Multi-herb cleanse blend containing cascara compared with placebo

In a 4-week double-blind trial in 22 healthy young women, a commercial detox blend of 8 herbs including cascara bark and senna leaf did not change gastrointestinal symptoms, body composition, waist size or blood safety markers compared with placebo. The cascara amount per serving was not disclosed.

Supported by Trial 1

Colon fluid secretion and laxative effect in rats (animal study)

In rats, cascara at 800 mg/kg by mouth caused diarrhea and net fluid secretion in the colon over 1 to 8 hours. Blocking nitric oxide production reduced both effects, which suggests nitric oxide is part of how cascara works. The dose is far above human use, and this does not show an effect in people.

Supported by Trial 6

Mechanism of action

1

Activation by colon bacteria

Cascarosides A and B carry both C- and O-linked sugars, and cascarosides C to F are O-glucosides. Human digestive enzymes largely do not split them, so little is absorbed in the upper gut. Bacteria in the large intestine convert them mainly into emodin-9-anthrone, and absorbed aglycones are turned into glucuronide and sulfate conjugates.

2

Faster transit and more fluid in the colon

The EU monograph describes two actions: stimulation of large intestine motility, which speeds colonic transit, and less absorption plus more secretion of water and electrolytes into the colon, through looser tight junctions. More fluid stays in the stool. The monograph classes cascara as a contact laxative (ATC code A06AB07).

3

Nitric oxide signaling in the colon (animal data)

In rats given a high oral dose of cascara, a drug that blocks nitric oxide synthesis reduced the resulting diarrhea and colonic fluid secretion, and L-arginine, the building block of nitric oxide, reversed this. The authors concluded that nitric oxide is involved in the laxative action. This comes from animal work only.

4

Why the bark is dried and aged before use

Fresh bark contains free anthrones and mono-anthrone O-glycosides that cause vomiting. During drying these are oxidized to dianthrone and anthraquinone O-glycosides that lack this effect, according to the EU assessment report. Medicinal cascara is made from the dried, aged bark.

Clinical trials

1
Multi-Herb Detox Supplement Containing Cascara Sagrada Bark vs Placebo in Healthy Women: 4-Week RCT
PubMed

Double-blind, randomized, placebo-controlled trial of a commercial detox supplement taken daily for 4 weeks. Each serving held 1,350 mg of a proprietary blend of papaya leaf, cascara sagrada bark, slippery elm bark, peppermint leaf, red raspberry leaf, fenugreek seed, ginger root and senna leaf. (Tinsley et al. 2019, J Diet Suppl)

Healthy young adult women; 22 completed the study.

No beneficial or harmful effects were found versus placebo for body composition, waist circumference, gastrointestinal symptoms or blood safety markers. The amount of cascara per serving was not disclosed, and cascara was one of 8 herbs, including senna, so its own effect cannot be separated.

2
Milk of Magnesia Plus Cascara vs No Preparation Before Gallium-67 Scans: RCT
PubMed

Randomized trial comparing no bowel preparation with 30 cc of milk of magnesia plus 5 cc of cascara, given to reduce intestinal gallium activity before gallium-67 scanning. (Silberstein et al. 1981, J Nucl Med)

50 patients having gallium-67 scans.

There was no significant difference between the two groups in how often intestinal gallium interfered with the scan readings or in the time needed to complete the study. Cascara was given with milk of magnesia, so its own effect cannot be separated.

3
Four Colon Cleansing Regimens Including Milk of Magnesia With Cascara Before Gallium-67 Scintigraphy: RCT
PubMed

Prospective randomized comparison of a high fiber diet, castor oil, milk of magnesia with cascara, and no preparation before gallium-67 scintigraphy; colonic activity was graded 0 to 3 by three independent observers. (Novetsky et al. 1981, AJR Am J Roentgenol)

309 patients having gallium-67 scintigraphy (76 assigned to milk of magnesia with cascara and 79 to no preparation).

Compliance was 17% with the fiber diet, 32% with castor oil, 36% with milk of magnesia and cascara, and 46% with no preparation. Among compliant patients, castor oil reduced colonic gallium activity versus no preparation (P = 0.047), but milk of magnesia with cascara did not differ from no preparation (P = 0.42). Poor compliance limits every comparison.

4
Cascara-Salax Plus 2 Liters of Golytely vs Other Colonoscopy Preparations: RCT
PubMed

Prospective randomized trial at a Zurich university hospital comparing three colon cleansing methods for colonoscopy: 4 liters of Golytely (a polyethylene glycol lavage solution), 2 liters of Golytely combined with Cascara-Salax, and X-Prep (a senna preparation) with an enema. (Hangartner et al. 1989, Endoscopy)

300 ambulatory patients having colonoscopy (102 in the Cascara-Salax group).

The cleanest colon came with 4 liters of Golytely, and 2 liters of Golytely with Cascara-Salax was the least effective; examination quality was equal with the other two regimens and clearly better than with the cascara regimen (P < 0.01). X-Prep caused more abdominal cramps than either Golytely regimen (P < 0.001). Cascara was given with lavage solution and, according to the EU assessment report, a saline laxative (magnesium sulfate), so its own effect cannot be separated.

5
Cascara and Bisacodyl on Precancerous Colon Lesions and Tumors in Rats: Animal Study
PubMed

Animal study in which rats received bisacodyl (4.3 or 43 mg/kg) or cascara (140 or 420 mg/kg), alone or with the colon carcinogen azoxymethane, for 13 weeks; colons were examined for aberrant crypt foci, which are early precancerous lesions, and for tumors. (Borrelli et al. 2001, Life Sci)

Rats in 10 treatment groups; no people were dosed.

Cascara at both doses did not cause aberrant crypt foci or tumors and did not change the number caused by azoxymethane. High-dose bisacodyl increased crypts per focus and tumors. The authors concluded that a laxative and diarrhea-producing dose of cascara showed no promoting or initiating activity in this rat model.

6
Cascara-Induced Diarrhea and Colon Fluid Secretion and the Role of Nitric Oxide in Rats: Animal Study
PubMed

Animal study of diarrhea and net colonic fluid secretion over 1 to 8 hours after cascara (800 mg/kg by mouth) or senna (60 mg/kg by mouth), with or without the nitric oxide synthase blocker L-NAME given by injection. (Izzo et al. 1996, Eur J Pharmacol)

Rats; no people were dosed.

L-NAME reduced cascara- and senna-induced diarrhea and fluid secretion, L-arginine counteracted this effect, and the inactive isomer D-NAME had no effect. The authors suggested that nitric oxide is involved in the laxative action. The cascara dose is far above human use.

Side effects and drug interactions

Common Potential side effects

Abdominal pain, cramping and liquid stools can occur, especially in people with an irritable colon or after too large a dose; the EU monograph says to lower the dose if this happens.
Long-term use can cause loss of water and electrolytes, especially potassium, and may lead to protein or blood in the urine. Overdose or misuse causes griping pain and severe diarrhea.
Chronic use can darken the lining of the colon (pseudomelanosis coli), which usually fades after stopping. German authorities received a report of it in a woman who had taken a cascara-only product for 4 years.
Liver injury is rare but documented. The US LiverTox database describes several cases, mostly with high doses taken longer than recommended, starting a few days to 2 months after use began; most resolved quickly after stopping, but severe cases with ascites and portal hypertension occurred, and restarting cascara should be avoided.
In one published case, a 48-year-old man developed jaundice 3 days after starting 3 capsules a day of aged cascara bark and later had ascites, recovering within 3 months; EU assessors judged the link unlikely because of alcohol, other liver-affecting drugs and the high dose. A Danish woman developed severe toxic hepatitis after 4 weeks of a cascara product.
EU food safety experts could not establish the safety of cascara bark preparations in 2024 because the tested materials contained a compound known to damage DNA in animals. The EU monograph rules out use in pregnancy because of genotoxicity data on emodin and aloe-emodin.
Harmless yellow or red-brown discoloration of urine and allergic reactions such as itching, hives or rash can occur. A pharmacy worker who handled cascara and passion flower preparations without protection developed work-related sneezing, nasal congestion, wheezing and breathlessness, with positive skin prick tests to both.
Not for use in pregnancy, while breastfeeding or in children under 12, and not with bowel blockage, inflammatory bowel disease, abdominal pain of unknown cause or severe dehydration, according to the EU monograph. A US lactation database notes loose stools in some breastfed infants.

Important Drug interactions

Digoxin and other cardiac glycosides: potassium loss from long-term use can strengthen their effect; ask a doctor before combining.
Antiarrhythmic drugs and medicines that prolong the QT interval: low potassium can interact with them; ask a doctor before combining.
Diuretics, corticosteroids and licorice root can add to potassium loss when taken with cascara.

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Frequently asked questions about Cascara Sagrada Bark (Rhamnus purshiana)

Is cascara sagrada the same as the coffee cherry cascara used in teas?

No. Cascara sagrada is the dried, aged bark of the Rhamnus purshiana tree and works as a stimulant laxative. Coffee cherry cascara, including extracts sold as CoffeeBerry, comes from the dried fruit husk of the coffee plant (Coffea arabica), a different plant used as a tea and polyphenol ingredient. Check the Latin name on the label.

Why was cascara taken out of US over-the-counter laxative drugs?

In 1998 FDA asked for mutagenicity, genotoxicity and carcinogenicity data on cascara, and no data were submitted. Its 2002 final rule found cascara ingredients not generally recognized as safe and effective for over-the-counter laxative use, affecting about 160 products. The bark still appears in some dietary supplement blends.

Why does cascara bark have to be dried and aged before use?

Fresh bark contains free anthrones and related glycosides that cause vomiting. During drying these compounds are oxidized into forms without this effect, according to the EU assessment report, and medicinal cascara is made from the dried, aged bark. Do not use freshly stripped bark.

Is cascara bark still allowed in food supplements in the EU?

Since 2021, EU food law has kept cascara bark preparations containing hydroxyanthracene derivatives under scrutiny, and emodin, one of the bark's constituents, is on the prohibited list for foods. EFSA could not establish their safety in 2024, and a draft regulation sent to the Council in July 2026 would ban them in foods if adopted. The EU herbal medicine monograph is a separate framework from these food rules.

Can cascara sagrada affect the liver?

Rarely. The US LiverTox database describes several cases of liver injury, mostly with high doses taken longer than recommended, starting a few days to 2 months after use began. Most resolved quickly after stopping, but some were severe. Stop and see a doctor if you notice yellow skin or eyes or dark urine, and do not restart it.

What is Cascara Sagrada Bark?

Cascara sagrada is the dried, aged bark of Rhamnus purshiana (also called Frangula purshiana), a buckthorn tree of the Pacific coast of North America. It is a stimulant laxative: its cascarosides pass the small intestine intact and colon bacteria convert them mainly into emodin-9-anthrone, which speeds colonic transit…

What is Cascara Sagrada Bark used for?

NutraSmarts does not list Cascara Sagrada Bark under a health category. What the research covers: EU herbal medicine regulators accept cascara bark as well-established use for short-term relief of occasional constipation.

What is the recommended dosage of Cascara Sagrada Bark?

No controlled trial has tested cascara bark alone. EU monograph: a preparation equal to 10 to 30 mg hydroxyanthracene derivatives (as cascaroside A) once daily at night, or a tea with no more than 30 mg in 150 ml boiling water. No more than 1 week. Always follow the product label and check with a healthcare provider for personal advice.

Is Cascara Sagrada Bark safe, and does it have side effects?

Side effects and cautions reported for Cascara Sagrada Bark include: Abdominal pain, cramping and liquid stools can occur, especially in people with an irritable colon or after too large a dose; the EU monograph says to lower the dose if this happens. It may also interact with some medications. Cascara Sagrada Bark is not right for everyone, so check with a healthcare provider first if you are pregnant or breastfeeding, have a medical condition, or take prescription medication.

Does Cascara Sagrada Bark interact with any medications?

Possible interactions include: Digoxin and other cardiac glycosides: potassium loss from long-term use can strengthen their effect; ask a doctor before combining. Antiarrhythmic drugs and medicines that prolong the QT interval: low potassium can interact with them; ask a doctor before combining. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Cascara Sagrada Bark?

NutraSmarts rates the evidence for Cascara Sagrada Bark as Preliminary (1 out of 5). It is backed by 6 study summaries and 16 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(16 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Rhamnus purshiana DC., cortex. Final, Revision 1. EMA/HMPC/726270/2016. European Medicines Agency. 2020;Adopted by the HMPC 6 May 2020..SourceUsed to support: Not PubMed-indexed; official EU monograph, read in full. Well-established use for short-term use in occasional constipation; 10 to 30 mg hydroxyanthracene derivatives (as cascaroside A) once daily at night, or a tea with no more than 30 mg in 150 ml boiling water; no more than 1 week, usually 2 to 3 doses that week. Describes bacterial conversion mainly to emodin-9-anthrone, motility and secretory effects, an 8 to 12 hour delay, pseudomelanosis coli, electrolyte loss, urine discoloration, toxic hepatitis with chronic overdose and interactions with cardiac glycosides, antiarrhythmics, QT-prolonging drugs, diuretics, corticosteroids and licorice root. Contraindicated in pregnancy, lactation and children under 12. The HMPC reviewed new aloe-emodin genotoxicity data in a 2022 addendum (EMA/HMPC/172975/2022) and kept the monograph unchanged.
  2. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment report on Rhamnus purshiana DC., cortex. Final, Revision 1. EMA/HMPC/909434/2019. European Medicines Agency. 2020;Dated 6 May 2020. Revision rapporteur J Wiesner (first assessment W Knöss)..SourceUsed to support: Not PubMed-indexed; official EU assessment report, read. Bark must contain at least 8.0% hydroxyanthracene glycosides, at least 60% cascarosides; fresh bark contains anthrones that cause vomiting and are oxidized during drying. States that the only clinical investigations of cascara test it in combination products, that there are no controlled clinical studies or clinical safety studies, and that efficacy is taken from pharmacology, expert opinion, clinical experience and senna and aloe data. Describes a placebo-controlled gallbladder study in 40 volunteers (54 mg cascaroside A caused significant contraction), assesses the Nadir 2000 liver case as unlikely by RUCAM, and lists a melanosis coli report and an occupational allergy case.
  3. Food and Drug Administration, HHS. Status of certain additional over-the-counter drug category II and III active ingredients. Final rule. Fed Regist. 2002;67(90):31125-7..PubMedUsed to support: FDA final rule (full text read on govinfo) declaring aloe and cascara sagrada ingredients, including cascara sagrada bark, extract and fluidextract and casanthranol, not generally recognized as safe and effective for OTC laxative use, effective 5 November 2002. In 1998 FDA had asked for mutagenicity, genotoxicity and carcinogenicity data and none were submitted for cascara. About 160 OTC laxative drug products contained cascara ingredients.
  4. European Commission. Commission Regulation (EU) 2021/468 of 18 March 2021 amending Annex III to Regulation (EC) No 1925/2006 of the European Parliament and of the Council as regards botanical species containing hydroxyanthracene derivatives. Official Journal of the European Union. 2021;OJ L 96, 19.3.2021, p. 6..SourceUsed to support: Not PubMed-indexed; EU regulation, read in full. Added aloe-emodin, emodin, danthron and all preparations in which they are present, and preparations from the leaf of Aloe species containing hydroxyanthracene derivatives, to Part A (prohibited) of Annex III. Placed preparations from the bark of Rhamnus frangula L. and Rhamnus purshiana DC. containing hydroxyanthracene derivatives, along with senna and rhubarb preparations, under Union scrutiny in Part C, based on the 2018 EFSA opinion.
  5. European Commission; Council of the European Union. Draft Commission Regulation (EU) amending Annex III to Regulation (EC) No 1925/2006 as regards certain botanical species containing hydroxyanthracene derivatives (SANTE/1196/2024 Rev.3, Council document 11964/26). Council of the European Union. 2026;Cover note dated 15 July 2026; Commission document D099926/3..SourceUsed to support: Not PubMed-indexed; draft EU regulation sent to the Council, read. Would move preparations from the bark of Rhamnus frangula L. and Rhamnus purshiana DC. containing hydroxyanthracene derivatives, and the senna and rhubarb entries, from Part C to Part A (prohibited) of Annex III, because the 2024 EFSA opinion could not establish their safety. Foods already lawfully on the market could stay for 12 months after entry into force (Article 2). A draft, not yet in force when read.
  6. EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck D, Bohn T, Castenmiller J, De Henauw S, Hirsch-Ernst KI, Knutsen HK, Mangelsdorf I, McArdle HJ, Naska A, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Rossi A, Titz A, Fiolet T, Maciuk A. Scientific Opinion on additional scientific data related to the safety of preparations of Rheum palmatum L., Rheum officinale Baill. and their hybrids, Rhamnus purshiana DC., Rhamnus frangula L. and Cassia senna L., submitted pursuant to Article 8(4) of Regulation (EC) No 1925/2006. EFSA J. 2024;22(5):e8766. doi: 10.2903/j.efsa.2024.8766.PubMedUsed to support: EFSA review of genotoxicity data submitted during the Union scrutiny of rhubarb, cascara, frangula and senna preparations. All submitted studies were negative, but the preparations were poorly characterized and contained a compound known to be genotoxic in vivo, so the Panel concluded that the safety of cascara (Rhamnus purshiana) bark preparations containing hydroxyanthracene derivatives cannot be established.
  7. National Institute of Diabetes and Digestive and Kidney Diseases. Cascara. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012;Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Cascara entry last updated 23 January 2017..PubMedUsed to support: NIH LiverTox entry, read in full. Cascara is made from the dried, aged bark of Rhamnus purshiana; typical dose 300 mg once daily for less than 1 week. Several cases of clinically apparent liver injury have been described with longer use of high doses, with onset from a few days to 2 months and a hepatocellular to cholestatic pattern; most resolved rapidly on stopping, but severe cases with acute liver failure, ascites and portal hypertension occurred, and restarting should be avoided. Notes that the injury may have been due to an undisclosed contaminant. Its 2017 text still describes cascara as an over-the-counter laxative available in the US without prescription, which conflicts with the 2002 FDA final rule that removed cascara from OTC laxative drug products; this record relies on the FDA rule for US status.
  8. National Institute of Child Health and Human Development. Cascara Sagrada. Drugs and Lactation Database (LactMed®). 2006;Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Cascara Sagrada entry revised 17 May 2021..PubMedUsed to support: NIH LactMed entry, read. Maternal cascara intake might cause loose stools in some breastfed infants and should be avoided; other laxatives are preferred. In 2 old uncontrolled studies, 10 of 22 breastfed newborns appeared to have loose stools after their mothers took 65 mg of cascara as fluidextract.
  9. 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. 2000;95(12):3634-7. doi: 10.1111/j.1572-0241.2000.03386.x.PubMedUsed to support: Case report of cholestatic hepatitis complicated by portal hypertension attributed to cascara sagrada; the authors suggested the anthracene glycosides or another constituent as the cause. Details from the EU assessment report and LiverTox: a 48-year-old man, jaundice 3 days after starting 3 capsules a day of 425 mg aged bark, ascites, recovery within 3 months. A single case, cited for safety only.
  10. Jacobsen C, Semb S, Kromann-Andersen H. [Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada]. Ugeskr Laeger. 2009;171(46):3367-9..PubMedUsed to support: Danish case report (English abstract read) of severe toxic hepatitis with beginning liver failure after 4 weeks of a cascara sagrada herbal medicinal product; the authors noted cascara was in 30 to 40 herbal medicinal products in Denmark and recommended their withdrawal. LiverTox summarizes the patient as a 49-year-old woman with jaundice 4 weeks after starting daily cascara, ascites, and recovery within 4 months of stopping. A single case, cited for safety only.
  11. Tinsley G, Urbina S, Santos E, Villa K, Foster C, Wilborn C, Taylor L. A Purported Detoxification Supplement Does Not Improve Body Composition, Waist Circumference, Blood Markers, or Gastrointestinal Symptoms in Healthy Adult Females. J Diet Suppl. 2019;16(6):649-658. doi: 10.1080/19390211.2018.1472713.PubMedUsed to support: Double-blind randomized placebo-controlled trial of a 4-week multi-ingredient detox supplement (1,350 mg proprietary blend including cascara sagrada bark and senna leaf) in healthy young women; 22 completed. No beneficial or harmful effects on body composition, waist circumference, gastrointestinal symptoms or blood markers versus placebo.
  12. Silberstein EB, Fernandez-Ulloa M, Hall J. Are oral cathartics of value in optimizing the gallium scan? Concise communication. J Nucl Med. 1981;22(5):424-7..PubMedUsed to support: Randomized trial in 50 patients: 30 cc milk of magnesia plus 5 cc cascara versus no bowel preparation before gallium-67 scanning. No significant difference in how often gallium interfered with readings or in time to complete the study.
  13. Novetsky GJ, Turner DA, Ali A, Raynor WJ Jr, Fordham EW. Cleansing the colon in gallium-67 scintigraphy: a prospective comparison of regimens. AJR Am J Roentgenol. 1981;137(5):979-81. doi: 10.2214/ajr.137.5.979.PubMedUsed to support: Randomized comparison in 309 patients of a high fiber diet, castor oil, milk of magnesia with cascara, or no preparation before gallium-67 scintigraphy. Compliance was 17%, 32%, 36% and 46%; castor oil reduced colonic activity versus no preparation (P = 0.047), while milk of magnesia with cascara did not (P = 0.42).
  14. Hangartner PJ, Münch R, Meier J, Ammann R, Bühler H. Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients. Endoscopy. 1989;21(6):272-5. doi: 10.1055/s-2007-1012967.PubMedUsed to support: Randomized trial in 300 outpatients before colonoscopy: 4 liters of Golytely, 2 liters of Golytely with Cascara-Salax, or X-Prep (senna) with an enema. The cascara regimen was least effective at cleansing and gave clearly worse examination quality (P < 0.01); X-Prep caused more cramps (P < 0.001).
  15. Borrelli F, Mereto E, Capasso F, Orsi P, Sini D, Izzo AA, Massa B, Boggio M, Mascolo N. Effect of bisacodyl and cascara on growth of aberrant crypt foci and malignant tumors in the rat colon. Life Sci. 2001;69(16):1871-7. doi: 10.1016/s0024-3205(01)01263-2.PubMedUsed to support: Rat study (13 weeks): cascara at 140 and 420 mg/kg did not induce colonic aberrant crypt foci or tumors and did not modify azoxymethane-induced foci or tumors, while high-dose bisacodyl increased crypts per focus and tumors. Animal study only.
  16. Izzo AA, Gaginella TS, Mascolo N, Borrelli F, Capasso F. NG-nitro-L-arginine methyl ester reduces senna- and cascara-induced diarrhoea and fluid secretion in the rat. Eur J Pharmacol. 1996;301(1-3):137-42. doi: 10.1016/0014-2999(96)00023-4.PubMedUsed to support: Rat study: cascara (800 mg/kg orally) and senna (60 mg/kg orally) caused diarrhea and net fluid secretion over 1 to 8 hours; the nitric oxide synthase inhibitor L-NAME reduced both, L-arginine counteracted this, and D-NAME had no effect, suggesting nitric oxide is involved. Animal study only.