Senna oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations containing senna.
Drugs List
Therapeutic Indications
Uses
Constipation
Dosage
Adults
Tablets
7.5mg to 15mg taken at bedtime.
Alternative sources state that unlicensed doses of up to 30mg might be used.
Oral solution
7.5mg to 15mg taken at bedtime. The maximum recommended daily dose is 30mg.
Children
Not all brands and formulations are licensed for use in children of all ages.
Children aged 12 to 18 years:
See Dosage; Adults.
Children aged 6 to 12 years:
7.5mg to 15mg once daily at bedtime.
Alternative sources state that unlicensed doses of up to 30mg might be used.
Children aged 2 to 6 years:
3.75mg to 7.5mg once daily at bedtime.
Alternative sources state that unlicensed doses of up to 30mg might be used in children aged 4 years and over.
Children aged 1 month to 2 years (unlicensed):
3.75mg to 15mg once a day.
Additional Dosage Information
New users should start at the lowest dose and increase, if necessary, by one half of the initial dose each day. Once regularity has been regained, the dosage should be reduced and can usually be stopped.
Contraindications
Abdominal pain of unknown cause
Neonates under 1 month
Acute gastrointestinal disorder
Appendicitis
Faecal impaction
Gastrointestinal atony
Gastrointestinal obstruction
Gastrointestinal stenosis
Hypokalaemia
Inflammatory bowel disease
Severe dehydration
Precautions and Warnings
Children 1 month to 2 years
Breastfeeding
Galactosaemia
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Lactose intolerance
Pregnancy
Renal impairment
Not all formulations are suitable for use in children under 12 years
Oral solution with maltitol unsuitable in hereditary fructose intolerance
Some formulations contain hydroxybenzoate
Some formulations contain lactose
Ensure patient has adequate fluid intake
If daily use is required, investigate the cause of constipation
Prolonged use may cause fluid/electrolyte imbalance and hypokalaemia
Discontinue if severe abdominal symptoms develop
Avoid long term use
Advise patient to change pads frequently if incontinent
Advise patient to seek medical advice if treatment is ineffective
May discolour urine yellow or brown
Long periods of use may decrease the sensitivity of the intestinal mucous membranes. An atonic non-functioning colon may develop.
Prolonged use can lead to fluid and electrolyte imbalance and hypokalaemia.
Patients with renal impairment should be aware of possible electrolyte imbalance.
Chronic use may cause pigmentation of the colon (pseudomelanosis coli) which is usually reversible after drug discontinuation.
Senna should only be used if a therapeutic effect cannot be achieved by a change in diet first or the use of bulk forming agents.
Prolonged excessive use may lead to fluid and electrolyte imbalance, diarrhoea, hypokalaemia, and may precipitate rebound constipation. Intestinal loss of fluids can promote dehydration. Symptoms may include thirst and oliguria. Senna must be discontinued in patients suffering from fluid loss where dehydration may be harmful (e.g. renal insufficiency, elderly patients).
Pregnancy and Lactation
Pregnancy
Use senna with caution during pregnancy.
The manufacturers state that as a consequence of experimental data concerning a genotoxic risk of several anthranoids e.g. emodin and aloe-emodin, use is not recommended during pregnancy. There are no reports of undesirable or damaging effects during pregnancy and on the foetus when used at the recommended dosage.
If dietary lifestyle changes fail to control constipation in pregnancy and a laxative treatment is necessary, senna may be considered the drug of choice, if a stimulant effect is needed.
Lactation
Use senna with caution during breastfeeding.
The manufacturers state that there are insufficient data on the excretion of metabolites in breast milk and use during breastfeeding is not recommended. Small amounts of active metabolites (rhein) are excreted in breast milk. A laxative effect in breast fed babies has not been reported.
LactMed notes that several studies using senna products have reported no effect on the infant. Usual doses of senna are considered acceptable to use during breastfeeding.
Counselling
Advise patient to seek medical advice if there is no bowel movement for more than 3 days.
Advise patient to seek medical advice if daily use is required or if they have severe and persistent abdominal pain during treatment.
Advise the patient that the medicine may discolour the urine yellow or brown.
Advise the patient to change pads frequently if incontinent.
Side Effects
Abdominal cramps
Abdominal pain
Albuminuria
Asthma
Cachexia
Chromaturia
Dehydration
Diarrhoea
Discolouration of urine
Exanthema
Finger clubbing
Haematuria
Hypersensitivity reactions
Hypertrophic osteoarthropathy
Hypogammaglobulinaemia
Hypokalaemia
Melanosis coli
Pruritus
Tetany
Urticaria
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: December 2020
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Summary of Product Characteristics: Senease Twelve Years Plus 7.5mg Tablets (P). Special Concept Development (UK) Limited T/A RxFarma. Revised July 2021.
Summary of Product Characteristics: Senokot 7.5mg/5ml Syrup 12 Years Plus (P). Forum Health Products Ltd. Revised December 2020.
Summary of Product Characteristics: Senokot 7.5mg Tablets (P). Forum Health Products Ltd. Revised September 2020.
Summary of Product Characteristics: Senokot 7.5mg Tablets Adult (GSL). Reckitt Benckiser Healthcare (UK) Ltd. Revised March 2020.
Summary of Product Characteristics: Senokot 7.5mg Tablets 12 Years Plus (P). Reckitt Benckiser Healthcare (UK) Ltd. Revised December 2020.
Summary of Product Characteristics: Senokot Max Strength Tablets 12 year plus (P). Reckitt Benckiser Healthcare (UK) Ltd. Revised April 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 10 June 2022.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Senna. Last revised: 31 October 2018
Last accessed: 10 December 2020.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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