Cascara

Common names: Cascara also is known as buckthorn, cascara sagrada, chittem bark, and sacred bark.

Efficacy rating:

●●●...Positive clinical trials

Safety rating:

What is Cascara?

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The official cascara sagrada is the dried bark of Rhamnus pushiana collected from wild deciduous trees. Cascara trees are found in North America in California, Oregon, Washington, Idaho, Montana, and as far north as Southeast British Columbia. The official cascara sagrada medicine is made from the dried bark of these trees. A synonym is Frangula purshiana.

What is Cascara used for?

The American cascara is a folkloric medicine of the early 1800s, having been introduced as a tree bark laxative by early Mexican and Spanish priests of California. However, the berries were used much earlier in Europe, and were official in the 1650 London Pharmacopoeia.

Cascara bark is an anthraquinone-containing stimulant laxative commonly used for managing simple constipation. Cascara extracts are used in laxatives. As in other laxatives (eg, aloe, senna), the anthraglycosides are responsible for the cathartic properties in cascara. Cascarosides A and B are the major active principles, which act on the large intestine to induce peristalsis and evacuation. More specifically, the anthraglycosides produce an active secretion of water and electrolytes within the small intestine and inhibit the absorption of these from the large intestine. This causes an increase in the volume of the bowel contents and strengthens the dilatation pressure in the intestine to stimulate peristalsis. Emodin is another glycoside present in cascara.

What is the dosage of Cascara?

Typical doses of cascara are 1 g of bark, 1 mL of fluid extract, or 300 mg of dried extract. A systematic review has been published on the use of cascara and other laxatives.

Is Cascara safe?

Cascara is contraindicated in ileus of any origin.

Documented adverse effects. Emmenagogue (to stimulate menstrual flow) and abortive effects. Avoid use.

No direct interactions are known with cascara except where chronic use leads to a potassium deficiency, which can potentiate the effects of cardiotonic glycosides (eg, digitalis). The anthraquinone glycosides should not be used for long periods of time because they can cause the above problems or lead to laxative dependence.

Extended or habitual use of cascara is to be avoided because it can cause chronic diarrhea and weakness, due to excessive potassium loss. Chronic use can cause melanin pigmentation of the mucous membranes of the colon. Emodin can produce dermatitis.

When used for short periods of time at appropriate doses, cascara appears to have no toxicities.

References

Copyright © 2006 Wolters Kluwer Health

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