Cascara

Scientific names: Rhamnus pushiana DC.

Common names: Cascara also is known as bitter bark, buckthorn, cascararinde, cascara sagrada, chittem bark, Cortex rhamni purshianae, purshiana bark, Rhamnus, and sacred bark.

Efficacy rating:

ÒÒÒ...Positive clinical trials

Safety rating:

...Little exposure or very minor concerns.

What is Cascara?

The official cascara sagrada is the dried bark of Rhamnus pushiana. Cascara trees are found in North America in California, Oregon, Washington, Idaho, Montana, and as far north as Southeast British Columbia, however they are considered an endangered species.

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What is it used for?

Traditional/Ethnobotanical uses

Cascara was a folk medicine used by native American people and immigrants as a natural laxative. The plant itself was not definitely identified by scientists until 1805, and the bark was not commonly used as medicine 1877. The berries of the European counterpart (European buckthorn, Rhamnus frangula), on the other hand, were described in the London Pharmacopoeia of 1650. In 2002, the FDA banned the use of cascara sagrada as an OTC laxative ingredient.

General uses

Limited clinical studies exist for cascara aside from those of its laxative effects. Attention has shifted to studying the effects of its constituent emodin, particularly with regard to possible therapeutic applications in the treatment of cancer.

What is the recommended dosage?

Cascara sagrada over-the-counter laxative products were declared no longer safe and effective by the US Food and Drug Administration (FDA) in 2002. Typical doses of cascara are 1 g of bark, 2 to 6 mL of fluid extract, or 325 mg of dried extract.

How safe is it?

Contraindications

Cascara is contraindicated in intestinal blockage and in inflammatory diseases of the colon, including ulcerative colitis, irritable bowel syndrome, and Crohn disease.

Pregnancy/nursing

Documented to cause abortion and increase milk flow of breast-feeding women. Avoid use. Cascara's active substances may be excreted in breast milk.

Interactions

None well documented.

Side Effects

Extended use may cause chronic diarrhea and consequent electrolyte imbalance.

Toxicities

Overdose of anthraquinone laxatives results in intestinal pain and severe diarrhea with consequent electrolyte imbalance and dehydration. No causal relationship between long-term use of cascara and colon cancer has been established despite concerns about its use.

References

  1. Cascara. Review of Natural Products. Facts & Comparisons. [database online]. St. Louis, MO: Wolters Kluwer Health, Inc; August 2010.

Copyright © 2009 Wolters Kluwer Health

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