Cascara Sagrada use while Breastfeeding

Summary of Use during Lactation

Maternal cascara intake might cause loose stools in some breastfed infants and should be avoided.[1] Other cathartics are preferred.

Drug Levels

After administration of 65 mg of cascara sagrada as cascara fluidextract, cascara was qualitatively detected in the breastmilk of 5 of 10 women collected over 20 hours.[2] The sensitivity of the assay was about 1100 mg/L of cascara.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

In 2 uncontrolled studies, a total of 10 of 22 breastfed neonates appeared to have loose stools after administration of 65 mg of cascara as cascara fluidextract to their mothers.[2]

In an observational case series, no cases of diarrhea were observed among the breastfed infants of 142 mothers who received 400 mg of cascara extract on day 3 postpartum.[3] This result might have been because of the small amount of colostrum received by the infants of this age.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Bisacodyl, Magnesium Hydroxide, Senna

References

1.

Lewis JH, Weingold AB., Committee of FDA-Related Matters American College of Gastroenterology. The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol. 1985;80:912–23. [PubMed: 2864852]

2.

Tyson RM, Shrader EA, Perlman HH. Drugs transmitted through breast milk. Part I: Laxatives. J Pediatr. 1937;11:824–32. [CrossRef]

3.

Duncan AS. Standardized senna as a laxative in the puerperium. A clinical assessment. Br Med J. 1957;1:439–41. [PMC free article: PMC1974525] [PubMed: 13396280]

Substance Name

Cascara Sagrada

CAS Registry Number

8047-27-6

Drug Class

Breast Feeding

Lactation

Cathartics

Gastrointestinal Agents