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Pronunciation

(SEN na)

Index Terms

  • Sennosides

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Leaves, Oral:

Generic: (454 g)

Liquid, Oral:

Senexon: 8.8 mg/5 mL (237 mL) [contains methylparaben, propylene glycol, propylparaben]

Powder, Oral:

Generic: (1 g [DSC])

Syrup, Oral:

Senna-GRX: 8.8 mg/5 mL (15 mL, 236 mL) [contains parabens]

Generic: 8.8 mg/5 mL (5 mL, 236 mL, 237 mL); 176 mg/5 mL (15 mL, 237 mL)

Tablet, Oral:

Ex-Lax: 15 mg [sodium free]

Ex-Lax Maximum Strength: 25 mg [sodium free]

Geri-kot: 8.6 mg

GoodSense Senna Laxative: 8.6 mg

Perdiem Overnight Relief: 15 mg

Senexon: 8.6 mg

Senna Lax: 8.6 mg

Senna Laxative: 8.6 mg

Senna Maximum Strength: 25 mg

Senna Smooth: 15 mg [contains sodium benzoate]

Senna-Gen: 8.6 mg [DSC]

Senna-Lax: 8.6 mg

Senna-Tabs: 8.6 mg

Senna-Time: 8.6 mg

SennaCon: 8.6 mg

Senno: 8.6 mg

Senokot: 8.6 mg

Senokot To Go: 8.6 mg [DSC]

Senokot XTRA: 17.2 mg

Generic: 8.6 mg, 15 mg

Tablet Chewable, Oral:

Ex-Lax: 15 mg

Ex-Lax: 15 mg [chocolate flavor]

Brand Names: U.S.

  • Ex-Lax Maximum Strength [OTC]
  • Ex-Lax [OTC]
  • Geri-kot [OTC]
  • GoodSense Senna Laxative [OTC]
  • Perdiem Overnight Relief [OTC]
  • Senexon [OTC]
  • Senna Lax [OTC]
  • Senna Laxative [OTC]
  • Senna Maximum Strength [OTC]
  • Senna Smooth [OTC]
  • Senna-Gen [OTC] [DSC]
  • Senna-GRX [OTC]
  • Senna-Lax [OTC]
  • Senna-Tabs [OTC]
  • Senna-Time [OTC]
  • SennaCon [OTC]
  • Senno [OTC]
  • Senokot To Go [OTC] [DSC]
  • Senokot XTRA [OTC]
  • Senokot [OTC]

Pharmacologic Category

  • Laxative, Stimulant

Pharmacology

The anthraquinone group of stimulant laxatives includes the plant-derived agents such as senna. Stimulant laxatives typically induce defecation by stimulating peristaltic activity on the intestine by direct action on intestinal mucosa or nerve plexus, therefore increasing motility.

Metabolism

Hepatic

Excretion

Feces (via bile); urine

Onset of Action

Oral: Within 6 to 24 hours

Use: Labeled Indications

Constipation: Relieves occasional constipation (irregularity); generally causes bowel movement in 6 to 12 hours

Dosing: Adult

Constipation: Oral:

Syrup (8.8 mg sennosides/5mL): 10 to 15 mL (17.6 mg to 26.4 mg sennosides) once daily; maximum: 15 mL (26.4 mg sennosides) twice daily.

Tablets:

8.6 mg sennosides/tablet: Two tablets (17.2 mg sennosides) once daily; maximum: 4 tablets (34.4 mg sennosides) twice daily

15 mg sennosides/tablet: Two tablets (30 mg sennosides) once or twice daily

17.2 mg sennosides/tablet: One tablet (17.2 mg sennosides) once daily; maximum: 2 tablets (34.4 mg sennosides) twice daily

25 mg sennosides/tablet: Two tablets (50 mg sennosides) once or twice daily

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Constipation: Children: Oral:

Syrup (8.8 mg sennosides/5mL):

Children 2 to <6 years: 2.5 to 3.75 mL (4.4 to 6.6 mg sennosides) once daily; maximum: 3.75 mL (6.6 mg sennosides) twice daily

Children 6 to <12 years: 5 to 7.5 mL (8.8 to 13.2 mg sennosides) once daily; maximum: 7.5 mL (13.2 mg sennosides) twice daily

Children ≥12 years and Adolescents: Refer to adult dosing.

Tablets:

8.6 mg sennosides/tablet:

Children 2 to <6 years: One-half tablet (4.3 mg sennosides) once daily; maximum: 1 tablet (8.6 mg sennosides) twice daily

Children 6 to <12 years: One tablet (8.6 mg sennosides) once daily; maximum: 2 tablets (17.2 mg sennosides) twice daily

Children ≥12 years and Adolescents: Refer to adult dosing.

15 mg sennosides/tablet:

Children 6 to <12 years: One tablet (15 mg sennosides) once or twice daily

Children ≥12 years and Adolescents: Refer to adult dosing.

17.2 mg sennosides/tablet:

Children 6 to <12 years: One-half tablet (8.6 mg sennosides) once daily; maximum: 1 tablet (17.2 mg sennosides) twice daily

Children ≥12 years and Adolescents: Refer to adult dosing.

25 mg sennosides/tablet:

Children 6 to <12 years: One tablet (25 mg sennosides) once or twice daily

Children ≥12 years and Adolescents: Refer to adult dosing.

Administration

Once-daily doses should be preferentially taken at bedtime. Administer 2 hours before or after other medications.

Storage

Store at 20°C to 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F to 86°F).

Drug Interactions

There are no known significant interactions.

Adverse Reactions

Frequency not defined: Abdominal cramps, diarrhea, nausea, vomiting

Warnings/Precautions

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

Other warnings/precautions:

• Appropriate use: Failure to have a bowel movement or occurrence of rectal bleeding after use should be reported to health care provider.

• Self-medication (OTC use): Not recommended for use in patients experiencing stomach pain, nausea, vomiting, or a sudden change in bowel movements which lasts >2 weeks. Not recommended for OTC use in children <2 years of age. Do not use for more than 1 week.

Pregnancy Considerations

An increased risk of congenital abnormalities was not observed following maternal use of senna during pregnancy (Acs, 2009). Short-term use of senna is generally considered safe during pregnancy (Mahadevan, 2006).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience abdominal cramps. Have patient report immediately to prescriber severe abdominal pain (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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