Chemistry:Senna glycoside

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Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][2] The medication is taken by mouth or via the rectum.[1][3] It typically begins working in minutes when given by rectum and within twelve hours when given by mouth.[4] It is a weaker laxative than bisacodyl or castor oil.[1]

Common side effects of senna glycoside include abdominal cramps.[4] It is not recommended for long-term use, as it may result in poor bowel function or electrolyte problems.[1] While no harm has been found to result from use while breastfeeding, such use is not typically recommended.[1] It is not typically recommended in children.[1] Senna may change urine to a somewhat reddish color.[1] Senna derivatives are a type of stimulant laxative and are of the anthraquinone type.[1] While its mechanism of action is not entirely clear, senna is thought to act by increasing fluid secretion within and contraction of the large intestine.[1]

It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[5] It is available as a generic medication and is relatively cheap.[1][3] The wholesale cost in the developing world is about 0.01 USD per pill.[6] Sennosides come from the group of plants Senna.[4] In plant form, it has been used at least since the 700s CE.[7] In 2016 it was the 287th most prescribed medication in the United States with more than one million prescriptions.[8]

Medical uses

Senna is used for episodic and chronic constipation though there is a lack of high-quality evidence to support its use for these purposes.[2] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[9][10]

Administration

It should be taken once daily at bedtime.[10][11] Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories act within two hours.[12]

Contraindications

According to Commission E senna is contraindicated in cases of intestinal obstruction, acute intestinal inflammation (e.g., Crohn's disease), ulcerative colitis, appendicitis, and abdominal pain of unknown origin.[9]

Senna is considered contraindicated in people with a documented allergy to anthraquinones. Such allergies are rare and typically limited to dermatological reactions of redness and itching.[9]

Adverse effects

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[9] Regular use of senna products can lead to a characteristic brown pigmentation of the internal colonic wall seen on colonoscopy. This abnormal pigmentation is known as melanosis coli.[12]

Interactions

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[13]

Mechanism of action

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[14]

Pharmacology

They are anthraquinone derivatives and dimeric glycosides.[medical citation needed]

Society and culture

Formulations

Senna is an over-the-counter medication available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers as various brand names.[10]

Brand names

Ex-Lax Maximum Strength, Ex-Lax, Geri-kot, GoodSense Senna Laxative, Natural Senna Laxative, Perdiem Overnight Relief, Senexon, Senna Lax, Senna Laxative, Senna Maximum Strength, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot To Go, Senokot XTRA, Senokot, Kayam churna.[9]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Senna". January 1, 2008. Archived from the original on 6 September 2015. https://web.archive.org/web/20150906045617/http://www.drugs.com/monograph/senna.html. Retrieved 11 August 2015. 
  2. 2.0 2.1 Wald, A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA 315 (2): 185-91. doi:10.1001/jama.2015.16994. PMID 26757467. 
  3. 3.0 3.1 Hamilton, Richard J. (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181. ISBN 9780763777685. https://books.google.ca/books?id=Urmh7ylCXnoC&pg=PA181. 
  4. 4.0 4.1 4.2 Navti, Phyllis (2010). Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. p. 337. ISBN 9780199559824. https://books.google.ca/books?id=KVicAQAAQBAJ&pg=PA337. 
  5. World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO. 
  6. "Senna". http://mshpriceguide.org/en/single-drug-information/?DMFId=717&searchYear=2014. Retrieved 11 August 2015. 
  7. Khare, C.P. (2004). Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 133. ISBN 9783642186592. https://books.google.ca/books?id=njLtCAAAQBAJ&pg=PA133. 
  8. "The Top 300 of 2019". https://clincalc.com/DrugStats/Top300Drugs.aspx. Retrieved 22 December 2018. 
  9. 9.0 9.1 9.2 9.3 9.4 Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  10. 10.0 10.1 10.2 Drugs.com "Archived copy". Archived from the original on 2014-04-19. https://web.archive.org/web/20140419013432/http://www.drugs.com/ppa/senna.html. Retrieved 2014-04-17. 
  11. Lexicomp Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; April 17, 2014.
  12. 12.0 12.1 McQuaid KR. Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In: Katzung BG, Masters SB, Trevor AJ. eds. Basic & Clinical Pharmacology, 12e. New York, NY: McGraw-Hill; 2012. "Archived copy". Archived from the original on 2014-04-19. https://web.archive.org/web/20140419013030/http://accessmedicine.mhmedical.com/content.aspx?bookid=388&Sectionid=45764290. Retrieved 2014-04-18. . Accessed April 18, 2014.
  13. "Senna: MedlinePlus Supplements". Archived from the original on 2015-04-06. https://web.archive.org/web/20150406045004/http://www.nlm.nih.gov/medlineplus/druginfo/natural/652.html. 
  14. Sharkey KA, Wallace JL. Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. New York, NY: McGraw-Hill; 2011. "Archived copy". Archived from the original on 2014-04-19. https://web.archive.org/web/20140419013258/http://accessmedicine.mhmedical.com/content.aspx?bookid=374&Sectionid=41266256. Retrieved 2014-04-18. . Accessed April 18, 2014.

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