sennosides

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sennosides

(sen-oh-sides) ,

Black-Draught

(trade name),

Ex-Lax

(trade name),

Ex-Lax Chocolated

(trade name),

Fletchers’ Castoria

(trade name),

Maximum Relief Ex-Lax

(trade name),

Sena-Gen

(trade name),

Senexon

(trade name),

Senokot

(trade name),

SenokotXTRA

(trade name)

Classification

Therapeutic: laxatives
Pharmacologic: stimulant laxatives
Pregnancy Category: C

Indications

Treatment of constipation, particularly when associated with:
  • Slow transit time,
  • Constipating drugs,
  • Irritable or spastic bowel syndrome,
  • Neurologic constipation.

Action

Active components of senna (sennosides) alter water and electrolyte transport in the large intestine, resulting in accumulation of water and increased peristalsis.

Therapeutic effects

Laxative action.

Pharmacokinetics

Absorption: Minimally absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile (laxative effect)

ROUTEONSETPEAKDURATION
PO6–12 hr†unknown3–4 days
†May take as long as 24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Abdominal pain of unknown cause, especially if associated with fever;Rectal fissures;Ulcerated hemorrhoids;Known alcohol intolerance (some liquid products).
Use Cautiously in: Chronic use (may lead to laxative dependence);Possible intestinal obstruction; Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Gastrointestinal

  • cramping (most frequent)
  • diarrhea (most frequent)
  • nausea

Genitourinary

  • pink-red or brown-black discoloration of urine

Fluid and Electrolyte

  • electrolyte abnormalities (chronic use or dependence)

Miscellaneous

  • laxative dependence

Interactions

Drug-Drug interaction

May ↓ absorption of other orally administered drugs because of ↓ transit time.

Route/Dosage

Larger doses have been used to treat/prevent opioid-induced constipation. Consult labeling of individual OTC products for more speceific dosing information
Oral (Adults and Children >12 yr) 12–50 mg 1–2 times daily.
Oral (Children 6–12 yr) 6–25 mg 1–2 times daily.
Oral (Children 2–6 yr) 3–12.5 mg 1–2 times daily.

Availability (generic available)

Noted as sennoside content
Tablets: 6 mgOTC, 8.6 mgOTC, 15 mg OTC, 17 mgOTC, 25 mgOTC
Granules: 15 mg/5 mLOTC, 20 mg/5 mLOTC
Syrup: 8.8 mg/5 mLOTC
Liquid: 25 mg/15 mLOTC, 33.3 mg/mL senna concentrateOTC
In combination with: psyllium and docusateOTC. See combination drugs.

Nursing implications

Nursing assessment

  • Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
  • Assess color, consistency, and amount of stool produced.

Potential Nursing Diagnoses

Constipation (Indications)
Diarrhea (Side Effects)

Implementation

  • Oral: Take with a full glass of water. Administer at bedtime for evacuation 6–12 hr later. Administer on an empty stomach for more rapid results.
    • Shake oral solution well before administering.
    • Granules should be dissolved or mixed in water or other liquid before administration.

Patient/Family Teaching

  • Advise patient that laxatives should be used only for short-term therapy. Long-term therapy may cause electrolyte imbalance and dependence.
  • Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake, and increasing mobility. Normal bowel habits are individualized and may vary from 3 times/day to 3 times/wk.
  • Inform patient that this medication may cause a change in urine color to pink, red, violet, yellow, or brown.
  • Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
  • Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present.

Evaluation/Desired Outcomes

  • A soft, formed bowel movement.

sennosides

(sĕn′ō-sīdz)
Anthraquinone glucosides present in senna that are used as cathartics.