senna, sennosides
Pharmacologic class: Anthraquinone laxative
Therapeutic class: Laxative (stimulant)
Pregnancy risk category C
Action
Causes local irritation in colon, which promotes peristalsis and bowel evacuation. Softens feces by increasing water and electrolytes in large intestine.
Availability
Granules: 15 mg/tsp
Liquid: 8.8 mg/5 ml, 25 mg/5 ml, 33.3 mg/ml (concentrate)
Tablets: 8.6 mg, 10 mg, 15 mg, 17 mg, 25 mg
Strips (orally disintegrating): 8.6 mg
Tablets (chewable): 10 mg, 15 mg
Indications and dosages
➣ Acute constipation; preparation for bowel examination
Adults and children ages 12 and older: For acute constipation, 12 to 50 mg P.O. daily or b.i.d. For bowel preparation, 105 to 157.5 mg (concentrate) 12 to 14 hours before scheduled procedure.
Children ages 6 to 11: 50% of adult dosage. Or, two orally disintegrating strips; don't exceed four strips in 24 hours.
Children ages 2 to 5: 33% of adult dosage. Or, one orally disintegrating strip; don't exceed two strips in 24 hours.
Contraindications
• Hypersensitivity to drug or its components
• GI bleeding or obstruction
• Suspected appendicitis or undiagnosed abdominal pain
• Acute surgical abdomen
• Fecal impaction
• Inflammatory bowel disease (such as Crohn's disease)
Precautions
Use cautiously in:
• pregnant or breastfeeding patients
• children.
Administration
• Give with a full glass of cold water.
• To prepare patient for bowel examination, give 12 to 14 hours before procedure, followed by a clear liquid diet.
Adverse reactions
GI: nausea, vomiting, diarrhea, abdominal cramps, nutrient malabsorption, yellow or yellowish-green feces, loss of normal bowel function (with excessive use), dark pigmentation of rectal mucosa (with long-term use), protein-losing enteropathy
GU: reddish-pink discoloration of alkaline urine, yellowish-brown discoloration of acidic urine
Metabolic: electrolyte imbalances (such as hypokalemia)
Other: laxative dependence (with long-term or excessive use)
Interactions
Drug-diagnostic tests. Calcium, potassium: decreased levels
Patient monitoring
• Assess bowel movements to determine laxative efficacy.
• In long-term use, monitor fluid balance, nutritional status, and electrolyte levels and watch for laxative dependence.
Patient teaching
• Tell patient using drug for constipation to take at bedtime with a glass of water.
• Instruct patient to place orally disintegrating strips on the tongue, allow strip to dissolve, then drink plenty of water.
• In long-term use, advise patient to watch for and report signs and symptoms of nutritional deficiencies and fluid and electrolyte imbalance.
• If patient will undergo bowel examination, advise him to take drug 12 to 14 hours before procedure, followed by a clear liquid diet.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.