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Related to sennosides: senna, docusate sodium


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Ex-Lax Chocolated

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Therapeutic: laxatives
Pharmacologic: stimulant laxatives
Pregnancy Category: C


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


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.


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

Time/action profile (laxative effect)

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


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


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


  • pink-red or brown-black discoloration of urine

Fluid and Electrolyte

  • electrolyte abnormalities (chronic use or dependence)


  • laxative dependence


Drug-Drug interaction

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


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)


  • 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.


Anthraquinone glucosides present in senna that are used as cathartics.
References in periodicals archive ?
1 [micro]M, Sennoside A at 20 [micro]M, Sennoside B at 20 [micro]M and RDS1760 at 25 [micro]M).
Specifically, these components included anthraquinone derivatives such as Emodin, Crysophanol, Aloe-Emodin, Physcion, Rhein and Sennoside (both Sennoside A and Sennoside B).
Evaluation of the effects of Sennoside A and B on mutated RT
Subsequently, considering the results obtained with Sennoside A on the NNRTI resistant RT mutants, we wanted to better characterize its behavior in the presence of Efavirenz in order to explore the possibility that the two compounds may interact with the same RT binding site.
Transport parameters of sennosides and sennidines in the Caco-2 assay ([p.
c[) and percent transport (%T) were determined for sennosides A and B as well as sennidines A and B, at concentrations of 100 and 200 [micro]M.
c] and %T) for sennosides and sennidines, determined at concentrations of 100 and 200 [micro]M, are summarized in Table 1.
Results of this study indicate poor transport of sennosides A and B and their aglycones across Caco-2 monolayers, with aglycones generally showing a higher permeability than glycosides.
Toxic effects of sennosides in laboratory animals and in vitro.
Sennosides and aloin do not promote dimethylhydrazine-induced colorectal tumors in mice.
Clinical studies do not show a loss of effect to laxatives (Muller Lissner, 1993) and studies carried out in rats also suggest that long-term sennoside treatment in diarrhogenic doses does not induce habituation in the sense of a reduced laxative effect and does not lead to secondary hyperaldosteronism (Leng-Peschlow et al.
Chronic sennoside treatment does not cause habituation and secondary hyperaldosteronism in rats.