After taking at least three tablets daily for 3 years for weight loss. She also experienced several months of secondary amenorrhea. Of senna leaf, Blumenthal et al. lists abdominal pain of unknown origin, acute intestinal inflammation (e.g., Crohn’s disease and colitis ulcerosa), and appendicitis as contraindications. Because of the anthraquinones, nonstandardized preparations should be avoided during pregnancy and lactation (CAN).
“Anthraquinones may be secreted into breast milk” (CAN). Should not be used in lactation, pregnancy, or with children under 12 years old (KOM). Occasional cramp-like discomfort of the GI tract may require dosage reduction (KOM). Side effects with chronic abuse: disturbance of electrolyte balance, especially hypokalemia (may be exacerbated by simultaneous administration of corticoadrenal steroids, licorice root, or thiazide diuretics), leading to cardiopathy, muscular weakness especially with concurrent uses of cardiac glycosides, corticosteroids, or diuretics (KOM).
Pigmentation of the intestinal mucosae (pseudomelanosis coli) is harmless and usually reverses on discontinuation of the drug. Laxative like this should not be used more than 1–2 weeks without medical advice (KOM). CAN report anthraquinones are purgative and irritate GI tract. Also contraindicated in hemorrhoids and nephropathy (CAN), intestinal obstruction, abdominal pain of unknown causes, any enterosis (appendicitis, colitis, Crohn’s disease, irritable bowel syndrome) hemorrhoids, nephropathy, menstruation (AHP).
Do not use more than 8–10 days (AHP). Do not use this in case of abdominal pain or diarrhea. Consult a health care provider prior to use in pregnancy or nursing. Discontinue use if diarrhea or watery stools occur. Not for long term use (AHP). “Some herbal laxative preparations, such as cascara and senna for example, can cause an increase in the potency of digoxin” (D’epiro, 1997).
Pedersen (1998) cautions against taking the fresh leaf (we have done that in Peru with modest laxative results). “Senna causes gripping unless taken in combination with carminative herbs such as ginger, cloves, or various mint species.” Although GRAS, senna can be more habit-forming than cascara (PED). Lininger et al. (1998) pronounce it “safe for children over the age of six” (half the adult dose) (SKY). I’d be more cautious.